Network analysis of anxiety and depressive symptoms during the COVID-19 pandemic in older adults in the United Kingdom

Abstract

The health crisis caused by COVID-19 in the United Kingdom and the confinement measures that were subsequently implemented had unprecedented effects on the mental health of older adults, leading to the emergence and exacerbation of different comorbid symptoms including depression and anxiety. This study examined and compared depression and anxiety symptom networks in two specific quarantine periods (June-July and November-December) in the older adult population in the United Kingdom. We used the database of the English Longitudinal Study of Aging COVID-19 Substudy, consisting of 5797 participants in the first stage (54% women) and 6512 participants in the second stage (56% women), all over 50 years of age. The symptoms with the highest centrality in both times were: "Nervousness (A1)" and "Inability to relax (A4)" in expected influence and predictability, and "depressed mood (D1"; bridging expected influence). The latter measure along with "Irritability (A6)" overlapped in both depression and anxiety clusters in both networks. In addition, a the cross-lagged panel network model was examined in which a more significant influence on the direction of the symptom "Nervousness (A1)" by the depressive symptoms of "Anhedonia (D6)", "Hopelessness (D7)", and "Sleep problems (D3)" was observed; the latter measure has the highest predictive capability of the network. The results report which symptoms had a higher degree of centrality and transdiagnostic overlap in the cross-sectional networks (invariants) and the cross-lagged panel network model of anxious and depressive symptomatology.

Keywords: Anxiety; Cross-lagged panel network; Depression; Network analysis; Older adult.

Figure 1

Network analysis of both waves (T1 and T2). Note: Red cluster: Anxiety; Green cluster: Depression. The percolated nodes are shown in 2 colors. The items with the highest centrality (BEI) sustained in both times have a square shape. Inverse items are marked with (R). A1: Nervousness, A2: Worry management, A3: Excessive worry, A4: Inability to relax, A5: Restlessness, A6: Irritable, A7: Fear, D1: Depressed, D2: Fatigue, D3: Restless sleep, D4: Happiness (R), D5: Loneliness, D6: anhedonia (R), D7: Hopelessness.

Figure 2

CLPN of the anxiety and depression model. Note: The axes are refined according to the significance of the relationships. The temporal autoregressions of the nodes are shown. A1: Nervousness, A2: Worry management, A3: Worry, A4: Inability to relax, A5: Restlessness, A6: Irritable, A7: Fear, D1: Depressed, D2: Fatigue, D3: Restless sleep, D4: Happiness (R), D5: Loneliness, D6: Anhedonia (R), D7: Hopelessness.