Core and bridge symptoms in self-perceived aging, depression, and anxiety among the elderly with multiple chronic conditions in Chinese communities: a network analysis perspective

BackgroundPrevious research has overlooked the role of self-perceived aging in the psychological well-being of older adults with multiple chronic conditions, and few studies have analyzed specific symptom interactions from a symptom network perspective. Our study aimed to explore the structure of the network among self-perceived aging, depression, and anxiety in community-dwelling older adults with multiple chronic conditions.MethodsThis was a cross-sectional survey conducted using convenience sampling from four prefecture-level cities in Jiangsu Province, China, between November 2022 and May 2023. A total of 478 participants were included in the analysis. The Brief Ageing Perceptions Questionnaire (B-APQ) and the Depression Anxiety and Stress Scales-21 (DASS-21) were used to assess self-perceived aging, depression, and anxiety among older adults. Network analysis was performed using R to explore the interrelationships among symptoms in the network and identify the core symptoms and bridge symptoms.ResultsNetwork analysis revealed that, after controlling for covariates, the node S5 ('Emotional-Representations') had the highest strength, followed by D7 ('Meaningless'), S2 ('Consequences-Positive'), S1 ('Consequences and Control Negative'), and D6 ('Worthless'). Furthermore, based on the bridge strength values, A5 ('Panic'), D7 ('Meaningless'), and S5 ('Emotional-Representations') were identified as bridge symptoms connecting self-perceived aging, depression, and anxiety. The study also identified several strong edge weight, most of which were linked to core symptoms and bridge symptoms.ConclusionThe study suggests that targeting "Emotional-Representations" as a core symptom can be effective in addressing psychological issues in older adults with multiple chronic conditions. Furthermore, preventing and inhibiting bridge symptoms such as "panic," "Meaningless," and "Emotional-Representations" could be potentially effective prevent widespread activation of symptoms (e.g., from self-perceived aging to depression).