Network analysis of mutuality and depression symptoms in stroke survivors in China

Depression represents a challenging neuropsychiatric issue following strokes and conceptualized as a network of individual symptoms that could affect each other in network theory. Clinical characteristics of depression are influenced by mutuality of stroke survivors and their spouses. No relevant research has examined the structure of depression network and how mutuality is related to depression among Chinese stroke survivors. This study aimed to investigate the structure of the depression network model, identify the pivotal symptoms influencing depression and explore the nodes that bridge depression and mutuality among Chinese stroke survivors. A sample of 847 stroke survivors in Henan Province, China, were invited to complete a survey that included the Patient Health Questionnaire (PHQ-9) and the 15-item Mutuality Scale (MS), which assessed depressive symptoms and mutuality, respectively. Results indicated that within the network of depressive symptoms, sadness (PHQ2) emerged as the central symptom. Getting help from spouse (MS6), attachment relationship (MS5), and concentration (PHQ7) were identified as the pivotal nodes bridging the connection between mutuality and depressive symptoms. Conversely, suicide ideation (PHQ9) and sleep disorders (PHQ3) were among the symptoms demonstrating the lowest predictability, indicating that their variance was less likely influenced by other depressive symptoms within the network. This is among the first studies investigating the inter-relationships between mutuality and depressive symptom from the network approach. Our findings provide an empirically-based perspective on the significance of dyadic interventions, with potential clinical implications for alleviating depressive symptom among stroke survivors.