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. 2024 Oct 28:15:1485726.
doi: 10.3389/fpsyt.2024.1485726. eCollection 2024.

Interconnected mental health symptoms: network analysis of depression, anxiety, stress, and burnout among psychiatric nurses in the context of the COVID-19 pandemic

Rui Tao #  1   2   3 , Song Wang #  1   2   3 , Qingfang Lu  4 , Yunxiao Liu  1   2   3 , Lei Xia  1   2   3 , Daming Mo  5 , Feng Geng  6 , Tingfang Liu  7 , Yuanli Liu  7 , Feng Jiang  8   9   10   11 , Huan-Zhong Liu  1   2   3   12 , Yi-Lang Tang  13   14
Affiliations

Interconnected mental health symptoms: network analysis of depression, anxiety, stress, and burnout among psychiatric nurses in the context of the COVID-19 pandemic

Rui Tao et al. Front Psychiatry. .

Abstract

Background: Mental health symptoms such as anxiety, depression, stress, and burnout are common among healthcare workers. However, the interconnections among them remain under-explored. This study aimed to address the interrelationships among these symptoms in psychiatric nurses.

Methods: We conducted a nationwide survey in the early stage of the COVID-19 pandemic (January to March 2021) to investigate the interconnectedness of depression, anxiety, stress, and burnout among psychiatric nurses. Using network analysis, we identified central symptoms, important bridge symptoms, and the correlations among these central symptoms.

Results: Of the 9,224 psychiatric nurses (79.2% female) included in the statistical analyses, 27.6% reported clinically significant depression, 31.2% anxiety, 14.5% stress, and 23.8% burnout. Network analysis revealed that stress had the highest expected influence (EI) value (0.920) and the highest strength among all nodes. The node for depression scored the highest in both closeness and betweenness. Emotional exhaustion (EE) had the highest bridge expected influence (BEI) of 0.340, with the strongest intergroup association between EE and depression. No significant differences were found in gender or frontline work experience (all p > 0.05).

Conclusions: Burnout, depression, anxiety, and stress are relatively common among psychiatric nurses in the context of the COVID-19 pandemic. While anxiety was the most prevalent, stress emerged as the core symptom, and depression as an important bridging node. Interventions targeting the core symptoms and bridging nodes may improve the mental health of psychiatric nurses.

Keywords: anxiety; burnout; depression; network analysis; psychiatric nurses; stress.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The network structure between the three subscales in the DASS-21 and MBI-HSS questionnaire. Positive connections are graphically depicted with dark blue lines, while negative connections are shown with dark red lines. The thickness of the edges indicates the strength of the correlation. Nodes with stronger correlation tend to be closer together spatially. DEP, Depression; ANX, Anxiety; STR, Stress; EE, Emotional Exhaustion; DP, Depersonalization; PA, Personal Accomplishment. (A) represents the network structure of the population sample, while (B) represents the network structure of the male sample, and (C) represents the network structure of the female sample.
Figure 2
Figure 2
Accuracy and stability of the network. (A) Accuracy of edges estimation in total sample; (B) Centrality stability was tested using the case-dropping bootstrap method. The horizontal axis represents the proportion of samples participating in the test in relation to the total sample size, while the vertical axis represents the average similarity to the original sample.
Figure 3
Figure 3
The bootstrap edge weights difference test of the node’s strength in the network. The black boxes indicate significant differences in strength between two variables. The grey boxes represent non-significant differences.
See this image and copyright information in PMC

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