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. 2024 Jul 1:356:568-576.
doi: 10.1016/j.jad.2024.04.036. Epub 2024 Apr 11.

Inter-relationships of depression and insomnia symptoms with life satisfaction in stroke and stroke-free older adults: Findings from the Health and Retirement Study based on network analysis and propensity score matching

Pan Chen  1 , He-Li Sun  1 , Ling Zhang  2 , Yuan Feng  2 , Sha Sha  2 , Zhaohui Su  3 , Teris Cheung  4 , Katrine K Wong  5 , Gabor S Ungvari  6 , Todd Jackson  7 , Qinge Zhang  8 , Yu-Tao Xiang  9
Affiliations

Inter-relationships of depression and insomnia symptoms with life satisfaction in stroke and stroke-free older adults: Findings from the Health and Retirement Study based on network analysis and propensity score matching

Pan Chen et al. J Affect Disord. .

Abstract

Background: Depression and insomnia are common co-occurring psychiatric problems among older adults who have had strokes. Nevertheless, symptom-level relationships between these disorders remain unclear.

Objectives: In this study, we compared inter-relationships of depression and insomnia symptoms with life satisfaction among older stroke patients and stroke-free peers in the United States.

Methods: The study included 1026 older adults with a history of stroke and 3074 matched controls. Data were derived from the US Health and Retirement Study. Depression, insomnia and life satisfaction were assessed. Propensity score matching was employed to identify demographically-similar groups of stroke patients and controls. Central and bridge symptoms were assessed using Expected influence (EI) and bridge EI, respectively.

Results: The prevalence of depression in the stroke group (25.0 %) was higher than that of controls (14.3 %, P < 0.001). In stroke group, "Feeling depressed" (CESD1; EI: 5.80), "Feeling sad" (CESD7; EI: 4.67) and "Not enjoying life" (CESD6; EI: 4.51) were the most central symptoms, while "Feeling tired in the morning" (JSS4; BEI: 1.60), "Everything was an effort" (CESD2; BEI: 1.21) and "Waking up during the night" (JSS2; BEI: 0.98) were key bridge symptoms. In controls, the most central symptoms were "Lack of happiness" (CESD4; EI: 6.45), "Feeling depressed" (CESD1; EI: 6.17), and "Feeling sad" (CESD7; EI: 6.12). Furthermore, "Feeling tired in the morning" (JSS4; BEI: 1.93), "Everything was an effort" (CESD2; BEI: 1.30), and "Waking up too early" (JSS3; BEI: 1.12) were key bridge symptoms. Life satisfaction had the most direct associations with "Not enjoying life" (CESD6) and "Feeling lonely" (CESD5) in the two groups, respectively.

Conclusion: Older adults with stroke exhibited more severe depression and insomnia symptoms. Interventions targeting central and bridge symptoms may help to mitigate the co-occurrence of these symptoms.

Keywords: Depression; Insomnia; Life satisfaction; Network analysis; Older adults; Stroke.

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Conflict of interest statement

Declaration of competing interest The authors have no conflicts of interest to declare. Financial disclosure The study was supported by the Capital Health Development Research Special Fund (2022-3-2124), the Training Plan for High Level Public Health Technical Talents Construction Project (Discipline Backbones-02-38), Beijing High Level Public Health Technology Talent Construction Project (Discipline Backbone-01-028), National Institute on Aging (NIA U01AG009740) and the University of Macau (MYRG2019-00066-FHS; MYRG2022-00187-FHS).

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