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

Tianyin Liu; Man-Man Peng; Frankie H C Wong; Dara K Y Leung; Wen Zhang; Gloria H Y Wong; Terry Y S Lum

doi:10.1093/geroni/igad075

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

Innov Aging. 2023 Jul 19;7(7):igad075. doi: 10.1093/geroni/igad075. eCollection 2023.

Authors

Tianyin Liu¹, Man-Man Peng², Frankie H C Wong³, Dara K Y Leung⁴, Wen Zhang⁵, Gloria H Y Wong¹, Terry Y S Lum^{1

4}

Affiliations

¹ Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China.
² Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University, Zhuhai, China.
³ Philip Merrill College of Journalism, University of Maryland, College Park, Maryland, USA.
⁴ Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, China.
⁵ School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China.

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.

Keywords: Common mental health issues; Depression and anxiety; Mental health; Quantitative research methods; Research domain criteria.

Associated data

ClinicalTrials.gov/NCT03593889