Depressive symptom networks before and after widowhood in middle-aged and older adults: findings from four prospective cohort studies

<b>Background:</b> As a significant traumatic event, widowhood may increase the risk of depression among middle-aged and older adults. Understanding how depressive symptoms evolve during this transition is therefore essential, as it provides critical insights for developing timely and targeted interventions to alleviate depressive symptoms in widowed individuals.<b>Objective:</b> This study explores the development of depressive symptoms before and after widowhood using longitudinal data from four multinational cohorts.<b>Methods:</b> We analysed 3766 individuals aged 45 or older from longitudinal databases in the US, UK, China, and Korea, who reported their marital status as widowed in any wave of interviews after 2010. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale (CES-D). This study employed cross-lagged panel network analysis to examine the associations between depressive symptoms before and after widowhood, as well as to identify the most susceptible and influential symptoms.<b>Results:</b> Higher 'Could not get going' at pre-widowhood was associated with greater 'Fear or sad' at post-widowhood (<i>β</i> = 0.148). 'Depressed mood' (predictability = 0.406) was the most susceptible symptom by other symptoms after widowhood. 'Exhaust' (influence = 0.392) exerted the strongest influence on other symptoms in the cross-lagged network.<b>Conclusion:</b> This study elucidated the mechanisms of influences among depressive symptoms before and after widowhood through network analysis of integrated multinational databases, identifying the most influential symptoms during this dynamic phase. The findings emphasize the importance of early identification and intervention for specific depressive symptoms in widowed individuals. They provide valuable insights for clinical practice and public health strategies, which can help reduce the psychological burden of widowhood.