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. 2023 Oct 1:338:384-392.
doi: 10.1016/j.jad.2023.06.034. Epub 2023 Jun 17.

Anxiety and depression played a central role in the COVID-19 mental distress: A network analysis

Giovanna Fico  1 , Vincenzo Oliva  2 , Michele De Prisco  3 , Lydia Fortea  4 , Adriana Fortea  5 , Anna Giménez-Palomo  6 , Gerard Anmella  1 , Diego Hidalgo-Mazzei  1 , Mireia Vazquez  7 , Marta Gomez-Ramiro  8 , Bernat Carreras  9 , Andrea Murru  10 , Joaquim Radua  11 , Philippe Mortier  12 , Gemma Vilagut  12 , Franco Amigo  12 , Montse Ferrer  13 , Helena García-Mieres  14 , Eduard Vieta  15 , Jordi Alonso  13
Affiliations

Anxiety and depression played a central role in the COVID-19 mental distress: A network analysis

Giovanna Fico et al. J Affect Disord. .

Abstract

Introduction: Psychological, socio-demographics, and clinical factors play an important role in patients with COVID-19, but their relationship is complex. The network approach might be used to disentangle complex interactions in different systems. Using data from a multicentre, cross-sectional, survey among patients with COVID-19 in Spain (July-November 2020), we investigated the network structure of mental disorders symptoms, social support, and psychological resilience, and changes in network structures according to the presence of a pre-existing mental disorder or hospitalization for COVID-19.

Methods: Subjects completed a survey to evaluate sociodemographic characteristics, COVID-19 infection status, resilience, social support, and symptoms of depression, anxiety disorders, post-traumatic stress disorder, panic attacks, and substance use disorder. 2084 patients with COVID-19 were included in the analysis. Network analysis was conducted to evaluate network and bridge centrality, and the network properties were compared between COVID-19 patients with and without a history of lifetime mental disorder, and between hospitalized and non-hospitalized patients.

Limitations: Generalization of our findings may be difficult since differences in network connectivity may exist in different populations or samples.

Results: Anxiety and depression showed high centrality in patients with COVID-19 and anxiety showed the highest bridge influence in the network. Resilience and social support showed a low influence on mental disorder symptoms. Global network estimations show no statistically significant changes between patients with and without pre-existing mental disorders or between hospitalized and non-hospitalized patients.

Conclusions: Anxiety might be a key treatment target in patients with COVID-19 since its treatment might prevent other mental health adverse outcomes.

Keywords: COVID-19; Depressive disorder; Hospitalization; Lockdown; Mental health; Network analysis; PTSD; Resilience; Social support.

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Conflict of interest statement

Declaration of competing interest GA has received CME-related honoraria, or consulting fees from Janssen-Cilag, Lundbeck, Lundbeck/Otsuka, and Angelini, with no financial or other relationship relevant to the subject of this article. AF has received CME-related educational support from Lundbeck, not related to the subject of this article. AM has received grants and served as consultant, advisor or CME speaker for the following entities: Angelini, Idorsia, Lundbeck, Pfizer, Takeda, outside of the submitted work. EV has received grants and served as consultant, advisor or CME speaker for the following entities: AB-Biotics, AbbVie, Adamed, Angelini, Biogen, Boehringer-Ingelheim, Celon Pharma, Dainippon Sumitomo Pharma, Ferrer, Gedeon Richter, GH Research, Glaxo-Smith Kline, Janssen, Lundbeck, Merck, Novartis, Orion Corporation, Organon, Otsuka, Rovi, Sage, Sanofi-Aventis, Sunovion, Takeda, and Viatris, outside the submitted work.

Figures

Fig. 1
Fig. 1
Graphical representation of the estimated network model. Pink nodes represent depressive symptoms measured with the PHQ-8 scale, the green node represents anxiety symptoms measured with the GAD-7 scale, and the blue node represents the trauma symptoms measured with the PCL-5 scale. The yellow node represents suicidal behavior measured with the C-SSRS. Orange and light blue nodes represent respectively resilience and social support data measured with the CD-RISC and OSSS-3 scales. Blue links indicate positive effects and red links negative effects (SOC SUPP - GUILT and RESIL - ANH). The edge thickness represents the strength of the association between symptom nodes. Abbreviations: GAD-7 total score, ANX: anxiety; PHQ-8 items: DEP: “sad mood”; ANH: “anhedonia”; ENERGY: “energy”; COG: “concentration”; GUIL: “guilty”; MOTOR: “motor”; APPET: “appetite”; SLEEP: “sleep”; TRAUMA: Trauma; CD-RISC total score, RESIL: “resilience”; OSSS-3 total score, SOC SUPP: “Social Support”; C-SSRS score, SUIC: suicidal behavior. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 2
Fig. 2
Centrality Plots for EBICglasso network depicting the expected influence, betweenness and closeness of each node (variable). Abbreviations: GAD-7 total score, ANX: anxiety; PHQ-8 items, DEP: “sad mood”; ANH: “anhedonia”; ENERGY: “energy”; TRAUMA: Trauma; COG: “concentration”; GUIL: “guilty”; MOTOR: “motor”; APPET: “appetite”; SLEEP: “sleep”; CD-RISC total score, RESIL: “resilience”; OSSS-3 total score, SOC SUPP: “Social Support”; C-SSRS score, SUIC: suicidal behavior.
See this image and copyright information in PMC

References

    1. Bai W., Zhao Y.-J., Cai H., Sha S., Zhang Q., Lei S.-M., Lok G.K.I., Chow I.H.I., Cheung T., Su Z., Jackson T., Xiang Y.-T. Network analysis of depression, anxiety, insomnia and quality of life among Macau residents during the COVID-19 pandemic. J. Affect. Disord. 2022;311:181–188. doi: 10.1016/J.JAD.2022.05.061. - DOI - PMC - PubMed
    1. Belz M., Hessmann P., Vogelgsang J., Schmidt U., Ruhleder M., Signerski-Krieger J., Radenbach K., Trost S., Schott B.H., Wiltfang J., Wolff-Menzler C., Bartels C. Evolution of psychosocial burden and psychiatric symptoms in patients with psychiatric disorders during the Covid-19 pandemic. Eur. Arch. Psychiatry Clin. Neurosci. 2022;272:29–40. doi: 10.1007/S00406-021-01268-6/FIGURES/2. - DOI - PMC - PubMed
    1. Borsboom D., Cramer A.O.J. 2013. Network Analysis: An Integrative Approach to the Structure of Psychopathology. - DOI - PubMed
    1. Borsboom D., Deserno M.K., Rhemtulla M., Epskamp S., Fried E.I., McNally R.J., Robinaugh D.J., Perugini M., Dalege J., Costantini G., Isvoranu A.M., Wysocki A.C., van Borkulo C.D., van Bork R., Waldorp L.J. Network analysis of multivariate data in psychological science. Nat. Rev. Methods Prim. 2021;1:1–18. doi: 10.1038/s43586-021-00055-w. 2021 1:1. - DOI
    1. Bovin M.J., Marx B.P., Weathers F.W., Gallagher M.W., Rodriguez P., Schnurr P.P., Keane T.M. Psychometric properties of the PTSD checklist for diagnostic and statistical manual of mental disorders-fifth edition (PCL-5) in veterans. Psychol. Assess. 2016;28:1379–1391. doi: 10.1037/PAS0000254. - DOI - PubMed

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