Psychological factors associated with anxiety and depression in adults with osteoporosis: A random forest analysis.

BACKGROUND

Global increases in life expectancy have been accompanied by a rising prevalence of osteoporosis, a chronic condition frequently associated with psychological distress, particularly anxiety and depression. Identifying psychological factors associated with these outcomes is important for supporting comprehensive psychiatric nursing assessment and care. However, most previous studies have relied on traditional analytic approaches that may be limited in capturing complex relationships among psychosocial variables.

METHODS

A cross-sectional study was conducted among 622 Saudi adults diagnosed with osteoporosis (mean age = 50.5 years, SD = 5.97; 65.3% men). Participants completed validated measures assessing anxiety, depression, insomnia, resilience, rumination, self-compassion, subjective well-being, self-rated health, and sociodemographic characteristics. A random forest analytical approach was applied to examine the relative importance of psychological and health-related factors associated with anxiety and depression. Hyperparameters were optimized using grid search with repeated 10-fold cross-validation.

RESULTS

Approximately 65% and 69% of participants scored above the screening cutoff for depressive and anxiety symptoms, respectively. The random forest analysis identified insomnia, self-compassion, rumination, resilience, and subjective well-being as the most influential factors associated with depression. Insomnia, self-compassion, resilience, rumination, and self-rated health were the most prominent factors associated with anxiety.

CONCLUSIONS

These findings highlight key psychological and health-related factors associated with anxiety and depression among adults with osteoporosis. The results underscore the relevance of incorporating focused psychological assessment-particularly of sleep disturbance, coping resources, and self-related processes-into psychiatric nursing practice when caring for individuals with osteoporosis. Such an approach may support earlier identification of psychological distress and more tailored mental health support within routine care.