Network analysis of anxiety, depressive symptoms, and suicidal tendencies among nursing students with recent suicidal...

Suicide prevention is increasingly gaining attention, especially for those who have suicidal ideation. Nursing students face unique stressors from academic and clinical demands, leading to high rates of anxiety, depressive symptoms, and suicidal tendencies. While previous research has focused on prevalence and single-variable associations, the complex interrelationships among these mental health issues remain understudied. This study aims to use network analysis to explore the connections between anxiety, depressive symptoms, and suicidal tendencies in nursing students with recent suicidal ideation.

A cross-sectional study was conducted among 558 nursing students from Guangxi Health Science College who reported recent suicidal ideation. Data on anxiety symptoms (Generalized Anxiety Disorder-7(GAD-7) Scale), depressive symptoms (Patient Health Questionnaire-9 (PHQ-9)), and suicidal tendencies (Chinese Version of the Beck Scale for Suicide Ideation (BSI-CV)) were collected via online surveys. Network modeling was performed using the Gaussian graph model with the graphical least absolute shrinkage and selection operator (GLASSO) algorithm to identify key symptoms and their relationships. Central and bridge symptoms were analyzed, and network stability was evaluated using bootstrapping. Additionally, a separate network of suicidal ideation and suicidal tendency was constructed to further explore the intrinsic associations of suicide-related symptoms.

The network model included 30 symptom nodes, with an average predictability of 62%, indicating strong interconnections. The most central symptoms were "motor changes," "actual preparation for suicide," and "lack of energy," which played pivotal roles in driving network connectivity. "Irritability," "anhedonia," and "depressed mood" emerged as critical bridge symptoms, linking anxiety, depression, and suicidal tendency communities. Strong within-community connections were found in each symptom group. The network showed robust stability. The separate suicidal ideation-suicidal tendency network had an average predictability of 0.45, with "actual preparation for suicide" as the most central symptom; "desire to live" and "passive suicidal desire" served as key bridge nodes in this network.

This study is the first to construct a network of anxiety, depressive symptoms, and suicidal tendencies in nursing students with recent suicidal ideation. Central symptoms like motor changes and actual preparations for suicide are key targets for disrupting the progression from ideation to action, while bridge symptoms such as irritability and depressed mood highlight the interconnected nature of these states. The identification of "desire to live" as a critical link between suicidal ideation and suicidal tendency provides a novel protective target for suicide prevention. The findings provide a holistic perspective for developing targeted interventions to improve mental health and prevent suicidal behavior in this high-risk group.

Not applicable.