Differential Associations Between Depressive Symptom-Domains With Anxiety, Loneliness, and Cognition in a Sample of Community Older Chinese Adults: A Multiple Indicators Multiple Causes Approach

Author:

Liu Tianyin12ORCID,Peng Man-Man3,Wong Frankie H C4ORCID,Leung Dara K Y5ORCID,Zhang Wen6ORCID,Wong Gloria H Y12ORCID,Lum Terry Y S125

Affiliation:

1. Department of Social Work and Social Administration , , Hong Kong , China

2. The University of Hong Kong , , Hong Kong , China

3. Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University , Zhuhai , China

4. Philip Merrill College of Journalism, University of Maryland , College Park, Maryland , USA

5. Sau Po Centre on Ageing, The University of Hong Kong , Hong Kong , China

6. School of Nursing and Health Studies, Hong Kong Metropolitan University , Hong Kong , China

Abstract

Abstract Background and Objectives Depressive symptoms are common in older adults, and often co-occur with other mental health problems. However, knowledge about depressive symptom-domains and their associations with other conditions is limited. This study examined depressive symptom-domains and associations with anxiety, cognition, and loneliness. Research Design and Methods A sample of 3,795 participants aged 60 years and older were recruited from the community in Hong Kong. They were assessed for depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder 7-item), loneliness (UCLA 3-item), and cognition (Montreal Cognitive Assessment 5-Minute Protocol). Summary descriptive statistics were calculated, followed by confirmatory factor analysis of PHQ-9. Multiple Indicators Multiple Causes analysis was used to examine the associations between mental health conditions in the general sample and subgroups based on depressive symptom severity. Results A 4-factor model based on the Research Domain Criteria showed the best model fit of PHQ-9 (χ2/df = 10.63, Root-Mean-Square Error of Approximation = 0.05, Comparative Fit Index = 0.96, Tucker–Lewis Index = 0.93). After adjusting for demographics, 4 depressive symptom-domains were differentially associated with anxiety, loneliness, and cognition across different depression severity groups. The Negative Valance Systems and Internalizing domain (NVS-I; guilt and self-harm) were consistently associated with anxiety (β = 0.45, 0.44) and loneliness (β = 0.11, 0.27) regardless of depression severity (at risk/mild vs moderate and more severe, respectively, all p < .001). Discussion and Implications The consistent associations between the NVS-I domain of depression with anxiety and loneliness warrant attention. Simultaneous considerations of depressive symptom-domains and symptom severity are needed for designing more personalized care. Clinical Trials Registration Number NCT03593889

Funder

Hong Kong Jockey Club Charities Trust

Publisher

Oxford University Press (OUP)

Subject

Life-span and Life-course Studies,Health Professions (miscellaneous),Health (social science)

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