{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T12:38:06Z","timestamp":1777725486133,"version":"3.51.4"},"reference-count":96,"publisher":"IMR Press","issue":"2","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["71774060"],"award-info":[{"award-number":["71774060"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Wuhan Municipal Health Commission and Bureau of Science and Technology Innovation of Wuhan Municipality","award":["WX23A99"],"award-info":[{"award-number":["WX23A99"]}]},{"name":"Young Top Talent Program in Public Health from Health Commission of Hubei Province","award":["EWEITONG[2021]74"],"award-info":[{"award-number":["EWEITONG[2021]74"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Alpha Psychiatry"],"abstract":"<jats:p>Background: Alcohol use inflicts substantial harm on older adults; however, research in China remains limited. The association between alcohol use and depression at the symptom level is particularly unclear. This study examined the prevalence and correlates of problematic alcohol use (PAU) and the network structure of comorbid PAU and depressive symptoms among older Chinese adults. Methods: A cross-sectional survey was conducted with 2643 adults aged \u226560 years in Wuhan, China. PAU was assessed using the Alcohol Use Disorders Identification Test (AUDIT), and depressive symptoms were measured with the 9-item Patient Health Questionnaire (PHQ-9). Multivariate logistic regression identified correlates of PAU. A regularized partial correlation network was constructed to examine the comorbid structure of AUDIT and PHQ-9 symptoms. Results: The prevalence of any alcohol use was 21.0%, and that of PAU was 8.4%. Significant correlates of PAU included depressive symptoms (OR = 1.68, p = 0.004), male sex (OR = 2.87, p = 0.001), employment (OR = 1.51, p = 0.034), rural residence (OR = 1.51, p = 0.034), and lower monthly household income (0\u201356 USD vs. \u2265490 USD: OR = 4.02, p = 0.020). In the network, the strongest edges were AUDIT\u2013PHQ-1 \u201canhedonia\u201d (edge weight = 0.272) and AUDIT\u2013PHQ-3 \u201csleep disturbance\u201d (edge weight = 0.183). Centrality indices revealed that PHQ-3 \u201csleep disturbance\u201d and PHQ-1 \u201canhedonia\u201d were the most central symptoms. Conclusions: Depressive symptoms were strongly associated with PAU among older Chinese adults. Male sex, employment, rural residence, and low income increased the risk. Anhedonia and sleep disturbance emerged as pivotal depressive symptoms bridging PAU. Interventions targeting reward processing and sleep regulation may mitigate this comorbidity.<\/jats:p>","DOI":"10.31083\/ap45934","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T10:41:17Z","timestamp":1777459277000},"source":"Crossref","is-referenced-by-count":0,"title":["Prevalence and Correlates of Problematic Alcohol Use Among Older Chinese Adults: A Study Combining Logistic Regression and Psychological Network Analysis"],"prefix":"10.31083","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-3220-5428","authenticated-orcid":true,"given":"Hang","family":"Qian","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, 430030 Wuhan, Hubei, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6548-0502","authenticated-orcid":true,"given":"She-Hui","family":"Chang","sequence":"additional","affiliation":[{"name":"Research Center for Psychological and Health Sciences, China University of Geosciences (Wuhan), 430074 Wuhan, Hubei, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7229-1519","authenticated-orcid":true,"given":"Bao-Liang","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, 430030 Wuhan, Hubei, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"16242","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Shield K, Manthey J, Rylett M, Probst C, Wettlaufer A, Parry CDH, et al. National, regional, and global burdens of disease from 2000 to 2016 attributable to alcohol use: a comparative risk assessment study. The Lancet. Public Health. 2020; 5: e51\u2013e61.","DOI":"10.1016\/S2468-2667(19)30231-2"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"GBD 2016 Alcohol Collaborators. Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2018; 392: 1015\u20131035.","DOI":"10.1016\/S0140-6736(18)31310-2"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, Patra J. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet. 2009; 373: 2223\u20132233.","DOI":"10.1016\/S0140-6736(09)60746-7"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Im PK, Wright N, Yang L, Chan KH, Chen Y, Guo Y, et al. Alcohol consumption and risks of more than 200 diseases in Chinese men. Nature Medicine. 2023; 29: 1476\u20131486.","DOI":"10.1038\/s41591-023-02383-8"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Rehm J, Imtiaz S. A narrative review of alcohol consumption as a risk factor for global burden of disease. Substance Abuse Treatment, Prevention, and Policy. 2016; 11: 37.","DOI":"10.1186\/s13011-016-0081-2"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Lin H, Xiao S, Zhai J, Zhang C. The Application of China\u2019s Proactive Health Management Model for Community-Dwelling Elderly in Mental Health. Alpha Psychiatry. 2025; 26: 38787.","DOI":"10.31083\/AP38787"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Yuan MD, Liu JF, Zhong BL. Prevalence of prolonged grief disorder and its symptoms among bereaved individuals in China: a systematic review and meta-analysis. General Psychiatry. 2024; 37: e101216.","DOI":"10.1136\/gpsych-2023-101216"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Chang G, Wang P. Investigation of drinking status in residents (\u2265 15 years old) of urban and rural areas in Tianjin. Chinese Journal of Prevention and Control of Chronic Diseases. 2016; 24: 493\u2013497+501.  (In Chinese)","DOI":"10.16386\/j.cjpccd.issn.1004-6194.2016.07.004"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Xu W, Chen Y, Xie J, Xing X, Wu Q, Zha Z, et al. Analysis of the Current Situation of Drinking Behavior among Adult Residents in Anhui Province from 2013 to 2014. Chinese Journal of Health Education. 2017; 33: 115\u2013119.  (In Chinese)","DOI":"10.16168\/j.cnki.issn.1002-9982.2017.02.005"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Huang LY, Zhang Y, Zhao Y, Jin QZ,Yu YJ, Tu RY, et al. The status of drinking and its associated factors among the elderly aged 60 and above in Beijing. Chinese Journal of Health Education. 2022; 38: 233\u2013239.  (In Chinese)","DOI":"10.16168\/j.cnki.issn.1002-9982.2022.03.009"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Xu X. Research and Analysis on the Characteristics of Adult Drinking Behavior in Qingdao and Its Correlation with Overweight\/Obesity [master\u2019s thesis]. Qingdao University. 2019.","DOI":"10.27262\/d.cnki.gqdau.2019.001396"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Smith JP, Randall CL. Anxiety and alcohol use disorders: comorbidity and treatment considerations. Alcohol Research: Current Reviews. 2012; 34: 414\u2013431.","DOI":"10.35946\/arcr.v34.4.06"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Xu X, Zhao L, Fang H, Guo Q, Wang X, Yu W, et al. Status of alcohol drinking among population aged 15 and above in China in 2010-2012. Journal of Hygiene Research. 2016; 45: 534\u2013537+567.","DOI":"10.19813\/j.cnki.weishengyanjiu.2016.04.005"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Wilson J, Tanuseputro P, Myran DT, Dhaliwal S, Hussain J, Tang P, et al. Characterization of Problematic Alcohol Use Among Physicians: A Systematic Review. JAMA Network Open. 2022; 5: e2244679.","DOI":"10.1001\/jamanetworkopen.2022.44679"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Imperatori C, Corazza O, Panno A, Rinaldi R, Pasquini M, Farina B, et al. Mentalization Impairment Is Associated with Problematic Alcohol Use in a Sample of Young Adults: A Cross-Sectional Study. International Journal of Environmental Research and Public Health. 2020; 17: 8664.","DOI":"10.3390\/ijerph17228664"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Wilson S, Bair JL, Thomas KM, Iacono WG. Problematic alcohol use and reduced hippocampal volume: a meta-analytic review. Psychological Medicine. 2017; 47: 2288\u20132301.","DOI":"10.1017\/S0033291717000721"},{"key":"ref17","unstructured":"World Health Organization. China country assessment report on ageing and health. World Health Organization. 2015. Available at: https:\/\/iris.who.int\/handle\/10665\/194271 (Accessed: 12 August 2025)."},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Xia Q, Zhou T, Xu H, Ge S, Tang X. The Relationship Between Alcohol Consumption and Frailty Among Older Adults in China: Results From the Chinese Longitudinal Healthy Longevity Survey. Journal of Transcultural Nursing. 2024; 35: 348\u2013356.","DOI":"10.1177\/10436596241259196"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"O\u2019Connell H, Chin AV, Cunningham C, Lawlor B. Alcohol use disorders in elderly people\u2013redefining an age old problem in old age. BMJ. 2003; 327: 664\u2013667.","DOI":"10.1136\/bmj.327.7416.664"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Yen FS, Wang SI, Lin SY, Chao YH, Wei JCC. The impact of heavy alcohol consumption on cognitive impairment in young old and middle old persons. Journal of Translational Medicine. 2022; 20: 155.","DOI":"10.1186\/s12967-022-03353-3"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Xie Z, Zhong G, Xu C, Chen T, Du Z, Wei Y, et al. Trends and cross-country inequalities of alcohol use disorders: findings from the global burden of disease study 2021. Globalization and Health. 2025; 21: 30.","DOI":"10.1186\/s12992-025-01124-5"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Bai J, Huang X, Ma Z, Ji B, Zheng X. Clinical Values of Serum Uric Acid Levels in the Occurrence of Cognitive Impairment in Alcohol-Dependent Patients. Alpha Psychiatry. 2023; 24: 43\u201348.","DOI":"10.5152\/alphapsychiatry.2023.221065"},{"key":"ref23","unstructured":"World Health Organization. Global status report on alcohol and health 2018. World Health Organization: Geneva. 2018."},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"Keyes KM, Hasin DS. Socio-economic status and problem alcohol use: the positive relationship between income and the DSM-IV alcohol abuse diagnosis. Addiction. 2008; 103: 1120\u20131130.","DOI":"10.1111\/j.1360-0443.2008.02218.x"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Zins M, Gu\u00e9guen A, Kivimaki M, Singh-Manoux A, Leclerc A, Vahtera J, et al. Effect of retirement on alcohol consumption: longitudinal evidence from the French Gazel cohort study. PLoS ONE. 2011; 6: e26531.","DOI":"10.1371\/journal.pone.0026531"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"Zhong BL, Xu YM, Xie WX, Lu J, Yu WB, Yan J. Alcohol Drinking in Chinese Methadone-maintained Clients: A Self-medication for Depression and Anxiety? Journal of Addiction Medicine. 2019; 13: 314\u2013321.","DOI":"10.1097\/ADM.0000000000000500"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Kuerbis A, Sacco P. The impact of retirement on the drinking patterns of older adults: a review. Addictive Behaviors. 2012; 37: 587\u2013595.","DOI":"10.1016\/j.addbeh.2012.01.022"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"Luo M, Bauman A, Phongsavan P, Ding D. Retirement transition and smoking and drinking behaviors in older Chinese adults: Analysis from the CHARLS study. Preventive Medicine Reports. 2023; 36: 102408.","DOI":"10.1016\/j.pmedr.2023.102408"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"Wemm SE, Larkin C, Hermes G, Tennen H, Sinha R. A day-by-day prospective analysis of stress, craving and risk of next day alcohol intake during alcohol use disorder treatment. Drug and Alcohol Dependence. 2019; 204: 107569.","DOI":"10.1016\/j.drugalcdep.2019.107569"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"Zaiser J, Hoffmann S, Zimmermann S, Gessner T, Deck M, Bekier NK, et al. Individual stress reactivity predicts alcohol craving and alcohol consumption in alcohol use disorder in experimental and real-life settings. Translational Psychiatry. 2025; 15: 226.","DOI":"10.1038\/s41398-025-03447-8"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"Ahmed MZ, Ahmed O, Hanbin S, Xie P, Jobe MC, Li W. Depression, Anxiety, and Stress Among Chinese People During the Omicron Outbreak and Its Impact on Sleep Quality and Alcohol Dependency. Alpha Psychiatry. 2024; 25: 329\u2013336.","DOI":"10.5152\/alphapsychiatry.2024.241574"},{"key":"ref32","doi-asserted-by":"publisher","unstructured":"Albright N, Morgan E. Assessing the relationship between mental health and AUDIT score among older sexual and gender minorities. Alcohol. 2025; 123: 51\u201356.","DOI":"10.1016\/j.alcohol.2024.12.005"},{"key":"ref33","doi-asserted-by":"publisher","unstructured":"Gibson RC, Waldron NK, Abel WD, Eldemire-Shearer D, James K, Mitchell-Fearon K. Alcohol use, depression, and life satisfaction among older persons in Jamaica. International Psychogeriatrics. 2017; 29: 663\u2013671.","DOI":"10.1017\/S1041610216002209"},{"key":"ref34","doi-asserted-by":"publisher","unstructured":"Wolde A. Alcohol Use Disorder and Associated Factors Among Elderly in Ethiopia. Substance Abuse: Research and Treatment. 2023; 17: 11782218231158031.","DOI":"10.1177\/11782218231158031"},{"key":"ref35","doi-asserted-by":"publisher","unstructured":"Cooper ML, Frone MR, Russell M, Mudar P. Drinking to regulate positive and negative emotions: a motivational model of alcohol use. Journal of Personality and Social Psychology. 1995; 69: 990\u20131005.","DOI":"10.1037\/\/0022-3514.69.5.990"},{"key":"ref36","doi-asserted-by":"publisher","unstructured":"Cai H, Jin Y, Liu R, Zhang Q, Su Z, Ungvari GS, et al. Global prevalence of depression in older adults: A systematic review and meta-analysis of epidemiological surveys. Asian Journal of Psychiatry. 2023; 80: 103417.","DOI":"10.1016\/j.ajp.2022.103417"},{"key":"ref37","doi-asserted-by":"publisher","unstructured":"Hu T, Zhao X, Wu M, Li Z, Luo L, Yang C, et al. Prevalence of depression in older adults: A systematic review and meta-analysis. Psychiatry Research. 2022; 311: 114511.","DOI":"10.1016\/j.psychres.2022.114511"},{"key":"ref38","doi-asserted-by":"publisher","unstructured":"Zhong BL, Ruan YF, Xu YM, Chen WC, Liu LF. Prevalence and recognition of depressive disorders among Chinese older adults receiving primary care: A multi-center cross-sectional study. Journal of Affective Disorders. 2020; 260: 26\u201331.","DOI":"10.1016\/j.jad.2019.09.011"},{"key":"ref39","doi-asserted-by":"publisher","unstructured":"Antu\u00f1a-Camblor C, Esteller-Collado G, Juarros-Basterretxea J, Mu\u00f1oz-Navarro R, Rodr\u00edguez-D\u00edaz FJ. Coping-strategies as a mediator between emotional disorders and problematic alcohol use. Alcohol. 2025; 124: 47\u201353.","DOI":"10.1016\/j.alcohol.2024.07.008"},{"key":"ref40","doi-asserted-by":"publisher","unstructured":"Turner S, Mota N, Bolton J, Sareen J. Self-medication with alcohol or drugs for mood and anxiety disorders: A narrative review of the epidemiological literature. Depression and Anxiety. 2018; 35: 851\u2013860.","DOI":"10.1002\/da.22771"},{"key":"ref41","doi-asserted-by":"publisher","unstructured":"Khantzian EJ. The self-medication hypothesis of substance use disorders: a reconsideration and recent applications. Harvard Review of Psychiatry. 1997; 4: 231\u2013244.","DOI":"10.3109\/10673229709030550"},{"key":"ref42","doi-asserted-by":"publisher","unstructured":"Khantzian EJ. The self-medication hypothesis of addictive disorders: focus on heroin and cocaine dependence. The American Journal of Psychiatry. 1985; 142: 1259\u20131264.","DOI":"10.1176\/ajp.142.11.1259"},{"key":"ref43","doi-asserted-by":"publisher","unstructured":"Oscar-Berman M, Marinkovi\u0107 K. Alcohol: effects on neurobehavioral functions and the brain. Neuropsychology Review. 2007; 17: 239\u2013257.","DOI":"10.1007\/s11065-007-9038-6"},{"key":"ref44","doi-asserted-by":"publisher","unstructured":"Ngui HHL, Kow ASF, Lai S, Tham CL, Ho YC, Lee MT. Alcohol Withdrawal and the Associated Mood Disorders-A Review. International Journal of Molecular Sciences. 2022; 23: 14912.","DOI":"10.3390\/ijms232314912"},{"key":"ref45","doi-asserted-by":"publisher","unstructured":"Steffens DC, Wang L, Manning KJ, Holzhauer CG. Alcohol Use Disorder in Older Adults: A Review of Recent Literature on Epidemiology, Cognitive Outcomes, and Neuroimaging Findings and Treatment. The American Journal of Geriatric Psychiatry: Open Science, Education, and Practice. 2024; 1: 39\u201351. https:\/\/doi.org\/","DOI":"10.1016\/j.osep.2024.05.003"},{"key":"ref46","doi-asserted-by":"publisher","unstructured":"Wang Q, Zhang Y, Wu C. Alcohol consumption and associated factors among middle-aged and older adults: results from China Health and Retirement Longitudinal Study. BMC Public Health. 2022; 22: 322.","DOI":"10.1186\/s12889-022-12718-8"},{"key":"ref47","doi-asserted-by":"publisher","unstructured":"Wang H, Peng J, Wang B, Lu X, Zheng JZ, Wang K, et al. Inconsistency Between Univariate and Multiple Logistic Regressions. Shanghai Archives of Psychiatry. 2017; 29: 124\u2013128.","DOI":"10.11919\/j.issn.1002-0829.217031"},{"key":"ref48","doi-asserted-by":"publisher","unstructured":"Borsboom D. A network theory of mental disorders. World Psychiatry. 2017; 16: 5\u201313.","DOI":"10.1002\/wps.20375"},{"key":"ref49","doi-asserted-by":"publisher","unstructured":"Xu S, Ju Y, Wei X, Ou W, Ma M, Lv G, et al. Network analysis of suicide ideation and depression-anxiety symptoms among Chinese adolescents. General Psychiatry. 2024; 37: e101225.","DOI":"10.1136\/gpsych-2023-101225"},{"key":"ref50","doi-asserted-by":"publisher","unstructured":"Lin J, Huang H, Si T, Chen L, Chen J, Su YA. Systemic low-grade inflammation associated with specific depressive symptoms: insights from network analyses of five independent NHANES samples. General Psychiatry. 2024; 37: e101301.","DOI":"10.1136\/gpsych-2023-101301"},{"key":"ref51","doi-asserted-by":"publisher","unstructured":"Chen J, Guo L, Chen TZ, Chen Y, Xu C, Zheng H, et al. Prediction and explanation of the increase in suicide risk of emerging adults: A comprehensive approach combining logistic regression, glasso network analysis, and Bayesian networks. Journal of Affective Disorders. 2025; 383: 469\u2013479.","DOI":"10.1016\/j.jad.2025.04.171"},{"key":"ref52","doi-asserted-by":"publisher","unstructured":"Doornwaard SM, Hazeleger V, Koning IM, Salah AA, Vos S, van den Eijnden RJ. Psychological Network Analysis for Risk and Protective Factors of Problematic Social Media Use. Information. 2025; 16: 567.","DOI":"10.3390\/info16070567"},{"key":"ref53","doi-asserted-by":"publisher","unstructured":"Qiu R, Gu Y. Network analysis of frailty indicators in hospitalized elderly patients: unveiling the role of depression and hemoglobin as core factors. Aging Clinical and Experimental Research. 2023; 35: 3189\u20133203.","DOI":"10.1007\/s40520-023-02608-3"},{"key":"ref54","doi-asserted-by":"publisher","unstructured":"Zhang W, Song X, Wang X, Jiang Z, Zhang Y, Cui Y. Network analysis of core factors related to non-suicidal self-injury in adolescents with mood disorders. Frontiers in Psychiatry. 2025; 16: 1557351.","DOI":"10.3389\/fpsyt.2025.1557351"},{"key":"ref55","doi-asserted-by":"publisher","unstructured":"Borsboom D, Cramer AOJ. Network analysis: an integrative approach to the structure of psychopathology. Annual Review of Clinical Psychology. 2013; 9: 91\u2013121.","DOI":"10.1146\/annurev-clinpsy-050212-185608"},{"key":"ref56","doi-asserted-by":"publisher","unstructured":"Jones PJ, Mair P, Riemann BC, Mugno BL, McNally RJ. A network perspective on comorbid depression in adolescents with obsessive-compulsive disorder. Journal of Anxiety Disorders. 2018; 53: 1\u20138.","DOI":"10.1016\/j.janxdis.2017.09.008"},{"key":"ref57","doi-asserted-by":"publisher","unstructured":"Zhong BL, Yuan MD, Li F, Sun P. The Psychological Network of Loneliness Symptoms Among Chinese Residents During the COVID-19 Outbreak. Psychology Research and Behavior Management. 2023; 16: 3767\u20133776.","DOI":"10.2147\/PRBM.S424565"},{"key":"ref58","doi-asserted-by":"publisher","unstructured":"Naing L, Nordin RB, Abdul Rahman H, Naing YT. Sample size calculation for prevalence studies using Scalex and ScalaR calculators. BMC Medical Research Methodology. 2022; 22: 209.","DOI":"10.1186\/s12874-022-01694-7"},{"key":"ref59","doi-asserted-by":"publisher","unstructured":"Li B, Shen YC, Zhang BQ, Zheng XH, Wang XG. Test of the Alcohol Use Disorders Identification Test (AUDIT). Chinese Journal of Mental Health. 2003; 17: 1\u20133.  (In Chinese)","DOI":"10.3321\/j.issn:1000-6729.2003.01.001"},{"key":"ref60","unstructured":"Zhang H, Sun JH, Yang FC. Application of the Chinese Version of Alcohol Use Disorder Identification Test in China: A Systematic Review. Chinese General Practice. 2015; 18: 4277\u20134282. (In Chinese)"},{"key":"ref61","unstructured":"Jin T, Chen SL, Shen Y, Fu GC. A study on the reliability and validity of the Patient Health Questionnaire Depression Scale in the elderly in the community. Zhejiang Preventive Medicine. 2011; 23: 27\u201329,33. (In Chinese)"},{"key":"ref62","doi-asserted-by":"publisher","unstructured":"Ezzati A, Jiang J, Katz MJ, Sliwinski MJ, Zimmerman ME, Lipton RB. Validation of the Perceived Stress Scale in a community sample of older adults. International Journal of Geriatric Psychiatry. 2014; 29: 645\u2013652.","DOI":"10.1002\/gps.4049"},{"key":"ref63","doi-asserted-by":"publisher","unstructured":"Wang Z, Wang Y, Wu ZG, Chen DD, Chen Y, Xiao ZP. Reliability and validity of the Chinese version of the Stress Perceived Scale. Journal of Shanghai Jiaotong University (Medical Science). 2015; 35: 1448\u20131451.  (In Chinese)","DOI":"10.3969\/j.issn.1674-8115.2015.10.004"},{"key":"ref64","doi-asserted-by":"publisher","unstructured":"Borsboom D, Deserno MK, Rhemtulla M, Epskamp S, Fried EI, McNally RJ, et al. Network analysis of multivariate data in psychological science. Nature Reviews Methods Primers. 2021; 1: 58.","DOI":"10.1038\/s43586-021-00055-w"},{"key":"ref65","doi-asserted-by":"publisher","unstructured":"Cheng HG, Deng F, Xiong W, Phillips MR. Prevalence of alcohol use disorders in mainland China: a systematic review. Addiction. 2015; 110: 761\u2013774.","DOI":"10.1111\/add.12876"},{"key":"ref66","doi-asserted-by":"publisher","unstructured":"Qiu Y, Lv X, Wu T, Zhang Y, Wang H, Li B, et al. Prevalence and Correlates of Risky Drinking Among the Oldest-Old in China: A National Community-Based Survey. Frontiers in Psychiatry. 2022; 13: 919888.","DOI":"10.3389\/fpsyt.2022.919888"},{"key":"ref67","doi-asserted-by":"publisher","unstructured":"Alhalaseh L, Abushams L, Qudah R, Van Hout MC, Wazaify M. Substance Use and Misuse Among Older Adults: A Scoping Review. Substance Use & Misuse. 2025; 60: 1709\u20131719.","DOI":"10.1080\/10826084.2025.2513525"},{"key":"ref68","doi-asserted-by":"publisher","unstructured":"Atkinson RM. Aging and alcohol use disorders: diagnostic issues in the elderly. International Psychogeriatrics. 1990; 2: 55\u201372.","DOI":"10.1017\/s1041610290000308"},{"key":"ref69","doi-asserted-by":"publisher","unstructured":"Kennedy GJ, Efremova I, Frazier A, Saba A. The Emerging Problems of Alcohol and Substance Abuse in Late Life. Journal of Social Distress and the Homeless. 1999; 8: 227\u2013239.","DOI":"10.1023\/A:1021392004501"},{"key":"ref70","doi-asserted-by":"publisher","unstructured":"Choi NG, DiNitto DM, Marti CN. Alcohol and other substance use, mental health treatment use, and perceived unmet treatment need: Comparison between baby boomers and older adults. The American Journal on Addictions. 2015; 24: 299\u2013307.","DOI":"10.1111\/ajad.12225"},{"key":"ref71","unstructured":"AKVARDAR Y, U\u00c7KU R. How are alcohol related problems prevented? Brief intervention approach in the treatment of alcohol use disorders. Anatolian Journal of Psychiatry. 2010; 11: 51\u201359."},{"key":"ref72","doi-asserted-by":"publisher","unstructured":"Wilsnack RW, Vogeltanz ND, Wilsnack SC, Harris TR, Ahlstr\u00f6m S, Bondy S, et al. Gender differences in alcohol consumption and adverse drinking consequences: cross-cultural patterns. Addiction. 2000; 95: 251\u2013265.","DOI":"10.1046\/j.1360-0443.2000.95225112.x"},{"key":"ref73","doi-asserted-by":"publisher","unstructured":"Erol A, Karpyak VM. Sex and gender-related differences in alcohol use and its consequences: Contemporary knowledge and future research considerations. Drug and Alcohol Dependence. 2015; 156: 1\u201313.","DOI":"10.1016\/j.drugalcdep.2015.08.023"},{"key":"ref74","doi-asserted-by":"publisher","unstructured":"Shaw BA, Agahi N, Krause N. Are changes in financial strain associated with changes in alcohol use and smoking among older adults? Journal of Studies on Alcohol and Drugs. 2011; 72: 917\u2013925.","DOI":"10.15288\/jsad.2011.72.917"},{"key":"ref75","doi-asserted-by":"publisher","unstructured":"Karriker-Jaffe KJ, Roberts SCM, Bond J. Income inequality, alcohol use, and alcohol-related problems. American Journal of Public Health. 2013; 103: 649\u2013656.","DOI":"10.2105\/AJPH.2012.300882"},{"key":"ref76","doi-asserted-by":"publisher","unstructured":"Li J, Wu B, Selb\u00e6k G, Krokstad S, Helvik AS. Factors associated with consumption of alcohol in older adults - a comparison between two cultures, China and Norway: the CLHLS and the HUNT-study. BMC Geriatrics. 2017; 17: 172.","DOI":"10.1186\/s12877-017-0562-9"},{"key":"ref77","doi-asserted-by":"publisher","unstructured":"Chen Y, Peng Y, Xu H, O\u2019Brien WH. Age Differences in Stress and Coping: Problem-Focused Strategies Mediate the Relationship Between Age and Positive Affect. International Journal of Aging & Human Development. 2018; 86: 347\u2013363.","DOI":"10.1177\/0091415017720890"},{"key":"ref78","doi-asserted-by":"publisher","unstructured":"Pizzagalli DA. Depression, stress, and anhedonia: toward a synthesis and integrated model. Annual Review of Clinical Psychology. 2014; 10: 393\u2013423.","DOI":"10.1146\/annurev-clinpsy-050212-185606"},{"key":"ref79","doi-asserted-by":"publisher","unstructured":"Khazanov GK, Forbes CN, Dunn BD, Thase ME. Addressing anhedonia to increase depression treatment engagement. The British Journal of Clinical Psychology. 2022; 61: 255\u2013280.","DOI":"10.1111\/bjc.12335"},{"key":"ref80","doi-asserted-by":"publisher","unstructured":"Koob GF, Volkow ND. Neurocircuitry of addiction. Neuropsychopharmacology. 2010; 35: 217\u2013238.","DOI":"10.1038\/npp.2009.110"},{"key":"ref81","doi-asserted-by":"publisher","unstructured":"Vink M, Kleerekooper I, van den Wildenberg WPM, Kahn RS. Impact of aging on frontostriatal reward processing. Human Brain Mapping. 2015; 36: 2305\u20132317.","DOI":"10.1002\/hbm.22771"},{"key":"ref82","unstructured":"Raz N, Rodrigue KM, Kennedy KM, Head D, Gunning-Dixon F, Acker JD. Differential aging of the human striatum: longitudinal evidence. AJNR. American Journal of Neuroradiology. 2003; 24: 1849\u20131856."},{"key":"ref83","doi-asserted-by":"publisher","unstructured":"Taylor WD, Zald DH, Felger JC, Christman S, Claassen DO, Horga G, et al. Influences of dopaminergic system dysfunction on late-life depression. Molecular Psychiatry. 2022; 27: 180\u2013191.","DOI":"10.1038\/s41380-021-01265-0"},{"key":"ref84","doi-asserted-by":"publisher","unstructured":"L\u00fcscher C, Ungless MA. The mechanistic classification of addictive drugs. PLoS Medicine. 2006; 3: e437.","DOI":"10.1371\/journal.pmed.0030437"},{"key":"ref85","doi-asserted-by":"publisher","unstructured":"Spitta G, Garbusow M, Buchert R, Heinz A. Dopamine and Alcohol: A Review of in vivo PET and SPECT Studies. Neuropsychobiology. 2023; 82: 319\u2013345.","DOI":"10.1159\/000534620"},{"key":"ref86","doi-asserted-by":"publisher","unstructured":"Cuijpers P, van Straten A, Warmerdam L. Behavioral activation treatments of depression: a meta-analysis. Clinical Psychology Review. 2007; 27: 318\u2013326.","DOI":"10.1016\/j.cpr.2006.11.001"},{"key":"ref87","doi-asserted-by":"publisher","unstructured":"Sandman CF, Craske MG. Psychological Treatments for Anhedonia. Current Topics in Behavioral Neurosciences. 2022; 58: 491\u2013513.","DOI":"10.1007\/7854_2021_291"},{"key":"ref88","doi-asserted-by":"publisher","unstructured":"Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep. 2004; 27: 1255\u20131273.","DOI":"10.1093\/sleep\/27.7.1255"},{"key":"ref89","doi-asserted-by":"publisher","unstructured":"Evans MA, Buysse DJ, Marsland AL, Wright AGC, Foust J, Carroll LW, et al. Meta-analysis of age and actigraphy-assessed sleep characteristics across the lifespan. Sleep. 2021; 44: zsab088.","DOI":"10.1093\/sleep\/zsab088"},{"key":"ref90","doi-asserted-by":"publisher","unstructured":"Kholghi G, Eskandari M, Shokouhi Qare Saadlou MS, Zarrindast MR, Vaseghi S. Night shift hormone: How does melatonin affect depression? Physiology & Behavior. 2022; 252: 113835.","DOI":"10.1016\/j.physbeh.2022.113835"},{"key":"ref91","doi-asserted-by":"publisher","unstructured":"Won E, Na KS, Kim YK. Associations between Melatonin, Neuroinflammation, and Brain Alterations in Depression. International Journal of Molecular Sciences. 2021; 23: 305.","DOI":"10.3390\/ijms23010305"},{"key":"ref92","doi-asserted-by":"publisher","unstructured":"McCullar KS, Barker DH, McGeary JE, Saletin JM, Gredvig-Ardito C, Swift RM, et al. Altered sleep architecture following consecutive nights of presleep alcohol. Sleep. 2024; 47: zsae003.","DOI":"10.1093\/sleep\/zsae003"},{"key":"ref93","doi-asserted-by":"publisher","unstructured":"Yang P, Weng J, Huang X. Sleep features in alcohol use disorder: A systematic review and meta-analysis of polysomnographic findings in case-control studies. The European Journal of Psychiatry. 2024; 38: 100231.","DOI":"10.1016\/j.ejpsy.2023.100231"},{"key":"ref94","doi-asserted-by":"publisher","unstructured":"Nielson SA, Kay DB, Dzierzewski JM. Sleep and Depression in Older Adults: A Narrative Review. Current Psychiatry Reports. 2023; 25: 643\u2013658.","DOI":"10.1007\/s11920-023-01455-3"},{"key":"ref95","doi-asserted-by":"publisher","unstructured":"Suraev A, Kong SD, Menczel Schrire Z, Tran BA, Cross N, Matar E, et al. Current and Emerging Sleep Interventions for Older Adults with or without Mild Cognitive Impairment. Current Treatment Options in Neurology. 2024; 26: 463\u2013483.","DOI":"10.1007\/s11940-024-00808-4"},{"key":"ref96","doi-asserted-by":"publisher","unstructured":"Kim C, Lee Y, Kang SG, Lee SH. Effectiveness of Information and Communication Technology-Based Cognitive Behavioral Therapy Using the Smart Sleep App on Insomnia in Older Adults: Randomized Controlled Trial. Journal of Medical Internet Research. 2025; 27: e67751.","DOI":"10.2196\/67751"}],"container-title":["Alpha Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.imrpress.com\/journal\/AP\/27\/2\/10.31083\/AP45934","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T10:42:28Z","timestamp":1777459348000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.imrpress.com\/journal\/AP\/27\/2\/10.31083\/AP45934"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,21]]},"references-count":96,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026]]}},"alternative-id":["S2757-8038(26)02677-0"],"URL":"https:\/\/doi.org\/10.31083\/ap45934","relation":{},"ISSN":["2757-8038"],"issn-type":[{"value":"2757-8038","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,21]]},"article-number":"45934"}}