Anxiety, depressive and insomnia symptoms among patients with depression: a network perspective

The aim of this study was to utilize network analysis to explore the interconnections among anxiety, depressive, and insomnia symptoms in depressed patients in China.

The study included two surveys, the baseline survey was conducted from May 18, 2020 to June 18, 2020, and the follow-up survey was conducted 5 months later. A total of 4476 patients completed the baseline survey, and 1877 of them completed the follow-up survey. Depression symptoms were evaluated using the 9-item Patient Health Questionnaire-9 (PHQ-9), anxiety symptoms were evaluated using the 7-item Generalized Anxiety Disorder (GAD-7), and insomnia symptoms were evaluated using the 7-item Insomnia Severity Index (ISI). The centrality indices are utilized in the network analysis, and using Network Comparison Test (NCT) to evaluate the differences between the network structures at two different time points.

Network analysis revealed that the central symptom value was ISI5 ("Interfere with your daily functioning") in the baseline networks and ISI4 ("Worried/distressed") in the follow-up networks, the symptom with the bridge symptom value in both networks was PHQ9-3 ("Sleep"). The NCT results revealed no significant differences in edge weights and global strength among participants who completed both baseline and follow-up surveys.

Our results suggest that central symptom (e.g., "Interfere with your daily functioning","Worried/distressed") and bridge symptom PHQ9-3 ("Sleep") can be prioritized as a target for intervention and treatment in patients with depression.