Abstract
Background: Depression and anxiety are the most common comorbid psychiatric disorders in the elderly. Psychiatrists have been reporting worsened depression symptoms and prognosis by comorbid anxiety symptoms. However, it is still unclear how anxiety affects the course of depression in the elderly. The aims of this study are (1) to identify the symptom network in late-life depression (LLD), and (2) to examine the role of anxiety in LLD with a network perspective. Methods: The study analyzed 776 community-based participants who were clinically diagnosed with depression and enrolled in Suwon Geriatric Mental Health Center. Network analysis was used to investigate the relationships between the symptoms of the Montgomery–Åsberg Depression Rating Scale (MADRS). The depression sample was divided into groups of low and high anxiety according to the Beck Anxiety Index. Propensity score matching (PSM) was used to minimize the effects of depression severity on the network. Network comparison test (NCT) were carried out to compare the global connectivity, global strength, and specific edge strength between the two subgroups. Results: Reported sadness, pessimistic thinking, and suicidal ideation are the core symptoms of LLD in terms of node strength. The MADRS sum score [mean (SD) 28.10 (9.19) vs 20.08 (7.11); P < .01] was much higher in the high anxiety group. The NCT before PSM showed the high anxiety group had significantly higher global strength (P < .01). However, the NCT after PSM did not reveal any statistical significance both in global structure (P = .46) and global strength (P = .26). A comparison between centrality indices showed a higher node strength of vegetative symptoms in the high anxiety group and this also remained after PSM. Conclusion: Based on the statistical analysis, anxiety worsens the severity of depression in the elderly. However, NCT after PSM revealed comorbid anxiety does not change the global structure and strength of the depression symptom network. Therefore, anxiety may affect LLD in a way of worsening the severity, rather than changing psychopathology. Additionally, the study revealed the centrality of vegetative symptoms was low in LLD but increased substantially in patients with comorbid anxiety.
Highlights
Depression in Late-LifeLate-life depression (LLD) poses a global burden [1]
We present one estimates of centrality to investigate the association of the 10 symptoms of the LifeLate-life depression (LLD) symptom network: strength [46, 47]
The result was consistent with a previous study of Parker et al [49]; The 10 items of MADRS were regrouped into three analytic models: factor 1, dysphoric apathy/retardation; factor 2, psychic anxiety; and factor 3, vegetative symptoms
Summary
Depression in Late-LifeLate-life depression (LLD) poses a global burden [1]. Approximately 10% of older population visiting primary care facilities manifest clinically significant depression [2]. Untreated LLD is associated with a poor quality of life, challenges with social and physical functioning, poor adherence to treatment, and worsening of chronic medical ailments [4]. Early identification of symptom presentations and understanding symptom relations of LLD may lead to a better prognosis, the manifestation of depression symptoms in older adults, especially the relationship between different symptoms has yet to be investigated. Our goal was to find the pattern of symptom presentation and relationship between symptoms of depression in the elderly using network analysis. Psychiatrists have been reporting worsened depression symptoms and prognosis by comorbid anxiety symptoms. It is still unclear how anxiety affects the course of depression in the elderly. The aims of this study are [1] to identify the symptom network in late-life depression (LLD), and [2] to examine the role of anxiety in LLD with a network perspective
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