Network Structure of Depression and Anxiety Symptoms in Older Asian Patients With Depressive Disorders: Findings From REAP-AD3

Abstract

Objective: The clinical presentation of depressive disorders might be influenced by age, and its diagnosis and treatment can be affected by ageism-related bias. A network analysis can reveal symptom patterns unrecognized by the reductionistic approach. Therefore, this study explores the network structure of depression and anxiety symptoms in older Asian patients with depressive disorders and examines age-related differences in the context of ageism.

Methods: We used data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants, Phase 3 study and included 2,785 psychiatric patients from 11 Asian countries. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Network analyses were conducted to identify symptom interconnections and centrality among older (>65 years), middle-aged (35-64 years), and young (18-34 years) adult groups. The network structures were also compared using a network comparison test.

Results: Depressed mood was the most central symptom across all age groups. Network comparisons revealed no significant structural differences among the three age groups, despite several variations in terms of global strength. The network structure of the older group was characterized by strong interconnections between somatic symptoms (insomnia-energy) and core depressive symptoms (little interest or pleasure-feelings of hopelessness).

Conclusion: This study reveals that the network structures of depression and anxiety symptoms have relatively consistent interconnections across age groups, despite subtle age-based differences. Specifically, older adults tend to present anxiety and depression symptoms as physical complaints. These findings challenge ageist stereotypes and advocate for inclusive, age-neutral approaches to treatment.

Keywords: Age; Ageism; Anxiety; Asian patients; Depression; Network analysis.

Figure 1.

Network structures of depression and anxiety symptoms in Asian patients with depressive disorders. (A) Older (>65 years), (B) middle-aged (35–64 years), and (C) young adult (18–34 years). The green lines represent positive associations between the connecting nodes, and the red lines represent negative associations. The line thickness reflects the edge strength. The nodes represent depression and anxiety symptoms evaluated using the PHQ-9 and GAD-7, respectively. PHQ-9, Patient Health Questionnaire-9; GAD-7, Generalized Anxiety Disorder-7; APE, poor appetite or overeating (PHQ-9); ANX, feeling nervous, anxious, or on edge (GAD-7); AWF, feeling afraid, as if something awful might happen (GAD-7); CNC, trouble concentrating on things, such as reading the newspaper or watching television (PHQ-9); DFF, worrying too much about different things (GAD-7); DEP, feeling down, depressed, or hopeless (PHQ-9); ENG, feeling tired or having little energy (PHQ-9); HUR, thoughts that you would be better off dead or of hurting yourself in some way (PHQ-9); INS, trouble falling or staying asleep, or sleeping too much (PHQ-9); IRR, becoming easily annoyed or irritable (GAD-7); PLE, little interest or pleasure in doing things (PHQ-9); RLX, trouble relaxing (GAD-7); RTL, being so restless that it is hard to sit still (GAD-7); SEL, feeling bad about yourself, or feeling that you are a failure or have let yourself or your family down (PHQ-9); SLW, moving or speaking so slowly that others could have noticed, or the opposite—being so fidgety or restless that you have been moving around much more than usual (PHQ-9); WOR, not being able to stop or control worrying (GAD-7).

Figure 2.

Network analysis of depression and anxiety symptoms in the cross-sample data set combining the three groups. A: Network structure of depression and anxiety symptoms. B: Node-strength centrality. The green lines represent positive associations between the connecting nodes, and the red lines represent negative associations. The line thickness reflects the edge strength. The nodes represent depression and anxiety symptoms evaluated using the PHQ-9 and GAD-7, respectively. PHQ-9, Patient Health Questionnaire-9; GAD-7, Generalized Anxiety Disorder-7; APE, poor appetite or overeating (PHQ-9); ANX, feeling nervous, anxious, or on edge (GAD-7); AWF, feeling afraid, as if something awful might happen (GAD-7); CNC, trouble concentrating on things, such as reading the newspaper or watching television (PHQ-9); DFF, worrying too much about different things (GAD-7); DEP, feeling down, depressed, or hopeless (PHQ-9); ENG, feeling tired or having little energy (PHQ-9); HUR, thoughts that you would be better off dead or of hurting yourself in some way (PHQ-9); INS, trouble falling or staying asleep, or sleeping too much (PHQ-9); IRR, becoming easily annoyed or irritable (GAD-7); PLE, little interest or pleasure in doing things (PHQ-9); RLX, trouble relaxing (GAD-7); RTL, being so restless that it is hard to sit still (GAD-7); SEL, feeling bad about yourself, or feeling that you are a failure or have let yourself or your family down (PHQ-9); SLW, moving or speaking so slowly that others could have noticed, or the opposite—being so fidgety or restless that you have been moving around much more than usual (PHQ-9); WOR, not being able to stop or control worrying (GAD-7).