Network analysis of depression, anxiety, and quality of life among widowed older adults in China

Mental health is an important aspect of healthy aging, especially for widowed older adults. This study aims to examine the interrelationships between depression and anxiety symptoms and their associations with quality of life among widowed older adults. Using data from the 2017–2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), we selected a sample of 6,061 widowed older adults (M age = 88.97, SD = 10.01). Depression, anxiety, and quality of life were assessed using the Center for Epidemiological Studies Depression (CESD-10) Scale, the Generalized Anxiety Disorder (GAD-7) Scale, and a self-reported question of quality of life (QoL), respectively. The network analysis was performed to identify central and bridge symptoms of depression and anxiety. Network stability was tested using a case-dropping bootstrap procedure. The “flow” package was used to identify symptoms directly or indirectly associated with QoL. The R package NetworkComparisonTest (NCT) was conducted to examine whether network characteristics differed by gender. Network analysis revealed that GAD2 “Uncontrollable worry” emerged as the most central symptom in the network of depression and anxiety. Bridge symptoms such as GAD1 “Nervousness”, CESD6 “Felt fearful”, and CESD1 “Felt bothered” were identified as triggers for depression and anxiety. CESD5 “Hopelessness” exhibited the most negative association with the quality of life among widowed older adults. Gender did not significantly influence the network structure and global strength. These findings deepen our understanding of the inter-relationships between depression and anxiety among Chinese widowed older adults. Targeting central and bridge symptoms for treatments or interventions, and promoting hope among widowed older adults may enhance their quality of life.