Prevalence and network analysis of comorbid anxiety and depression symptoms and their association with quality of life among Chinese empty-nest elderly

Abstract Background The growing number of empty-nest elderly in China has become a critical public health concern. Unaccompanied and unattended, empty nest elderly are more susceptible to mental health disorders, particularly anxiety and depression. The aim of this study was to investigate the prevalence and network structure of comorbid anxiety and depression, and explored their association with quality of life (QoL) among Chinese empty-nest elderly. Methods We included 5110 empty-nest elderly aged 65 and above from the Chinese Longitudinal Healthy Longevity Survey (CLHLS2018). Anxiety symptoms, depression symptoms, and QoL were respectively assessed using the Generalized Anxiety Disorder Scale-7 (GAD-7), the Center for Epidemiologic Studies Depression Scale-10 (CESD-10), and the World Health Organization Quality of Life-brief (WHOQOL-Bref). We performed network analyses of comorbid anxiety and depression to identify central symptoms and bridge symptoms, and showed a flow network of their associations with QoL. Results The prevalence of comorbid anxiety and depression symptoms among Chinese empty-nest elderly was 8.67%. Network analysis revealed CESD3 (felt depressed), GAD4 (trouble relaxing) and GAD2 (uncontrollable worry) were the most influential central symptoms in the structure of the anxiety and depression network. Concurrently, GAD1 (nervousness), GAD4(trouble relaxing), CESD1 (bothered by things) and CESD6 (felt fearful) were identified as critical bridge symptoms between anxiety and depression symptoms. Moreover, CESD10 (sleep disturbances) exhibited the strongest negative association with QoL among Chinese empty-nest elderly. Conclusion This study elucidates the network interconnection between anxiety and depression symptoms among Chinese empty-nest elderly. Findings suggest that targeted interventions addressing central and bridge symptoms may alleviate comorbid anxiety and depression symptoms in this population. Furthermore, sleep disturbances are key symptoms to address to reduce adverse effects on mental health and improve QoL among Chinese empty-nest elderly.