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. 2022 Aug 4:14:1351-1362.
doi: 10.2147/NSS.S367974. eCollection 2022.

Network Analysis of Comorbid Anxiety and Insomnia Among Clinicians with Depressive Symptoms During the Late Stage of the COVID-19 Pandemic: A Cross-Sectional Study

Hong Cai #  1   2   3 , Yan-Jie Zhao #  1   2   3 , Xiaomeng Xing #  4 , Tengfei Tian #  4 , Wang Qian  4 , Sixiang Liang  4 , Zhe Wang  4 , Teris Cheung  5 , Zhaohui Su  6 , Yi-Lang Tang  7   8 , Chee H Ng  9 , Sha Sha  4 , Yu-Tao Xiang  1   2   3
Affiliations

Network Analysis of Comorbid Anxiety and Insomnia Among Clinicians with Depressive Symptoms During the Late Stage of the COVID-19 Pandemic: A Cross-Sectional Study

Hong Cai et al. Nat Sci Sleep. .

Abstract

Background: A high proportion of clinicians experienced common anxiety, insomnia and depression during the COVID-19 pandemic. This study examined the item-level association of comorbid anxiety and insomnia symptoms among clinicians who suffered from depressive symptoms during the late stage of the COVID-19 pandemic using network analysis (NA).

Methods: Clinicians with depressive symptoms (with a Patients Health Questionnaire (PHQ-9) total score of 5 and above) were included in this study. Anxiety and insomnia symptoms were measured using the Generalized Anxiety Disorder Scale - 7-item (GAD-7) and Insomnia Severity Index (ISI), respectively. Network analysis was conducted to investigate the network structure, central symptoms, bridge symptoms, and network stability of these disturbances. Expected influence (EI) was used to measure the centrality of index.

Results: Altogether, 1729 clinicians were included in this study. The mean age was 37.1 [standard deviation (SD)=8.04 years], while the mean PHQ-9 total score was 8.42 (SD=3.33), mean GAD-7 total score was 6.45 (SD=3.13) and mean ISI total score was 8.23 (SD=5.26). Of these clinicians, the prevalence of comorbid anxiety symptoms (GAD-7≥5) was 76.8% (95% CI 74.82-78.80%), while the prevalence of comorbid insomnia symptoms (ISI≥8) was 43.8% (95% CI: 41.50-46.18%). NA revealed that nodes ISI7 ("Interference with daytime functioning") (EI=1.18), ISI4 ("Sleep dissatisfaction") (EI=1.08) and ISI5 ("Noticeability of sleep problem by others") (EI=1.07) were the most central (influential) symptoms in the network model of comorbid anxiety and insomnia symptoms in clinicians. Bridge symptoms included nodes PHQ3 ("Sleep") (bridge EI=0.55) and PHQ4 ("Fatigue") (bridge EI=0.49). Gender did not significantly influence the network structure, but "having the experience of caring for COVID-19 patients" significantly influenced the network structure.

Conclusion: Central symptoms and key bridge symptoms identified in this NA should be targeted in the treatment and preventive measures for clinicians suffering from comorbid anxiety, insomnia and depressive symptoms during the late stage of the COVID-19 pandemic.

Keywords: anxiety; depression; health personnel; network analysis; sleep.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Network structure of depression, anxiety and insomnia in clinicians during the late stage of the COVID-19 pandemic.
Figure 2
Figure 2
Network structure of depression, anxiety and insomnia in clinicians only showing bridge connection during the late stage of the COVID-19 pandemic.
Figure 3
Figure 3
The stability of centrality and bridge centrality indices using case-dropping bootstrap.
Figure 4
Figure 4
Flow network of quality of life.
See this image and copyright information in PMC

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