Detecting risk for depression and anxiety symptoms among older bereaved women using text-based analysis in the Nurses' Health Study II.

Abstract

We analyzed free-text narratives about recent bereavement experiences from 1,997 women aged 55-73 years (M = 65.9, SD = 4.4) enrolled in the Nurses' Health Study II to identify associations between text characteristics and post-bereavement mental health. We applied covariate-adjusted linear mixed effects models to assess the association between word count and expression of positive versus negative sentiment (emotional valence) in first-person bereavement narratives and standardized Patient Health Questionnaire-4 (PHQ-4) total, anxiety, and depression symptom scores over six months, stratified by loss of a partner or child versus a close other. Emotional valence was quantified using the VADER algorithm. Among women bereaved of a close other, word count was positively associated with log PHQ-4 total (0.06 SD, 95%CI [0.02, 0.09]), anxiety (0.05 SD, 95%CI [0.02, 0.09]), and depression (0.06 SD, 95% CI [0.03, 0.09]) symptom scores. Negatively scored emotional valence was associated with elevated log PHQ-4 total (-0.05 SD, 95%CI [-0.08, -0.01]), anxiety (-0.04 SD, 95%CI [-0.08, 0.00]), and depression (-0.04 SD, 95%CI [-0.07, -0.01]) symptom scores. Estimated associations among women bereaved of a partner or child were elevated but underpowered. Qualitative approaches in epidemiological cohorts offer promise in identifying novel characteristics associated with bereavement outcomes among older women.