Prevalence of depression and its network structure and association with quality of life in older adults with hypertension : findings of a national survey

Abstract

Introduction: Based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS), this study aimed to examine the prevalence and correlates of depression, and its network structure and association with quality of life (QOL) in older adults with hypertension. Methods: Depression and QOL were measured using the 10-item Center for Epidemiologic Studies Short Depression Scale (CESD-10) and the World Health Organization Quality of Life-brief version, respectively. Univariable and multivariable analyses were performed. Network analysis was used to explore the interconnections between depressive symptoms. The flow function was used to identify depressive symptoms that were directly associated with QOL. Results: A total of 5032 older adults with hypertension were included. The prevalence of depression (CESD-10 total score ≥ 10) was 28.3% (95% confidence interval: 27.08%–29.59%), which was significantly associated with poor QOL (P < 0.001). Participants who were male (P < 0.001), resided in urban areas (P = 0.006), lived with their family (P < 0.001), had perceived fair or good economic status (P < 0.001), and higher level of instrumental activities of daily living (P < 0.001) had lower risk of depression. In the network model of depression, CESD3 ‘Feeling blue/depressed’, CESD4 ‘Everything was an effort’ and CESD8 ‘Loneliness’ were the most central symptoms. CESD10 ‘Sleep disturbances’ had the highest negative association with QOL, followed by CESD5 ‘Hopelessness’, and CESD7 ‘Lack of happiness’. Conclusion: Depression was common among older adults with hypertension and significantly associated with poor QOL. To prevent and reduce the negative impact of depression in this population, appropriate interventions should target both central symptoms and the depressive symptoms associated with QOL.