Network of depression and anxiety symptoms in patients with epilepsy

Depression and anxiety are often comorbid in people with epilepsy. Network models consider this comorbidity as an interacting system of depressive and anxiety symptoms. The present study investigates the network structure of depressive and anxiety symptoms in people with epilepsy and aims to identify the central and bridge symptoms to provide suggestions for the prevention of and intervention for depression-anxiety comorbidity in patients with epilepsy.

A total of 313 patients with epilepsy were enrolled in our study. Anxiety symptoms were evaluated with the Generalized Anxiety Disorder 7-Item questionnaire. Depressive symptoms were evaluated with the Patient Health Questionnaire-9. Network analyses were used for the statistical analysis.

The findings indicated that ten edges with the strongest regularized partial correlations existed in the network. Six were among depressive symptoms, such as "sleep difficulties" with "fatigue" and " feeling of worthlessness" with "thoughts of death". Four were among anxiety symptoms, such as "nervousness or anxiety" with "uncontrollable worry" and "uncontrollable worry" with "worry too much". Those strongest edges had no connection linking anxiety and depressive symptoms. The symptoms "depressed or sad mood", "trouble relaxing" and "uncontrollable worry" had the highest strength centrality in the network. The results revealed three bridge symptoms: "psychomotor agitation/retardation", "irritable", and "depressed or sad mood".

"Feeling of worthlessness" was identified as a key priority due to associations with suicidal ideation. The current study highlighted the critical central symptoms "depressed or sad mood", "trouble relaxing" and "uncontrollable worry" and the critical bridge symptoms "psychomotor agitation/retardation", "irritable", and "depressed or sad mood". Implications for clinical prevention and intervention based on these symptoms are discussed.