Detecting risk for depression and anxiety symptoms among older bereaved women using text-based analysis in the Nurses' Health Study II.

We analyzed free-text narratives about recent bereavement experiences from 1997 women aged 55-73 years (M = 65.9, SD = 4.4) enrolled in the Nurses' Health Study II to identify associations between text characteristics and postbereavement mental health. We applied covariate-adjusted linear mixed effects models to assess the association between word count and expression of positive vs negative sentiment (emotional valence) in first-person bereavement narratives and standardized Patient Health Questionnaire-4 (PHQ-4) total, anxiety, and depression symptom scores over 6 months, stratified by loss of a partner or child vs a close other. Emotional valence was quantified using the Valence Aware Dictionary and sEntiment Reasoner (VADER) algorithm. Among women bereaved of a close other, word count was positively associated with log PHQ-4 total (0.06 SD [95% CI, 0.02-0.09]), anxiety (0.05 SD [95% CI, 0.02-0.09]), and depression (0.06 SD [95 % CI, 0.03-0.09]) symptom scores. Negatively scored emotional valence was associated with elevated log PHQ-4 total (-0.05 SD [95% CI, -0.08 to -0.01]), anxiety (-0.04 SD [95% CI, -0.08 to 0.00]), and depression (-0.04 SD [95% CI, -0.07 to -0.01]) symptom scores. Estimated associations among women bereaved of a partner or child were elevated but underpowered. Qualitative approaches in epidemiologic cohorts offer promise in identifying novel characteristics associated with bereavement outcomes among older women.