Topological architecture and cross-domain co-occurrence of chronic diseases and depressive symptoms in elderly Chinese adults: A real-world network analysis.

BACKGROUND

This study employed network analysis to characterize the co-occurrence between chronic diseases and depressive symptoms, found sex-based disparities, and delineated distinct co-occurrence patterns in elderly Chinese adults.

METHODS

This cross-sectional study was conducted between July and November 2024, enrolling 6785 participants aged 60 years and above from four Chinese provinces. Absolute co-occurrence frequency matrices between chronic diseases and depressive symptoms were visualized using heatmaps. Network analysis was employed to estimate centrality and bridge metrics, identifying highly central and bridge nodes, while network stability and accuracy were evaluated. Furthermore, the network comparison test was utilized to investigate sex-based disparities, and symptom co-occurrence patterns were explored.

RESULTS

The prevalence of chronic diseases and depressive symptoms co-occurrence reached 61.95%, with females exhibiting a higher symptom co-occurrence burden than males. Network analysis found "depressed" (D3) and "bothered" (D1) as potentially central symptoms, while asthma (C10) and "lonely" (D9) were found to be potentially key bridge nodes linking the chronic disease and depressive domains. The female network demonstrated higher global strength compared to the male network (48.07 vs. 32.27, P = 0.010). Among the five identified symptom co-occurrence patterns, "Systemic Cardio-Metabolic-Inflammatory Load" was the most prevalent (37.12%), followed by "Severe Organ Dysfunction and Survival Distress" (17.57%) and three independent depressive symptom sub-clusters.

CONCLUSION

This study found potential central and bridge nodes. The observed sex disparities and heterogeneous symptom co-occurrence patterns.