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. 2024 Apr 20:14:20451253241243292.
doi: 10.1177/20451253241243292. eCollection 2024.

Network analysis of the comorbidity between post-traumatic stress, depression and anxiety symptoms among frontline healthcare workers during the COVID-19 pandemic

Hui Ouyang  1   2 , Lili Wu  1   2 , Wenjie Yan  1   2 , Keyi Si  3 , Hongli Lv  4 , Jingye Zhan  1   2 , Jing Wang  1   2 , Yanpu Jia  1   2 , Zhilei Shang  1   2 , Wenfang Chen  5 , Weizhi Liu  6   2
Affiliations

Network analysis of the comorbidity between post-traumatic stress, depression and anxiety symptoms among frontline healthcare workers during the COVID-19 pandemic

Hui Ouyang et al. Ther Adv Psychopharmacol. .

Abstract

Background: Coronavirus disease 2019 pandemic pointed out significant mental symptoms of frontline healthcare workers (HCWs).

Objective: We aimed to estimate the prevalence and comorbidity of post-traumatic stress symptoms (PTSS), depression and anxiety symptoms in HCWs from Fangcang shelter hospitals during the pandemic.

Design: Demographic information, post-traumatic stress disorder checklist for DSM-5 (PCL-5), Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Questionnaire (GAD-7) were obtained online based on stratified random sampling design during April 2022, with 284 eligible responses.

Method: Hierarchical regression analyses were applied to investigate independent variables associated with psychological status outcomes (PHQ-9, GAD-7 and PCL-5), and the network analyses were applied to explore the comorbidity using all items of PCL-5, PHQ-9 and GAD-7.

Results: (1) 10.56%, 13.03% and 8.10% of HCWs reported PTSS, depression and anxiety symptoms. Fifty-three (18.66%) HCWs experienced at least one mental health disorder, among which 26.42-37.74% HCWs had comorbidity of two or three mental disorders; (2) several influence factors of mental health were identified, including medical professions, working hours, contacted patients (p < 0.05); (3) prominent bridge symptoms between PTSS and depression were sleep problems, suicide ideation, concentration difficulties and recklessness. Comorbidity between PTSS and anxiety was thought to mainly stem from negative affect, such as afraid, anxious, annoyed and worrying. Depressed mood and worry might be good targets during treatment of comorbidity of depression and anxiety.

Conclusion: Our data suggest mild level of PTSS, depression and anxiety symptoms among HCWs during the pandemic and might give novel insights into assessment and intervention of comorbidity.

Keywords: COVID-19; anxiety; depression; healthcare workers; post-traumatic stress symptoms.

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Conflict of interest statement

The authors declare that there is no conflict of interest. The data that support the findings of this study are available on request from the corresponding author upon reasonable request.

Figures

Figure 1.
Figure 1.
Flowchart of the enrolment of participants from Fangcang shelter hospital during the Omicron outbreak in Shanghai.
Figure 2.
Figure 2.
Network structure of PTSS, depression and anxiety (a), and the centrality index of the network structure (b). The items of PTSS, depression and anxiety were labelled in black, grey and white, respectively. Thickness of connection lines represented the edge weight. The positive and negative connections were marked by solid lines and dashed lines, respectively. PTSS, post-traumatic stress symptom.
Figure 3.
Figure 3.
Network analyses between PTSD and depression (a), PTSD and anxiety (c), depression and anxiety (e). The network structure was on the left, the bridge strength was on the right. The items of PTSS, depression and anxiety were labelled in black, grey and white, respectively. Thickness of connection lines represented the edge weight. The positive and negative connections were marked by solid lines and dashed lines, respectively. See Figure 2 for the full name of each node. PTSD, post-traumatic stress disorder; PTSS, post-traumatic stress symptoms.
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