Synergies vs. Clustering Only of Depressive Symptoms in Diabetes and Co-Occurring Conditions: Symmetric Indicators with Asymmetric, Bidirectional Influences in MIMIC Models

Abstract

I extend multiple indicators multiple causes (MIMIC) models to unveil unbiased, asymmetric, bidirectional influences using indicators of the same items within variable-defined subgroups. The strategy discerns (1) item-variation in interaction (and derivative) terms that capture synergies and cluster together (formative or causal indicators) from (2) item-variation in duplicate terms when items lack synergy and cluster together only (reflective or effect indicators). An item may reveal either or both influences. These symmetric indicators yield estimates of (1) the unique variation and synergy of each formative indicator within the structural model portion of the MIMIC model (based on moderated regression) and (2) the remaining shared variation in the reflective indicator within the measurement model portion (based on confirmatory factor analysis). I reveal two patterns of comorbidity in disease subgroups of specific co-occurring conditions across a community sample of older adults and in age and gender subsamples. First, as structural model indicators, depressive symptoms may display different synergies as they cluster within a disease subgroup of diabetes and specific co-occurring conditions. As measurement model indicators, depressive symptoms capture non-synergistic clustering within the disease subgroup. Second, diabetes may mediate the co-occurring condition when depressive symptoms lack synergies but cluster within the disease subgroup. Researchers should distinguish both comorbidity patterns, which have different implications. I offer insights for adaptive modeling, conceptualizing and screening symptom clusters, metabolomics, and economic or social monitoring.