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Multicenter Study
. 2023 Apr 3;6(4):e238263.
doi: 10.1001/jamanetworkopen.2023.8263.

Shared Risk Factors for Depressive Disorder Among Older Adult Couples in Korea

Ji Won Han  1   2 , Hee Won Yang  3 , Jong Bin Bae  1   2 , Dae Jong Oh  4 , Dong Gyu Moon  1 , Eunji Lim  5 , Jin Shin  1 , Bong Jo Kim  6 , Dong Woo Lee  7 , Jeong Lan Kim  8 , Jin Hyeong Jhoo  9 , Joon Hyuk Park  10 , Jung Jae Lee  11 , Kyung Phil Kwak  12 , Seok Bum Lee  11 , Seok Woo Moon  13 , Seung-Ho Ryu  14 , Shin Gyeom Kim  15 , Ki Woong Kim  1   2   16
Affiliations
Multicenter Study

Shared Risk Factors for Depressive Disorder Among Older Adult Couples in Korea

Ji Won Han et al. JAMA Netw Open. .

Abstract

Importance: Although couples may share many risk factors for depressive disorders in their lifetime, whether these factors mediate the shared risk of depressive disorders has rarely been investigated.

Objectives: To identify the shared risk factors for depressive disorder in couples and investigate their mediating roles in the shared risk of depressive disorders among older adult couples.

Design, setting, and participants: This nationwide, multicenter, community-based cohort study assessed 956 older adults from the Korean Longitudinal Study on Cognitive Aging and Dementia (KLOSCAD) and a cohort of their spouses (KLOSCAD-S) between January 1, 2019, to February 28, 2021.

Exposures: Depressive disorders of the KLOSCAD participants.

Main outcomes and measures: The mediating roles of shared factors in couples on the association between one spouse's depressive disorder and the other's risk of depressive disorders was examined using structural equation modeling.

Results: A total of 956 KLOSCAD participants (385 women [40.3%] and 571 men [59.7%]; mean [SD] age, 75.1 [5.0] years) and their spouses (571 women [59.7%] and 385 men [40.3%]; mean [SD] age, 73.9 [6.1] years) were included. The depressive disorders of the KLOSCAD participants were associated with an almost 4-fold higher risk of depressive disorders in their spouses in the KLOSCAD-S cohort (odds ratio, 3.89; 95% CI, 2.06-7.19; P < .001). Social-emotional support mediated the association between depressive disorders in the KLOSCAD participants and their spouses' risk of depressive disorders by itself (β = 0.012; 95% CI, 0.001-0.024; P = .04; mediation proportion [MP] = 6.1%) and through chronic illness burden (β = 0.003; 95% CI, 0.000-0.006; P = .04; MP = 1.5%). Chronic medical illness burden (β = 0.025; 95% CI, 0.001-0.050; P = .04; MP = 12.6%) and presence of a cognitive disorder (β = 0.027; 95% CI, 0.003-0.051; P = .03; MP = 13.6%) mediated the association.

Conclusions and relevance: The risk factors shared by older adult couples may mediate approximately one-third of the spousal risk of depressive disorders. Identification of and intervention in the shared risk factors of depression among older adult couples may reduce the risk of depressive disorders in the spouses of older adults with depression.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure.
Figure.. Mediating Role of the Factors Shared Within Couples in the Shared Risk of Depressive Disorders
Direct and indirect associations between index participants’ depressive disorders and the risk of depressive disorders (A) and depressive symptoms (B) of spouses are shown along with standardized coefficients. All lines indicate statistically significant associations. The orange lines indicate significant mediation pathways with 95% CIs using the adjusted bootstrap percentile method. The Cumulative Illness Rating Scale (CIRS) scores were square-root transformed for normal distribution. GDS indicates Geriatric Depression Scale. aP < .01. bP < .001. cP < .05.
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