Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Mar 12:13:1495284.
doi: 10.3389/fpubh.2025.1495284. eCollection 2025.

Inter-relationships of depression and anxiety symptoms among widowed and non-widowed older adults: findings from the Chinese Longitudinal Healthy Longevity Survey based on network analysis and propensity score matching

Yinglin Li #  1 , Doudou Lin #  2 , Xuan Gong #  3 , Dou Fu  2 , Ling Zhao  2 , Weibing Chen  2 , Jie Chen  4 , Shanshan Liu  2 , Guirong Yang  5 , Zhongxiang Cai  1
Affiliations

Inter-relationships of depression and anxiety symptoms among widowed and non-widowed older adults: findings from the Chinese Longitudinal Healthy Longevity Survey based on network analysis and propensity score matching

Yinglin Li et al. Front Public Health. .

Abstract

Background: Depression and anxiety are prevalent mental health issues among older adult widowed adults. However, the symptom-level relationships between these conditions remain unclear. Due to the high correlations and complex relationships among various symptoms, this study employs network analysis to explore differences in the network structures of depression and anxiety symptoms between widowed and non-widowed older adults.

Methods: Propensity score matching was used to identify widowed older adults with similar demographic characteristics. Data from 1,736 widowed and 1,736 matched controls were analyzed using the Chinese Longitudinal Healthy Longevity Survey (2017-2018). Depression and anxiety were measured by the Center for Epidemiologic Studies Depression Scale-10 (CESD-10) and the seven-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Central and bridge symptoms were evaluated using expected influence (EI) and bridge expected influence (BEI), respectively.

Results: Network analysis revealed similarities in central symptoms between widowed and non-widowed older adults, with both groups exhibiting "Feeling depressed or down" (CESD3), "Feeling tense and having difficulty relaxing" (GAD4), and "Being unable to stop or control worrying" (GAD2) as core symptoms. However, differences emerged in bridge symptoms. In the widowed group, "Feeling anxious, worried, or distressed" (GAD1) was most strongly connected to "Felt lonely" (CESD8); "Worrying too much about various things" (GAD3) was strongly linked to "Feeling increasingly exhausted and useless with age" (CESD4); and "Feeling depressed or down" (CESD3) had a strong association with "Becoming easily annoyed or irritable" (GAD6). In the non-widowed group, "Feeling anxious, worried, or distressed" (GAD1) exhibited the strongest association with "Having good sleep quality" (CESD10); "Getting upset over small matters" (CESD1) was closely connected to "Feeling anxious, worried, or distressed" (GAD1); and "Worrying too much about various things" (GAD3) was most strongly connected to "Feeling depressed or down" (CESD3).

Conclusion: Common central and bridge symptoms highlight universal intervention targets. Addressing "Feeling depressed or down" in widowed and "Getting upset over small matters" in non-widowed older adults may help prevent depression-anxiety comorbidity. These findings support targeted interventions to improve mental health outcomes. Future research should evaluate tailored intervention effectiveness.

Keywords: anxiety; depression; network analysis; older adults; widowed.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The network structure of depression and anxiety in widowed and non-widowed groups.
Figure 2
Figure 2
Standardized values (z-score) of expected influence (EI) for each node in the widowed and non-widowed groups.
Figure 3
Figure 3
Bridge centrality indices (z-score) for the widowed and non-widowed groups.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. WHO Mental health of older adults. (2023) Available online at: https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-... (Accessed June 27, 2024).
    1. Ma H, Zhao M, Liu Y, Wei P. Network analysis of depression and anxiety symptoms and their associations with life satisfaction among Chinese hypertensive older adults: a cross-sectional study. Front Public Health. (2024) 12:1370359. doi: 10.3389/fpubh.2024.1370359, PMID: - DOI - PMC - PubMed
    1. WHO Ageing and health. (2022) Available online at: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health (Accessed June 27, 2024).
    1. Li X, Ge T, Dong Q, Jiang Q. Social participation, psychological resilience and depression among widowed older adults in China. BMC Geriatr. (2023) 23:454. doi: 10.1186/s12877-023-04168-7, PMID: - DOI - PMC - PubMed
    1. Zhang Y, Chen X, Sun Y, Feng S, Wang F, Gu H, et al. . Relationship of widowhood with pulse pressure, fasting blood glucose, and mental health in older adults: a propensity matching score analysis. Front Public Health. (2023) 11:1257133. doi: 10.3389/fpubh.2023.1257133, PMID: - DOI - PMC - PubMed

Supplementary concepts