Dissecting Depression in Cardiovascular Disease in Middle-Aged and Older Adults: Evidence That Comorbidity is Associated with Higher Depression Network Strength

Objective: Depression is prevalent among older adults with cardiovascular disease (CVD). This study utilized network analysis to examine depressive symptom structures in older adults with and without CVD and explored the impact of comorbidities. Methods: Based on 15,234 participants from the 2018 CHARLS data, propensity score matching (PSM) was used to construct a matched cohort of CVD and non-CVD individuals. Depressive symptoms were assessed via the CESD-10. Network analysis identified central symptoms and compared network connectivity and strength. Results: The CVD group exhibited significantly higher depression prevalence and symptom severity than the non-CVD group. In the CVD network, “depressed”, “could not get going”, and “bothered” were the most central symptoms. Notably, CVD patients with comorbidities showed significantly higher global network strength (S=0.44, P =0.008) than those without, indicating a more tightly coupled and potentially more persistent symptom structure. Conclusion: Older adults with CVD demonstrate distinct depression symptom interactions. The increased network density in patients with comorbidities suggests a higher vulnerability to self-sustaining depressive states. Targeting central symptoms like “feeling depressed” and “inability to get going” may optimize psychological interventions and clinical management for this population.