Network analysis of anxiety, depression, stress, and sleep disturbances in healthcare workers

This study employed a network analysis approach to examine the interrelationships between anxiety, depression, stress, and sleep disturbances among healthcare workers, providing a symptom-level perspective on these prevalent mental health concerns.

This cross-sectional survey was conducted among healthcare workers from medical institutions in Fujian Province, China. Data were collected using the Depression-Anxiety-Stress Scale-21 (DASS-21) and the Pittsburgh Sleep Quality Index (PSQI). After item redundancy screening, Gaussian graphical models with EBICglasso regularization were estimated in R. Nodes represented DASS-21 items and PSQI components, and edges represented regularized partial correlations after conditioning on all other nodes. Network accuracy and stability were assessed using bootstrap procedures, and subgroup differences by gender, length of employment, and education level were examined using the Network Comparison Test.

This study included 1, 335 participants. Network analysis revealed that fear without cause was the most central symptom, with 'panic' and 'overreaction' also identified as key symptoms within the network. Bridging symptoms, such as overreaction, persistent sadness, were found to show high bridge strength between anxiety, depression, and stress. The network of comorbid symptoms and disturbances highlighted daytime dysfunction and sleep disturbances as central sleep-related nodes associated with psychological symptoms. No significant differences were observed in the network characteristics between the gender and length of employment subgroups in the subgroup analysis; however, differences were noted in the network characteristics based on education level. Persistent sadness and lack of enjoyment were also identified as key factors contributing to the overall psychological symptom network.

This study identified key symptom-level associations among anxiety, depression, stress, and sleep disturbances in healthcare workers. Fear without cause, panic, overreaction, persistent sadness, lack of enjoyment, daytime dysfunction, and sleep disturbances may be useful candidate targets for future longitudinal and intervention studies. These findings should be interpreted as cross-sectional associations rather than causal relationships.