Unveiling intervention targets: urban-rural disparities in depression-anxiety symptoms networks among Chinese older adults living alone

BACKGROUND: Living alone is a significant risk factor for depression and anxiety among older adults in China. However, geographic disparities in the symptom-level network structure of depression and anxiety remain unexamined. This study aims to investigate urban-rural differences in the depression-anxiety network to identify central and bridge symptoms as potential intervention targets. METHODS: We analyzed data from 2,477 older adults aged ≥ 65 years living alone (urban: n = 413; rural: n = 2,064), drawn from the 2017-2018 Chinese Longitudinal Healthy Longevity Survey. Depressive and anxiety symptoms were assessed utilizing the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) and the 7-item Generalized Anxiety Disorder Scale (GAD-7), respectively. We constructed a network structure of depressive and anxiety symptoms and calculated expected influence (EI) and bridge expected influence (BEI) indices to identify central and bridge symptoms. Furthermore, a comparative analysis of the network structure across urban and rural groups was conducted. RESULTS: CESD3 (Feeling blue/depressed), GAD2 (Uncontrollable worry), and GAD4 (Trouble relaxing) were the most central symptoms in the network. CESD10 (Sleep disturbances) and GAD1 (Nervousness) were the key bridge symptoms. The urban-rural comparison revealed that while both groups shared CESD3 (Feeling blue/depressed) and GAD2 (Uncontrollable worry) as central symptoms, they exhibited distinct profiles: GAD3 (Worry too much) was central in the rural network, whereas GAD4 (Trouble relaxing) was central in the urban network. Bridge symptoms remained consistent across both groups. The network comparison test indicated no significant global structural difference, but significant differences were found in specific edge weights and node centralities (EI/BEI). CONCLUSIONS: Central and bridge symptoms may represent effective intervention targets for anxiety and depressive symptoms in older adults living alone. Clinical interventions should consider geographic disparities in symptom presentation.