Network analysis of depression, anxiety, insomnia and quality of life among Macau residents during the COVID-19 pandemic

Bai, Wei; Zhao, Yanjie; Cai, Hong; Sha, Sha; Zhang, Qinge; Lei, Si Man; Lok, Grace K.I.; Chow, Ines H.I.; Cheung, Teris; Su, Zhaohui; Jackson, Todd; Xiang, Yu‐Tao

doi:10.1016/j.jad.2022.05.061

Cited by 57 publications

(79 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…82 It is worth noting that trouble relaxing clustered within the psychomotor community and related in the network most strongly to restlessness (of the type which makes it difficult to sit still). This corroborates Bai et al, 17 in which trouble relaxing showed the second-highest EI, and psychomotor symptoms (restlessness; irritability; and agitation/retardation) showed the highest BEI after sleep problems. Considered alongside extant research, findings suggest processes potentially involved in the pathogenesis and/or maintenance of insomnia such as hyperactive stress reactivity, repetitive negative thinking, and physiological hyperarousal may inhibit rest and relaxation, and this may contribute to or otherwise reflect interplay between insomnia, depression, and anxiety symptomatology.…”

Section: Discussionsupporting

confidence: 91%

“…Indeed, relaxation therapy has shown therapeutic potential as monotherapy for depression 91 and in anxiety. 92 Results diverged in certain respects from Bai et al, 17 in which sleep maintenance (difficulty staying asleep) was identified as the highest-EI node. In the present study, difficulty maintaining sleep in the night and early morning ranked 3rd-and 4th-lowest in EI, respectively.…”

Section: Discussionmentioning

confidence: 85%

“…The strongest edges in the network (i.e., uncontrollable worrying-excessive worrying; anhedoniadepressed mood/hopelessness) corroborate empirical literature on symptom interaction in depression and anxiety. 7,9,17,[79][80][81] This analysis suggests that such findings largely generalise to insomnia patients, including those with subclinical and/or undiagnosed depression/anxiety. Trouble relaxing was identified as a central symptom and, as the identified bridge symptom, between insomnia, depression, and anxiety symptoms.…”

Section: Discussionmentioning

confidence: 96%

“…In the present study, difficulty maintaining sleep in the night and early morning ranked 3rd-and 4th-lowest in EI, respectively. The high EI of sleep maintenance in Bai et al 17 largely reflects the node's very strong edge with severity of sleep onset (difficulty initiating sleep), the strongest edge in their network, as such this may be a statistical artefact reflecting topological overlap between the two nodes. This association was also not evident in the present analysis where there was a negative association between similar items: night-time awakenings and time to sleep.…”

Section: Discussionmentioning

confidence: 96%

“…14 Cognitive therapy (CT) and behavioural therapy (BT) for insomnia show different symptom-specific effects (sleep efficiency; difficulty maintaining sleep; dissatisfaction with sleep for BT, and interference with daily functioning; difficulty initiating sleep; early morning awakenings; and worry about sleep for CT) 15 while, in a separate study, sleep related behaviours were associated with BT, and worry; impaired quality of life (QOL); dysfunctional beliefs; monitoring sleep-related threats for CT. 16 To our knowledge, only one prior published network analysis has investigated insomnia symptoms discretely in relation to both depression and anxiety symptoms. 17 Bai et al 17 Psychosocial wellbeing and functional impairments associated with insomnia, depression, and anxiety appear to be intensified in the case of comorbidity. While levels of impairment in depression and anxiety are roughly comparable, comorbid depression-anxiety is linked with significantly greater impairment than in either disorder alone.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Insomnia, depression, and anxiety symptoms interact and individually impact functioning: A network and relative importance analysis in the context of insomnia

Bard¹,

O’Driscoll²,

Miller³

et al. 2022

Preprint

View full text Add to dashboard Cite

Study Objectives. Insomnia, depression, and anxiety show high rates of comorbidity and functional impairment. Transdiagnostic symptom interactions may be implicated in this comorbidity. This network analysis sought to assess how symptoms of insomnia, depression, and anxiety may interact and individuallypredict impairment across several domains for individuals with insomnia.Methods. Baseline psychometric data from a randomised controlled trial were analysed (N = 1,711). A regularised partial correlation network was estimated from the symptom data. Centrality (symptom connectivity), community structure (symptom clustering), and bridging (inter-community connectivity) wereassessed. The replicability of the network model was assessed via confirmatory analyses in a holdout sample. Separately, Shapley values were estimated to determine the relative importance of each symptom in predicting functioning (i.e., psychological wellbeing, psychosocial functioning, and physical healthimpairment).Results. The most connected nodes were uncontrollable worrying; trouble relaxing; and depressed mood/hopelessness. Five communities were identified with trouble relaxing identified as the bridge symptom between communities. The model showed good fit in the holdout sample. Low energy and depressive affectsymptoms (feelings of failure/guilt; depressed mood/hopelessness; anhedonia) were key predictors in the relative importance analysis across multiple domains of impairment.Conclusion. Trouble relaxing may be of clinical and transdiagnostic significance in the context of insomnia. In terms of how symptoms relate to functioning, it was clear that, while low energy and feelings of failure/guilt were prominent predictors, a range of symptoms are associated with functional impairment.Consideration of both symptoms and functional impairment across domains may be useful in determining targets for treatment.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Insomnia, depression, and anxiety symptoms interact and individually impact functioning: A network and relative importance analysis in the context of insomnia

Bard¹,

O’Driscoll²,

Miller³

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

Psychopathology symptoms of frontline nurses under sudden public health crisis: A network analysis

Dong,

Zhang,

Cao

2024

Stress and Health

View full text Add to dashboard Cite

Public health crises can significantly impact the emotional well‐being of healthcare workers. Network analysis is a novel approach to exploring interactions between mental disorders at the symptom level. This study aimed to elucidate the characteristics of post‐traumatic stress disorder (PTSD), anxiety, depression, and insomnia symptoms network among frontline nurses under sudden public health crisis. A cross‐sectional survey was conducted online among 556 frontline nurses through convenience sampling in Hubei Province, China, from 21 February 2020, to 10 March 2020. Symptoms of PTSD, anxiety, depression, and insomnia were assessed by the Post‐Traumatic Stress Disorder Checklist (PCL‐5), Generalized Anxiety Disorder scale (GAD‐7), Patient Health Questionnaire (PHQ‐9) and Insomnia Severity Index, respectively. Central symptoms (the most important symptoms, activation has the strongest influence the other nodes) and bridge symptoms (nodes where deactivation can prevent activation from spreading from one disorder to another) were identified via centrality and bridge centrality indices, respectively. Network stability was examined using the case‐dropping procedure. We found that the correlation between PHQ‐9 item 9 ‘suicidal thoughts’ and PCL‐5 item 16 ‘reckless or self‐destructive behaviour’ was the strongest. Moreover, ‘reckless or self‐destructive behaviour’ was the strongest central symptom, and PHQ‐9 item 3 ‘sleep problems’ was the most important bridge symptom. Other major symptoms included GAD‐7 item 6 ‘uncontrollable anxiety’ and PHQ‐9 item 2 ‘depressed or sad mood’. Timely, systemic targeting interventions on central symptoms and bridge symptoms may effectively alleviate co‐occurring experiences of psychopathological symptoms among frontline nurses.

show abstract

Symptom cluster among cancer survivors from a nationally representative survey: a network analysis

Zhang,

Lao,

Liu

et al. 2024

Support Care Cancer

View full text Add to dashboard Cite

Network analysis of depression, anxiety, insomnia and quality of life among Macau residents during the COVID-19 pandemic

Cited by 57 publications

References 47 publications

Insomnia, depression, and anxiety symptoms interact and individually impact functioning: A network and relative importance analysis in the context of insomnia

Insomnia, depression, and anxiety symptoms interact and individually impact functioning: A network and relative importance analysis in the context of insomnia

Psychopathology symptoms of frontline nurses under sudden public health crisis: A network analysis

Symptom cluster among cancer survivors from a nationally representative survey: a network analysis

Contact Info

Product

Resources

About