Comorbidity Network of Self-Stigma, Insomnia, and Mental Health in Chronic Disease Patients: A Network Analysis

Patients with chronic illnesses frequently exhibit symptoms including self-stigma, insomnia, depression, and anxiety. While previous research has primarily focused on the effects of individual symptoms, a comprehensive analysis of the complex interactions among these symptoms remains lacking. The present study investigates these interactions using network analysis.

The study collected data on the psychological status of 406 patients using self-assessment scales (sleep/anxiety/depression scales). We conducted network analyses with the R packages botnet and qgraph to evaluate the bridging relationships between symptom networks and the strength of these networks. Additionally, we analyzed the interrelationships among the various symptoms of self-stigma, insomnia, depression, and anxiety, and explored the core and bridging symptoms within the symptom networks.

Network analyses identified self-stigma emotions and daytime conditions as the core symptoms of self-stigma and insomnia within the dimensional network models of self-stigma, depression, anxiety, and insomnia. The most significant bridging symptoms in these models were anxiety, depression, self-stigma, emotions, and daytime conditions. In contrast, the prominent bridging symptoms in the self-stigma, depression, anxiety, and insomnia dimensional network models were SD6 (Bad mood or unstable mood during the day), AN2 (Unable to stop or control worrying), DP2 (Feeling down, depressed, hopeless), and SS1 (Patient identity is burdens). Additionally, SS9 (Illness-concealed social avoidance) and SD7 (Poor or unstable mental state during daytime physical activities) emerged as the core symptoms of self-stigma and insomnia symptoms, respectively.

This network analysis identified self-stigma cognition and sleep quality as central symptoms within the self-stigma-insomnia network structure. It pinpointed a lack of interest and pleasure in activities, along with the inability to stop or control worrying, as bridge symptoms in the self-stigma-insomnia-depression and self-stigma-insomnia-anxiety network structures.