Differential Associations Between Depressive Symptom-Domains With Anxiety, Loneliness, and Cognition in a Sample of Community Older Chinese Adults: A Multiple Indicators Multiple Causes Approach

Background and Objectives: Depressive symptoms are common in older adults, and often co-occur with other mental health problems. However, knowledge about depressive symptom-domains and their associations with other conditions is limited. This study examined depressive symptom-domains and associations with anxiety, cognition, and loneliness. Research Design and Methods: A sample of 3,795 participants aged 60 years and older were recruited from the community in Hong Kong. They were assessed for depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder 7-item), loneliness (UCLA 3-item), and cognition (Montreal Cognitive Assessment 5-Minute Protocol). Summary descriptive statistics were calculated, followed by confirmatory factor analysis of PHQ-9. Multiple Indicators Multiple Causes analysis was used to examine the associations between mental health conditions in the general sample and subgroups based on depressive symptom severity. Results: A 4-factor model based on the Research Domain Criteria showed the best model fit of PHQ-9 (chi(2)/df = 10.63, Root-Mean-Square Error of Approximation = 0.05, Comparative Fit Index = 0.96, Tucker-Lewis Index = 0.93). After adjusting for demographics, 4 depressive symptom-domains were differentially associated with anxiety, loneliness, and cognition across different depression severity groups. The Negative Valance Systems and Internalizing domain (NVS-I; guilt and self-harm) were consistently associated with anxiety (beta = 0.45, 0.44) and loneliness (beta = 0.11, 0.27) regardless of depression severity (at risk/mild vs moderate and more severe, respectively, all p <.001). Discussion and Implications: The consistent associations between the NVS-I domain of depression with anxiety and loneliness warrant attention. Simultaneous considerations of depressive symptom-domains and symptom severity are needed for designing more personalized care. Translational Significance: Depressive symptoms are common in older adults and are heterogeneous with multiple symptom-domains. This study investigated depressive symptom-domains among community-dwelling older Chinese in Hong Kong, and examined their association with anxiety, loneliness, and cognition. We found four depressive symptom-domains in this sample, and people with different depressive symptom-domains have differential possibilities to demonstrate co-occurrent anxiety, loneliness, and cognitive decline. Those with feelings of inappropriate guilt and suicidal ideation were more likely to show anxiety symptoms and loneliness as well. A more finegrained assessment of depression is needed for personalized care.