423. Suicidal symptoms as central nodes in late-life depression: a network analysis in older Koreans

Abstract

Abstract Background Late-life depression is a major public health concern, particularly in rapidly aging societies such as South Korea, where suicide rates among older adults are among the highest in OECD countries. While network analysis has provided symptom-level insights into depressive disorders, few studies have examined DSM-based depressive symptom networks in older Asian populations using diagnostic interview data. Aims & Objectives This study aimed to investigate the network structure of DSM-IV depressive symptoms in community-dwelling older Korean adults, to identify central and highly predictable symptoms, and to examine sex differences in symptom interconnectivity. Method Data were drawn from a population-based epidemiological survey of Korean adults aged ≥65 years (n = 2,007). Sixteen DSM-IV depressive symptoms were assessed using the Korean version of the Composite International Diagnostic Interview (CIDI 2.1) and coded dichotomously. Symptom networks were estimated using phi coefficients in a weighted undirected network. Community detection, centrality indices, and symptom predictability were calculated. Sex-specific networks were constructed and compared descriptively. Results Two distinct symptom communities were identified: one comprising affective and somatic symptoms (e.g., depressed mood, low energy, appetite loss) and another characterized by atypical and suicide-related symptoms (e.g., hypersomnia, appetite gain, suicidal ideation, suicide attempt). Suicide attempt emerged as the most central and most predictable symptom in the overall network. Other highly central symptoms included low energy, low self-confidence, and concentration difficulties. Female participants showed a denser symptom network than males, with stronger interconnections among suicide-related symptoms. Discussion & Conclusions This DSM-based network analysis highlights suicidal symptoms as a core structural component of late-life depression in older Korean adults, contrasting with findings from many Western studies where such symptoms are often peripheral. Sex differences suggest that depressive symptoms, particularly those related to suicide, are more tightly interconnected in older women. These findings underscore the importance of culturally and demographically informed approaches to assessment and intervention in geriatric depression and support symptom-focused strategies for suicide prevention in high-risk aging populations.