Depression and anxiety symptom networks in hemorrhoid patients: evidence from the UK biobank

Hemorrhoidal disease is highly prevalent and associated with significant psychological distress. However, the interplay between depression and anxiety symptoms and their variation across subgroups remains uncharacterized. This study identifies the key symptoms contributing to distress in these patients and explores subgroup differences to optimize mental health interventions.

We analyzed data from 10,482 hemorrhoid patients in the UK Biobank and constructed Gaussian Graphical Models (GGMs) based on PHQ-9 and GAD-7 symptom scores. Network estimation was carried out using EBIC graphical lasso regularization, and centrality metrics including strength, betweenness, and closeness were calculated using the qgraph package. Subgroup comparisons by gender, smoking history, age, and time interval were performed using the NetworkComparisonTest with 1,000 bootstrap iterations.

The symptom network showed high stability (CS = 0.75), with "Sad mood" (strength = 1.41) and "Too much worry" (betweenness = 2.54) acting as central bridges between depressive and anxiety symptoms. Gender differences were pronounced: male and female networks differed significantly in both global strength (S = 0.19, p = 0.03) and structure (M = 0.10, p = 0.01), with women showing stronger emotion-cognition connections and men emphasizing somatic-behavioral linkages. Patients assessed ≥ 20 years after hemorrhoid diagnosis exhibited increased global connectivity (S = 0.23, p = 0.02) despite stable core architecture (M = 0.07, p = 0.73).

"Sad mood" and "Too much worry" are key treatment targets in hemorrhoid-related psychopathology. Gender-stratified approaches, such as emotion-focused therapies for women and behavioral activation for men, may help disrupt the pain-distress cycle. Applying principles of network psychiatry could optimize integrated care for this underserved population.