Abstract
The clinical presentation of late-life depression is highly heterogeneous and likely influenced by the co-presence of somatic diseases. Using a network approach, this study aims to explore how depressive symptoms are interconnected with each other, as well as with different measures of somatic disease burden in older adults. We examined cross-sectional data on 2860 individuals aged 60+ from the Swedish National Study on Aging and Care in Kungsholmen, Stockholm. The severity of sixteen depressive symptoms was clinically assessed with the Comprehensive Psychopathological Rating Scale. We combined data from individual clinical assessment and health-registers to construct eight system-specific disease clusters (cardiovascular, neurological, gastrointestinal, metabolic, musculoskeletal, respiratory, sensory, and unclassified), along with a measure of overall somatic burden. The interconnection among depressive symptoms, and with disease clusters was explored through networks based on Spearman partial correlations. Bridge centrality index and network loadings were employed to identify depressive symptoms directly connecting disease clusters and depression. Sadness, pessimism, anxiety, and suicidal thoughts were the most interconnected symptoms of the depression network, while somatic symptoms of depression were less interconnected. In the network integrating depressive symptoms with disease clusters, suicidal thoughts, reduced appetite, and cognitive difficulties constituted the most consistent bridge connections. The same bridge symptoms emerged when considering an overall measure of somatic disease burden. Suicidal thoughts, reduced appetite, and cognitive difficulties may play a key role in the interconnection between late-life depression and somatic diseases. If confirmed in longitudinal studies, these bridging symptoms could constitute potential targets in the prevention of late-life depression.
Highlights
Late-life depression represents a major public health concern due to its impact on disability, quality of life, and health-related behaviours [1]
Sample characteristics Participants excluded due to missing information on any depressive symptom (n = 182), were more likely to be older, more cognitively impaired, and with a higher number of chronic diseases compared to those included in the analyses (p < 0.01 for all, data not shown)
The means and standard deviations of the depressive symptom scores in the total sample, and according to somatic disease burden are presented in Supplementary Table 4
Summary
Late-life depression represents a major public health concern due to its impact on disability, quality of life, and health-related behaviours [1]. Chronic somatic diseases involve neurobiological alterations, such as microvascular brain damage, autonomic, immunometabolic, or neuroendocrine dysregulation, which can have important implications for the risk of late-life depression [4]. These mechanisms coexist and interact with an array of psychological reactions to illness, that are closely related to depression, namely demoralization, anxiety, or death thoughts [4,5,6]. Chronic somatic diseases are likely an important factor shaping the pathophysiology and clinical heterogeneity of late-life depression [7,8,9]. The interplay between the broad account of somatic conditions in late-life and individual depressive symptoms remains unclear
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