The prevalence and correlates of depression and anxiety symptoms among older adults in Shenzhen, China

# 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".

# 中国深圳市老年人群抑郁与焦虑症状的流行现状及相关关联因素

本研究采用基于人群的横断面调查研究设计，使用多阶段整群随机抽样方法，从中国深圳市10个行政区中抽取具有代表性的研究样本。2020年10月至2021年2月期间，共计邀请5372名参与者参与本研究，要求其完成心理健康评估问卷。其中41名参与者因问卷填写质量不佳被排除，最终纳入5331名参与者（占比99.2%）用于数据分析。

本研究采用结构化问卷收集参与者的社会人口学特征与健康评估参数，问卷内容涵盖社会人口学特征、生活方式、身体健康状况与心理健康状况。研究人员通过张贴海报、广播播报、媒体渠道等多种方式，在抽中的社区开展心理健康调查宣传，以获得社区的理解、关注与配合。随后研究人员根据样本名单进行个体预约，向受访者说明调查目的、流程与参与益处，并获取知情同意，随后确定面对面入户调查的具体时间。鉴于心理健康相关问题属于敏感信息，我们要求所有参与者在私密的一对一环境中完成调查。

**数据集包含：**
**1. 社会人口学特征**
* 受教育程度：分类变量，共分为5个等级，1=小学及以下，2=初中，3=高中/职业中专，4=大学专科，5=硕士及以上，用于反映参与者的不同教育水平。
* 婚姻状况：分类变量，分为2个等级，1=未婚/离异/丧偶，2=已婚，用于反映参与者的不同婚姻状态。
* 慢性疾病患病情况：以二级及以上医院的诊断为依据，分类变量，分为2个等级，1=否，2=是。
* 个人月收入：分类变量，共分为5个等级，1=≤216.74美元，2=216.89~433.63美元，3=433.78~722.82美元，4=722.96~1156.59美元，5=≥1156.74美元，用于反映参与者的个人月平均收入水平。
* 饮酒行为：分类变量，分为3个等级，1=从不饮酒者，2=曾饮酒者（既往有饮酒史但目前戒酒），3=当前饮酒者（每周饮酒1次及以上）。
* 吸烟行为：分类变量，分为3个等级，1=从不吸烟者，2=曾吸烟者（既往有吸烟史但目前戒烟），3=当前吸烟者。
* 过去一年健康状况：分类变量，共分为5个等级，1=良好，2=较好，3=一般，4=较差，5=极差。
* 睡眠时长：连续变量，用于反映参与者近1年的夜间平均睡眠时长。

**2. 心理健康**
* PHQ-9平均得分：连续变量。本研究采用患者健康问卷9条目抑郁量表（Patient Health Questionnaire Depression Scale-9 item, PHQ-9）评估参与者的抑郁症状发生情况。PHQ-9共包含9个条目，用于评估受访者过去1年的抑郁状态与严重程度，每个条目采用0（完全没有）至3（几乎每天）的4级计分，总分为0~27分，得分越高提示抑郁症状越严重。
* 抑郁症状：以PHQ-9得分≥5作为截断值，得分≥5提示存在抑郁症状，得分<5提示无抑郁症状。该变量为分类变量，分为2个等级，0=否，1=是。
* GAD-7平均得分：连续变量。本研究采用广泛性焦虑障碍7条目量表（Generalized Anxiety Disorder 7-item scale, GAD-7）评估参与者的焦虑症状发生情况。(25) 受访者回顾过去1年的焦虑状态与严重程度，每个条目采用0（完全没有）至3（几乎每天）的4级计分，总分为0~21分，得分越高提示参与者的焦虑症状越严重。
* 焦虑症状：以GAD-7得分≥5作为截断值，得分≥5提示存在焦虑症状，得分<5提示无焦虑症状。该变量为分类变量，分为2个等级，0=否，1=是。
* AD8平均得分：连续变量。本研究采用8条目确诊痴呆问卷（8-item Ascertain Dementia Questionnaire, AD8）评估早期轻度认知障碍（Mild Cognitive Impairment, MCI）。该量表共包含8个条目，内容包括主动性下降、对爱好的投入度降低、重复做同一件事、学习新事物困难、忘记当前年份、处理复杂财务事务困难、回忆他人约会时存在困难、记忆与思维问题。总分为0~8分，得分越高提示认知损害越严重。
* 轻度认知障碍（MCI）：以AD8得分≥2作为判定节点，得分≥2提示可能存在轻度认知障碍，得分<2提示认知功能正常。该变量为分类变量，分为2个等级，0=否，1=是。
* CSID平均得分：连续变量。本研究采用简易社区痴呆筛查量表（Brief Community Screening Instrument for Dementia, CSI-D）评估参与者的早期痴呆发生情况。该量表包含7个认知条目，按难度从高到低排序分别为：描述锤子的用途、命名肘部、指向窗户再指向门、识别附近商店的位置、识别当前季节、识别当前星期、延迟回忆三个单词。量表总分为0~9分，得分越高提示认知功能越好。
* 早期痴呆：以CSID得分≤7作为早期痴呆的判定阈值，得分>7提示无早期痴呆证据，得分≤7提示存在早期痴呆。该变量为分类变量，分为2个等级，0=否，1=是。
* 失眠（ISI）：连续变量。本研究采用失眠严重指数量表（Insomnia Severity Index, ISI）评估参与者的失眠发生情况与严重程度，共包含7个条目。(27) 受访者被要求回顾过去1个月的失眠症状，每个条目采用0（完全没有）至3（几乎每天）的4级计分，总分为0~21分，得分越高提示失眠症状越严重。
* 失眠：以得分≥7作为截断值，得分≥7提示存在失眠症状，得分<7提示无失眠症状。该变量为分类变量，分为2个等级，0=否，1=是。
* 孤独感（ULS-6）：连续变量。本研究采用加州大学洛杉矶分校孤独量表简化版（University of California Los Angeles Loneliness Scale simplified version, ULS-6）评估受访者的社交互动需求与实际社交水平之间的差异。ULS-6经中文翻译与修订，共包含6个条目，每个条目采用1（从不）至4（总是）的4级计分，总分为6~24分，得分越高提示孤独感越严重。

各数据集的详细信息详见CODE文件。

**代码/软件**
本研究的统计分析采用R 4.1.0版本完成。描述性分析采用R包"compareGroups"进行。采用单因素线性回归识别与抑郁症状、焦虑症状相关的影响因素。将单因素分析中具有统计学显著性的变量纳入多因素逐步线性回归模型，以评估抑郁症状与焦虑症状之间的关联。上述分析通过R包"car"与"MASS"完成。