Depression and loneliness in older Chinese rural adults living alone: A network analysis

Depression and loneliness are common. However, the relationship between the two at the symptomatic level remains unclear.

This study aimed to establish a comorbidity network structure for depression and loneliness and to identify central, bridging symptoms and sex differences among older Chinese rural adults living alone.

This cross-sectional study included 1115 rural older adults living alone (Mean age: 74.15 ± 7.00; range: 60-93 years; 77.58 % female; 65.83 % illiterate). All participants completed the 9-item Patient Health Questionnaire (PHQ-9) and the 6-item Loneliness Scale (ULS-6). Centrality indices of symptom nodes and network stability were assessed. Network Comparison Test (NCT) was conducted to examine sex differences in network characteristics.

Within the comorbidity network of depression and loneliness, PHQ2 (Sad mood), ULS3 (Feeling left out), and ULS5 (Unhappy being so withdrawn) exhibited the highest strength centrality (1.135, 1.077, and 1.049 respectively). The bridge symptoms in the network were ULS1 (Lack of companionship, r_{bridge strength} = 0.218), PHQ2 (Sad Mood, r_{bridge strength} = 0.170) and ULS6 (People are around me but not with me, r_{bridge strength} = 0.152). No significant sex differences were found in overall network strength (S = 0.250, p = 0.455) or edge weights (M = 0.325, p = 0.059).

Network analysis identified central symptoms PHQ2 (Sad mood), ULS3 (Feeling left out), and ULS5 (Unhappy being so withdrawn) with bridging symptoms ULS1 (Lack of companionship), PHQ2 (Sad Mood) and ULS6 (People are around me but not with me). These symptoms may provide insights for prevention and treatment.