673 middle-aged and older individuals from Xining City, Qinghai Province, China (average altitude: 2,261 m) were analyzed for mental health associations.
The strongest association in the network was found between excessive worrying and difficulty in controlling those worries.
Core symptoms identified included trouble relaxing, depressed mood, and feelings of being left out.
Bridge symptoms, which connect different aspects of mental health, included restlessness, psychomotor agitation, and loneliness.
There was no difference in the overall network structure between male and female participants, but significant differences in network strength were observed.
In the female network, the association between anhedonia and depressed mood was stronger compared to males, indicating potential gender differences in mental health experiences.
Simplified
BACKGROUND: Low oxygen levels, low atmospheric pressure, and intense sunlight characterize high-altitude regions. These environmental factors can disrupt the body's biochemical mechanisms and neural functions, which may increase the risk of mental health issues in affected individuals. Depression, anxiety, and loneliness are common mental health conditions. Our study conducted methods to investigate the relationships among anxiety, depression, and loneliness in middle-aged and older individuals in Xining City, Qinghai Province, China (average altitude: 2,261 m). Additionally, the study conducted a comparative analysis of the network structures to explore gender differences.The objective of this study was to provide theoretical intervention strategies and practical guidelines for the mental health of middle-aged and older individuals in high-altitude regions.
METHOD: This study utilized convenience sampling to select 673 middle-aged and older individuals from Xining City, Qinghai Province, China (average altitude 2,261 m). The following instruments were utilized in the study: a basic demographic survey questionnaire, the Nine-item Patient Health Questionnaire (PHQ-9), the Seven-item Generalized Anxiety Disorder scale (GAD-7), and the UCLA Loneliness Scale Chinese Simplified Version (ULS-8). R version 4.4.1 was used for the statistical description and network analysis.Descriptive analysis was presented using mean (SD) or number(percentage).We explored the network structure comprising anxiety, depression, and loneliness. It also compared the network structures of male and female samples to explore gender differences.
RESULTS: In the network, the strongest association was found between GAD2 "Cannot stop/control worrying" and GAD3 "Worrying too much". The core symptoms identified were GAD4 "Trouble relaxing"; PHQ2 "Depressed mood"; and ULS3 "Feeling left out". Bridge symptoms included GAD5 "Being restless"; PHQ8 "Psychomotor retardation or agitation"; and ULS6 "Feeling lonely". A comparison of male and female networks indicated that there was no difference in the global network; however, a significant difference in the global strength was observed. The top three pairs with the strongest associations were: ULS7 "I would like to make friends" -ULS8 "I can find someone to be with me when I want to be"; GAD3 "Worrying too much" -GAD2 "Cannot stop/control worrying"; and PHQ1 "Anhedonia" -PHQ2 "Depressed mood". However, the weight of PHQ1 "Anhedonia" - PHQ2 "Depressed mood" was significantly higher in the female network than in the male network, while the weights of the other two pairs were similar. The core symptoms of the male network were GAD4 "Trouble relaxing"; GAD5 "Being restless" and PHQ2 "Depressed mood". The core symptoms of the female network were identified as: PHQ2 "Depressed mood"; ULS3 "Feeling left out"; and GAD3 "Worrying too much".The PHQ2 "Depressed mood" was identified as a core symptom in both the male and female networks. However, the expected influence index of the PHQ2 "Depressed mood" for the female network was found to be higher than that for the male network.
CONCLUSION: "Trouble relaxing", "Depressed mood", "Feeling left out", "Being restless", "Psychomotor retardation or agitation", and "Feeling lonely" could be key targets for the prevention of anxiety, depression, and loneliness in the middle-aged and older population in high-altitude areas.Additionally, there were significant differences in overall intensity between male and female networks, with gender-specific strategies recommended.
Key numbers
36.4%
Detection Rate of Loneliness
Percentage of participants experiencing moderate to severe loneliness.
27.8%
Detection Rate of Depression
Percentage of participants with moderate to severe depression.
20.2%
Detection Rate of Anxiety
Percentage of participants with moderate to severe anxiety.
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Declarations. Ethics approval and consent to participate: This study complied with the provisions of the Declaration of Helsinki. In this study, all researchers obtained the free and informed consent of the participants prior to completing the questionnaire survey. All participants provided written informed consent to participate in this study. The Medical Research Ethics Committee of Qinghai University Medical College has approved the ethical review of this study (2023–027). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
