DOI: 10.5061/dryad.bnzs7h4j1
title: The prevalence and correlates of depression and anxiety symptoms among older adults in Shenzhen, China

description: Objectives: To investigate the prevalence of depression and
 anxiety symptoms among older adults in an urban district in China, as well
 as their associated factors. Participants: A total of 5,372
 community-dwelling older adults aged 65 years or older were initially
 recruited. Ultimately, 5,331 participants met the inclusion criteria and
 were included in this study. Methods: Participants completed a
 sociodemographic questionnaire, along with assessments including the
 Patient Health Questionnaire-9, Generalized Anxiety Scale-7, UCLA
 Loneliness Simplification Scale, Insomnia Severity Index Scale, Community
 Dementia Brief Screening Scale, and the 8-item Dementia Screening
 Questionnaire. Statistical analyses included the Shapiro‒Wilk test,
 independent t-test, Wilcoxon rank test, c2 test, and univariate and
 multivariate linear regression analysis. Results: The prevalence of
 depression and anxiety symptoms among older adults in Shenzhen communities
 was 10.4% and 11.3%, respectively. In multivariate analysis, age (B=-0.01,
 P&lt;0.05), relatively poor health status in the past year (B=1.00,
 P&lt;0.01), poor health status in the past year (B=2.40,
 P&lt;0.01), ISI score (B=0.21, P&lt;0.01), AD8 score (B=0.22,
 P&lt;0.01), ULS score (B=0.24, P&lt;0.01) were significantly
 associated with the severity of depression symptom, Compared to their
 respective reference categories, relatively poor health status in the past
 year (B=0.50, P&lt;0.01), poor health status in the past year (B=1.32,
 P&lt;0.01), ISI score (B=0.23, P&lt;0.01), sleep duration (B=0.05,
 P&lt;0.01), AD8 score (B=0.21, P&lt;0.01), CSID score (B=0.13,
 P&lt;0.01), ULS score (B=0.22, P&lt;0.01) were significantly
 associated with the severity of anxiety symptom. Conclusions: We observed
 a high prevalence of depression and anxiety symptoms among older adults in
 this study. The existing welfare system and infrastructure should remain
 and targeted mental health programs addressing the identified risk factors
 should be proposed.
description: Study population This study employed a
 cross-sectional population-based survey research design and used a
 multistage random whole-group sampling method to select representative
 samples from 10 districts in Shenzhen. First, we conducted sampling by
 region and population distribution based on Shenzhen's 2018
 population statistics. One street was randomly selected from each
 administrative district, and one community was further randomly selected
 from each street in the first stage. In the second phase, all eligible
 households were drawn from each of the selected communities. In the final
 phase, we selected eligible family members from each of the designated
 families and recruited participants from the selected families from April
 2017 to October 2017. To be eligible, participants had to meet the
 following criteria: (1) aged 65 or above; (2) residing in Shenzhen for at
 least 6 months; and (3) providing informed consent. Participants were
 excluded if they refused to sign the informed consent form after repeated
 explanations by the investigator, could not be located on at least three
 return visits, or had a history of a serious medical condition that might
 prevent them from completing the survey. From October
 2020 to February 2021, a total of 5,372 participants were invited to
 participate in the study and were asked to complete a mental health
 assessment questionnaire. Of these, 41 participants were excluded due to
 poor questionnaire completion quality, leaving 5,331 participants (99.2%)
 for data analysis. All eligible participants received mental health
 education, and those with abnormal assessment results were referred to the
 nearest mental health care facility for counselling and medical
 care. Before the formal survey began, the research team
 recruited investigators who were experienced in mental health work and
 provided them with structured training sessions. The training covered the
 purpose of this study, community outreach strategies, proper questionnaire
 administration, and the importance of standardized assessments and
 research procedures. Investigators utilized various means such as posters,
 radio broadcasts, and media channels, to promote mental health surveys in
 the sampled communities and to gain the understanding, attention, and
 cooperation of the community. Investigators then made individual
 appointments according to the sample list, explained the purpose of the
 survey, the process, and the benefits of participation to the respondents,
 and obtained consent. A specific time for the face-to-face household
 survey was then determined. As mental health-related issues are sensitive
 information, we asked all participants to complete the survey in a private
 one-on-one setting. Measurements A
 structured questionnaire was utilized to gather information on the
 participants' sociodemographic characteristics and health assessment
 parameters. The questionnaire required approximately 25 minutes to
 complete and consisted of four sections, which included sociodemographic
 characteristics, lifestyle, physical health, and mental health. whether
 the participants suffer from chronic diseases, is based on the diagnosis
 of chronic disease by second level and above hospitals. Additionally, a
 comprehensive self-reported assessment of the participants' health
 status in the past year was used, with five ratings ranging from good to
 poor. Drinking behaviour was categorized into three groups: drinkers (1 or
 more drinks per week), previous drinkers who currently abstain from
 alcohol, and nondrinkers. Smoking behaviour was classified into three
 categories: smokers, individuals with a previous history of smoking who
 currently abstain, and never smokers. The Patient
 Health Questionnaire Depression Scale-9 item (PHQ-9) was utilized to
 evaluate the occurrence of depressive symptoms in the participants. The
 PHQ-9 comprises nine items that measure the respondent's depressive
 state and severity in the past year, with each item rated on a four-point
 scale from 0 (not at all) to 3 (almost every day). The total score ranges
 from 0-27, with higher scores indicating more severe depression. In this
 study, we used a score of 5 as the cut-off point, with a score greater
 than or equal to 5 indicating the presence of depressive symptoms and a
 score less than 5 indicating the absence of depressive symptoms. The
 Cronbach's alpha for the scale was 0.805. The
 Generalized Anxiety Disorder 7-item scale (GAD-7) was utilized to assess
 the occurrence of anxiety symptoms in the participants. Respondents recall
 their anxiety status and severity assessment within the past year, rating
 each item on a four-point scale from 0 (not at all) to 3 (almost every
 day), with a total score range of 0–21. Higher scores indicate more severe
 anxiety in participants. For this study, a score of 5 was used as the
 threshold, with scores greater than or equal to 5 indicating the presence
 of anxiety symptoms and scores less than 5 indicating the absence of
 anxiety symptoms. The Cronbach's alpha for the scale was
 0.911. A simplified version of the UCLA Loneliness
 Scale (ULS-6) was utilized to evaluate the discrepancy between the
 respondents' desire for social interaction and their actual level of
 interaction. The ULS-6 was translated and revised in Chinese and comprises
 six items, each rated on a four-point scale from 1 (never) to 4 (always).
 The total score ranges from 6 to 24, with higher scores indicating more
 severe loneliness. The Cronbach's alpha for the scale was
 0.870. The Insomnia Severity Index (ISI) was utilized
 to evaluate the occurrence and severity of insomnia in the participants,
 consisting of seven items. Respondents are asked to recall their insomnia
 symptoms in the past month. Each item is rated on a four-point scale
 ranging from 0 (not at all) to 3 (almost every day). The total score
 ranges from 0–21, with higher scores indicating more severe insomnia
 symptoms. In this study, a score of 7 was chosen as the threshold, with
 scores greater than or equal to 7 indicating the presence of insomnia
 symptoms and scores less than 7 indicating the absence of insomnia
 symptoms. The Cronbach's alpha for the scale was 0.929.
 The Brief Community Screening Instrument for Dementia (CSI-D) was
 utilized to assess the presence of early dementia among the participants.
 The scale includes seven cognitive items, which are ranked in descending
 order of difficulty as follows: describing the purpose of a hammer, naming
 the elbow, pointing to the window and then to the door, identifying the
 location of a nearby shop, identifying the current season, identifying the
 current week, and recalling three words after a delay. The total score on
 the scale ranges from 0 to 9, with higher scores indicating better
 cognitive functioning. In this study, a score of 7 was used as the
 threshold for early dementia, with scores greater than 7 indicating no
 evidence of early dementia and scores less than or equal to 7 indicating
 the presence of early dementia. The Cronbach's alpha for the scale
 was 0.674. The 8-item Ascertain Dementia Questionnaire
 (AD8) was utilized to assess early mild cognitive impairment (MCI) on an
 eight-item scale. These items include diminished assertiveness, reduced
 engagement in hobbies, repetition of the same thing, difficulty in
 learning new things, forgetting the current year, difficulty handling
 complex financial matters, difficulty recalling appointments with others,
 and problems with memory and thinking. The total score ranges from 0 to 8,
 with higher scores indicating more severe cognitive impairment. In this
 study, a score of 2 was used as the nodal point, with scores greater than
 or equal to 2 indicating possible mild cognitive impairment and scores
 less than 2 indicating normal cognitive functioning. The Cronbach's
 alpha for this scale was 0.796. Statistical
 analysis The statistical analysis was conducted using
 R version 4.1.0. Means and standard deviations are used to describe
 continuous variables, while frequencies and percentages are used for
 categorical variables. The Shapiro‒Wilk test was used to check the
 normality of continuous variables. The Shapiro‒Wilk test was used to check
 the normality of continuous variables. Student’s independent t-test or
 Wilcoxon’s rank test was used to compare quantitative variables, depending
 on the normal distribution test results. The chi-square test was used for
 categorical variables. The R package "compareGroups" was
 utilized for descriptive analysis. Dummy variables were created for
 categorical variables, and the first reference group for each variable was
 set as the reference group for regression analysis. One-way linear
 regression was used to identify the factors associated with depressive
 symptoms and anxiety symptoms. The variables that were statistically
 significant in the univariate analysis were included in a multifactorial
 stepwise linear regression model to evaluate the relationship between
 depressive symptoms and anxiety symptoms. The analyses were performed
 using the R packages "car" and "MASS". The test level
 was set to a two-sided alpha of 0.05, and a P-value less than 0.05 was
 considered statistically significant.
description: # The prevalence and correlates of depression and anxiety symptoms among
 older adults in Shenzhen, China
 --- This study employed a
 cross-sectional population-based survey research design and used a
 multistage random whole-group sampling method to select representative
 samples from 10 districts in Shenzhen, China . From October 2020 to
 February 2021, a total of 5,372 participants were invited to participate
 in the study, and were asked to complete a mental health assessment
 questionnaire. Of these, 41 participants were excluded due to poor
 questionnaire completion quality, leaving 5,331 participants (99.2%) for
 data analysis. A structured questionnaire was utilized to gather
 information on the participants' sociodemographic characteristics and
 health assessment parameters. The questionnaire included sociodemographic
 characteristics, lifestyle, physical health, and mental health.
 Investigators utilized various means such as posters, radio broadcasts,
 and media channels, to promote mental health surveys in the sampled
 communities and to gain the understanding, attention, and cooperation of
 the community. Investigators then made individual appointments according
 to the sample list, explained the purpose of the survey, the process, and
 the benefits of participation to the respondents, and obtained consent. A
 specific time for the face-to-face household survey was then determined.
 As mental health-related issues are sensitive information, we asked all
 participants to complete the survey in a private one-on-one setting.
 **Datasets included:** **1. sociodemographic characteristics** *
 Education, represent the different levels of education of the
 participants, categorical variable, levels 1-5, 1= Primary school and
 below, 2= Junior high school, 3= Highschool/vocational secondary school,
 4= College, 5= Master and above. * Marriage, represent different marital
 statuses of participants, categorical variable, levels = 1-2,
 1=Unmarried/divorced/widowed, 2=Married. * Suffering from chronic
 diseases, is based on the diagnosis of chronic disease by second level and
 above hospitals, categorical variable, levels = 1-2, 1=NO, 2=YES. *
 Monthly personal income, refers to a participant's average monthly
 income, categorical variable, levels 1-5, 1= ≤$216.74, 2=$216.89-$433.63,
 3=$433.78-$722.82, 4=$722.96-$1156.59, 5=≥$1156.74. * Drinking, refers to
 a participant's drinking behaviour, categorical variable, levels 1-3,
 1=Nondrinker, 2=Ex-drinker (previous drinkers who currently abstain from
 alcohol), 3=Current drinker (1 or more drinks per week). * Smoking, refers
 to a participant's smoking behaviour, categorical variable, levels
 1-3, 1=Nonsmoker, 2=Ex-smoker (individuals with a previous history of
 smoking who currently abstain), 3=Current smoker. * Health status in the
 past year, categorical variable, levels 1-5, 1=Good, 2=Relatively good,
 3=Ordinary, 4=Relatively poor, 5=Poor. * Sleep duration, continuous
 variables, refers to the participant's average sleep duration at
 night in the most recent year. **2.mental health** * Mean score of the
 PHQ-9, continuous variables. The Patient Health Questionnaire Depression
 Scale-9 item (PHQ-9) was utilized to evaluate the occurrence of depressive
 symptoms in the participants. The PHQ-9 comprises nine items that measure
 the respondent's depressive state and severity in the past year, with
 each item rated on a four-point scale from 0 (not at all) to 3 (almost
 every day). The total score ranges from 0-27, with higher scores
 indicating more severe depression. * Depressive symptoms, we used a PHQ-9
 score of 5 as the cut-off point, with a score greater than or equal to 5
 indicating the presence of depressive symptoms and a score less than 5
 indicating the absence of depressive symptoms. Categorical variable,
 levels 0-1, 0=NO, 1=YES. * Mean score of the GAD-7, continuous variables.
 The Generalized Anxiety Disorder 7-item scale (GAD-7) was utilized to
 assess the occurrence of anxiety symptoms in the participants. (25)
 Respondents recall their anxiety status and severity assessment within the
 past year, rating each item on a four-point scale from 0 (not at all) to 3
 (almost every day), with a total score range of 0-21. Higher scores
 indicate more severe anxiety in participants. * Anxiety symptoms, a GAD-7
 score of 5 was used as the threshold, with scores greater than or equal to
 5 indicating the presence of anxiety symptoms and scores less than 5
 indicating the absence of anxiety symptoms. Categorical variable, levels
 0-1, 0=NO, 1=YES. * Mean score of the AD8, continuous variables. The
 8-item Ascertain Dementia Questionnaire (AD8) was utilized to assess early
 mild cognitive impairment (MCI) on an eight-item scale. These items
 include diminished assertiveness, reduced engagement in hobbies,
 repetition of the same thing, difficulty in learning new things,
 forgetting the current year, difficulty handling complex financial
 matters, difficulty recalling appointments with others, and problems with
 memory and thinking. The total score ranges from 0 to 8, with higher
 scores indicating more severe cognitive impairment. * Mild cognitive
 impairment, a AD8 score of 2 was used as the nodal point, with scores
 greater than or equal to 2 indicating possible mild cognitive impairment
 and scores less than 2 indicating normal cognitive functioning.
 Categorical variable, levels 0-1, 0=NO, 1=YES. * Mean score of the CSID,
 continuous variables. The Brief Community Screening Instrument for
 Dementia (CSI-D) was utilized to assess the presence of early dementia
 among the participants. The scale includes seven cognitive items, which
 are ranked in descending order of difficulty as follows: describing the
 purpose of a hammer, naming the elbow, pointing to the window and then to
 the door, identifying the location of a nearby shop, identifying the
 current season, identifying the current week, and recalling three words
 after a delay. The total score on the scale ranges from 0 to 9, with
 higher scores indicating better cognitive functioning. * Early dementia, a
 CSID score of 7 was used as the threshold for early dementia, with scores
 greater than 7 indicating no evidence of early dementia and scores less
 than or equal to 7 indicating the presence of early dementia. Categorical
 variable, levels 0-1, 0=NO, 1=YES. * Insomnia (ISI), continuous variables.
 The Insomnia Severity Index (ISI) was utilized to evaluate the occurrence
 and severity of insomnia in the participants, consisting of seven items.
 (27) Respondents are asked to recall their insomnia symptoms in the past
 month. Each item is rated on a four-point scale ranging from 0 (not at
 all) to 3 (almost every day). The total score ranges from 0-21, with
 higher scores indicating more severe insomnia symptoms. * Insomnia, a
 score of 7 was chosen as the threshold, with scores greater than or equal
 to 7 indicating the presence of insomnia symptoms and scores less than 7
 indicating the absence of insomnia symptoms. Categorical variable, levels
 0-1, 0=NO, 1=YES. * Loneliness (ULS-6), continuous variables. A simplified
 version of the UCLA Loneliness Scale (ULS-6) was utilized to evaluate the
 discrepancy between the respondents' desire for social interaction
 and their actual level of interaction. The ULS-6 was translated and
 revised in Chinese and comprises six items, each rated on a four-point
 scale from 1 (never) to 4 (always). The total score ranges from 6 to 24,
 with higher scores indicating more severe loneliness. Details for each
 dataset are provided in the CODE file.   \***Code/Software** The
 statistical analysis was conducted using R version 4.1.0. The R package
 "compareGroups" was utilized for descriptive analysis. One-way
 linear regression was used to identify the factors associated with
 depressive symptoms and anxiety symptoms. The variables that were
 statistically significant in the univariate analysis were included in a
 multifactorial stepwise linear regression model to evaluate the
 relationship between depressive symptoms and anxiety symptoms. The
 analyses were performed using the R packages "car" and
 "MASS".