Symptom Structure of Depression in Older Adults on the Qinghai-Tibet Plateau: A Network Analysis

Previous studies have confirmed that depression among residents in high-altitude areas is more severe, and that depression may be more persistent and disabling in older adults. This study aims to identify the symptom structure of depression among older adults on the Qinghai-Tibet Plateau (the highest plateau in the world) from a network perspective. This cross-sectional study enrolled 507 older adults (ages 60-80 years old) from the Yushu Prefecture, which is on the Qinghai-Tibet Plateau, China. Depressive symptoms were self-reported using the shortened Center for Epidemiological Studies-Depression Scale (CES-D-10). Then, a Gaussian graphical model (GGM) of depression was developed. Poor sleep, fear, and hopelessness about the future exhibited high centrality in the network. The strongest edge connections emerged between unhappiness and hopelessness about the future, followed by hopelessness about the future and fear; hopelessness about the future and poor sleep; fear and unhappiness; and then poor sleep and unhappiness in the network. The findings of this current study add to the small body of literature on the network structure and complex relationships between depressive symptoms in older adults in high-altitude areas.