Sex Differences in Depressive Symptom Networks Among Community-Dwelling Older Adults

Background: Compared to male individuals, an increased prevalence of depression has been reported in older female individuals consistently over time. Sex (male/female) differences in depressive symptom networks may help explain the underlying causes of this increased vulnerability for female individuals. Objective: This cross-sectional study investigated the sex (male/female) differences in depressive symptom networks among community-dwelling older adults in South Korea. Methods: The analysis was based on the 2019 Korean Community Health Survey data targeting adults aged 65 years or older. Using network analysis, depressive symptom networks were constructed according to the items listed in the Patient Health Questionnaire-9 for propensity score-matched male and female groups. Strength centrality and network stability were tested. A network comparison test was performed to investigate the difference between the networks based on the invariance of global strength, network structure, edge strength, and specific centrality measures. Results: Symptoms central to the network were similar between sexes, which were suicidal ideation, hopelessness, and psychomotor retardation/agitation. However, the global structure and network structure differed between sexes. The female symptom network showed more strengthened edges. Notably, four edges-loss of interest-hopelessness, sleep disturbance; low energy/fatigue; loss of interest-concentration difficulty; and worthlessness-concentration difficulty-were more pronounced in the female network. Strength centrality did not differ between the two networks. Discussion: Our results may help guide future research and clinical interventions for female depression. In addition, educating health professionals on the differences in depressive symptom presentation will be crucial to ensuring that older female adults receive appropriate treatment.