Inter-Relationships Between Depressive Symptoms and Sleep Problems among Older Adults with Depression: Findings of a National Survey in the USA.

BACKGROUND:Depressive symptoms and sleep problems are prevalent among older adults with depression. To reduce their adverse impact, it is important to understand the changes in symptom patterns as the Coronavirus disease 2019 (COVID-19) pandemic emerged. This longitudinal study examined the interactive changes between depressive symptoms and sleep problems among older adults with depression before and during the COVID-19 pandemic from a network perspective in the USA. METHODS:This network analysis study was based on data from the three waves (2016, 2018, and 2020) of the Health and Retirement Study (HRS). Depressive symptoms were measured using the eight-item version of the Center for Epidemiologic Studies Depression Scale (CESD-8), and sleep problems were assessed with the four-item Jenkins Sleep Scale (JSS-4). The study examined central symptoms and bridge symptoms within the network model. RESULTS:A total of 2905 older adults with depression were included in the analyses. The prevalence of depressive symptoms did not significantly change in the study wave during the COVID-19 compared to the pre-pandemic waves. "Feeling Depressed" was the most central symptom of the depression-sleep problems network in the 2016 wave, while "Feeling Sad" was the most central symptom in both the 2018 and 2020 waves. Additionally, "Feeling Loneliness" was the key bridge symptom of the depression-sleep problems network in the 2016 wave, while "Not Enjoying Life" was the key bridge symptom in the 2018 wave, and "Feeling Rested in Morning" was the key bridge symptom in the 2020 wave. CONCLUSION:The findings highlighted that central and bridge symptoms were potential targets in treating depressive symptoms and sleep problems among older adults with depression across the study period in the USA.