Depression and Anxiety among Migrant Older Adults during the COVID-19 Pandemic in China: Network Analysis of Continuous Cross-Sectional Data

Many Chinese migrant older adults are more prone to mental health problems due to their “migrant” status. During the COVID-19 pandemic, restrictions on their mobility exacerbated these conditions. Mental health is a crucial dimension of healthy aging. Network analysis offers a novel method for exploring interactions between mental health problems at the symptom level. This study employs network analysis to examine the interactions between comorbid depressive and anxiety symptoms across different stages of the COVID-19 pandemic. Surveys were conducted from September 2019 to January 2020 (T1), September 2020 to January 2021 (T2), and September 2021 onwards (T3). Depression and anxiety symptoms were measured by the Patient Health Questionnaire-9 (PHQ-9) and the Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Expected Influence (EI) and Bridge Expected Influence (Bridge EI) were used to identify central and bridge symptoms in the network. Network stability and accuracy tests were performed. Among the Chinese migrant older adults, the anxiety prevalence was 18.50% at T1, 21.11% at T2, and 9.38% at T3. The prevalence of depression was 26.95% at T1, 55.44% at T2, and 60.24% at T3. The primary central symptoms included ‘Afraid something will happen’ (A2), ‘Irritability’ (A6), ‘Panic’ (A7), ‘Feeling of worthlessness’ (D6), ‘Anhedonia’ (D1), and ‘Feeling of fear’ (A5). The major bridge symptoms included ‘Feeling of fear’ (A5), ‘Panic’ (A7), ‘Irritability’ (A6), ‘Fatigue’ (D4), ‘Anhedonia’ (D1), and ‘Depressed or sad mood’ (D2). Differences in network structure were observed across the periods. The network analysis further revealed the evolving relationships between central and bridge symptoms over time, highlighting the importance of targeted intervention strategies for central and bridge symptoms of comorbid depression and anxiety at different periods.