Supplementary Material for: Inter-relationships of depression with cognitive function and their association with quality of life in older adults with hypertension: national survey findings from a network perspective

Objectives: Depression and cognitive declines are common and frequently co-occur among older adults with hypertension but their symptom-level relationships are poorly understood. This study explored inter-relationships between depressive symptoms and cognitive function as well as their associations with quality of life (QoL) in a national hypertension sample from China. Methods: Depressive symptoms, cognitive function, and global QoL were assessed utilizing Chinese versions of the 10-item Center for Epidemiological Studies Short Depression Scale (CESD-10), Mini Mental State Examination, and World Health Organization Quality of Life-brief version (WHOQOL-BREF), respectively. Central symptoms and bridge symptoms were identified with centrality strength and bridge strength indexes, while symptoms having links to QoL were analyzed via flow network analysis. Results: The study included 4,683 older adults. The prevalence of depression (CESD-10 total score ≥ 10) and cognitive impairment (MMSE total score < 24) were 28.5% (95% CI= 27.2–29.8%) and 19.9% (n= 933; 95% CI= 18.8-21.1%), respectively. "Feeling blue/depressed" (CESD3) and "Language" (Lan) were identified as the most central (influential) symptoms in the network model. "Naming" (Nam) and "Language" (Lan) were identified as most important bridge symptoms. Finally, "Sleep disturbances" (CESD10) and "Hopelessness" (CESD5) had the strongest negative associations with QoL. Conclusions: Targeting central and bridge symptoms (e.g., depressed emotions, language and naming ability) may provide pathways for addressing both depressive symptoms and cognitive declines among older adults with hypertension. Moreover, improving sleep quality and alleviating hopelessness could help to increase QoL in this population.