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

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.