Network structure of depression and anxiety symptoms in Chinese female nursing students

Abstract

Background Comorbidity between depressive and anxiety disorders is common. From network perspective, mental disorders arise from direct interactions between symptoms and comorbidity is due to direct interactions between depression and anxiety symptoms. The current study investigates the network structure of depression and anxiety symptoms in Chinese female nursing students and identifies the central and bridge symptoms as well as how other symptoms in present network are related to depression symptom “thoughts of death”. Methods To understand the full spectrum of depression and anxiety, we recruited 776 Chinese female nursing students with symptoms of depression and anxiety that span the full range of normal to abnormal. Depression symptoms were measured by Patient Health Questionnaire-9 while anxiety symptoms were measured by Generalized Anxiety Disorder 7-Item Questionnaire. Network analysis was used to construct networks. Specifically, we computed the predictability, expected influence and bridge expected influence for each symptom and showed a flow network of “thoughts of death”. Results Nine strongest edges existed in network were from the same disorder. Four were between depression symptoms, like “sleep difficulties” and “fatigue”, and “anhedonia” and “fatigue”. Five were between anxiety symptoms, like “nervousness or anxiety” and “worry too much”, and “restlessness” and “afraid something will happen”. The symptom “fatigue”, “feeling of worthlessness” and “irritable” had the highest expected influence centrality. Results also revealed two bridge symptoms: “depressed or sad mood” and “irritable”. As to “thoughts of death”, the direct relations between it and “psychomotor agitation/retardation” and “feeling of worthlessness” were the strongest direct relations. Conclusions The current study highlighted critical central symptoms “fatigue”, “feeling of worthlessness” and “irritable” and critical bridge symptoms “depressed or sad mood” and “irritable”. Particularly, “psychomotor agitation/retardation” and “feeling of worthlessness” were identified as key priorities due to their strongest associations with suicide ideation. Implications for clinical prevention and intervention based on these symptoms are discussed.

The relations between different components of intolerance of uncertainty and symptoms of generalized anxiety disorder: a network analysis

“…The strongest edges exist within each community, which is aligned with the previous network studies consisting of two communities (i.e., one community consists of depression symptoms and the other community consists of anxiety symptoms) [31,[58][59][60][61][62]. Within components of IU, the present study finds a strongest edge exists between IU1 "Unforeseen events upset me greatly" and IU2 "It frustrates me not having all the information I need", which is similar to the results of previous networks of IU [63].…”

The Depression Anxiety Stress Scale 21: Development and Validation of the Depression Anxiety Stress Scale 8-Item in Psychiatric Patients and the General Public for Easier Mental Health Measurement in a Post COVID-19 World

“…Feeling worthless and hopeless are key symptoms that can mostly differentiate depressed from nondepressed patients [ 64 ]. These symptoms also strongly correlate with suicide ideation [ 65 ]. However, investigations reporting on the frequency of depressive symptoms in different conditions (e.g., traumatic brain injury, the general public, nursing students) report higher prevalence of symptoms of fatigue, anhedonia, insomnia, and severe feelings of sadness or depressed mood [ 64 , 65 , 66 ].…”

“…These symptoms also strongly correlate with suicide ideation [ 65 ]. However, investigations reporting on the frequency of depressive symptoms in different conditions (e.g., traumatic brain injury, the general public, nursing students) report higher prevalence of symptoms of fatigue, anhedonia, insomnia, and severe feelings of sadness or depressed mood [ 64 , 65 , 66 ]. In an investigation involving 117 patients with partially or fully remitted major depressive disorder, fatigue was highly associated with feeling “blue”.…”

The Depression Anxiety Stress Scale 21: Development and Validation of the Depression Anxiety Stress Scale 8-item in Psychiatric Patients and the General Public for Easier Mental Health Measurement in a Post-COVID-19 World

“…These symptoms also strongly correlate with suicide ideation [39]. However, investigations reporting on the frequency of depressive symptoms in different conditions (e.g., traumatic brain injury, the general public, nursing students) report higher prevalence of symptoms of fatigue, anhedonia, insomnia, and severe feelings of sadness or depressed mood [38][39][40]. In an investigation involving 117 patients with partially or fully remitted major depressive disorder, fatigue was highly associated with feeling "blue".…”

“…Feeling worthless and hopeless are key symptoms that can most differentiate depressed from nondepressed patients [38]. These symptoms also strongly correlate with suicide ideation [39]. However, investigations reporting on the frequency of depressive symptoms in different conditions (e.g., traumatic brain injury, the general public, nursing students) report higher prevalence of symptoms of fatigue, anhedonia, insomnia, and severe feelings of sadness or depressed mood [38][39][40].…”