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. 2025 Mar 11;25(1):229.
doi: 10.1186/s12888-025-06637-2.

Using network analysis to identify central symptoms of depression and anxiety in different profiles of infertility patients

Fang Liu #  1   2 , Wei Qiao #  1 , Wenju Han #  3 , Xueming Fan #  4 , Yingbo Chen  1 , Ruonan Lu  1 , Yujie Zhai  1 , Tianci Pan  3 , Xiuxia Yuan  2   5   6 , Xueqin Song  7   8   9 , Dongqing Zhang  10
Affiliations

Using network analysis to identify central symptoms of depression and anxiety in different profiles of infertility patients

Fang Liu et al. BMC Psychiatry. .

Abstract

Background: Depression and anxiety were not only common but also with serious consequence in infertility patients. The current study endeavors to define distinct depression and anxiety profiles of infertility patients and identify central symptoms within different profiles to facilitate targeted interventions.

Method: The research employed K-means Clustering to delineate the depression and anxiety profiles, followed by a repetition of the analysis using Latent Class Analysis (LCA). Furthermore, network analysis was utilized to identify central symptoms within the various profiles.

Result: K‑means Clustering identified Cluster 1 (16.15%), Cluster 2 (37.08%) and Cluster 3 (46.77%), while LCA yielded the low-risk group (47.23%), the mild-risk group (34.46%) and the high-risk group (18.31%). A majority of patients in the three clusters were predominantly in a single LCA-derived patient class (88.38-100%). Network analysis revealed that connections within each symptom in PHQ-9 and GAD-7 were stronger than those between symptoms. Furthermore, PHQ 2 ("sad mood"), GAD 1 ("nervousness") and GAD 2 ("uncontrollable worry") were identified as the central symptoms in Cluster 1 GAD 3 ("excessive worry"), GAD 2 ("uncontrollable worry") and GAD 5 ("restlessness") emerged as the central symptoms in Cluster 2) Additionally, PHQ 4 ("fatigue"), GAD 6 ("irritability") and GAD 3 ("excessive worry") were identified as the central symptoms in Cluster 3.

Conclusions: We defined three distinct depression and anxiety profiles among infertility patients and pinpointed central symptoms within each profile. These findings underscore the importance of directing research towards those central symptoms within each profile in order to develop targeted intervention strategies.

Keywords: Anxiety; Depression; Infertility; K-means clustering; Latent class analysis; Network analysis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Ethical Review Board of Dalian Women and Children’s Medical Group (internal file number: 2024002). All participants gave informed consent to participate and they have the right to refuse and terminate the survey at any time. Moreover, all data were collected anonymously and treated with absolute confidentiality. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Results of K‑means Clustering and LCA. Notes: (a) elbow test; (b) k-means clustering. The variability between each individual pair is evaluated along two principal components, which are the orthogonal axes along which the data have the most variability. (c) latent class analysis; Abbreviations: SSE, sum of squared errors; PHQ-9 symptoms: PHQ 1, anhedonia; PHQ 2, sad mood; PHQ 3, sleep; PHQ 4, fatigue; PHQ 5, appetite; PHQ 6, guilt; PHQ 7, concentration; PHQ 8, motor; PHQ 9, suicide. GAD-7 symptoms: GAD 1, nervousness; GAD 2, uncontrollable worry; GAD 3, excessive worry; GAD 4, trouble relaxing; GAD 5, restlessness; GAD 6, irritability; GAD 7, feeling afraid
Fig. 2
Fig. 2
The overlap of K-means clustering results with LCA results
Fig. 3
Fig. 3
The network structure and EI centrality in three profiles of infertility patients. Notes: (a-c): The network structure of Cluster 1, Cluster 2, and Cluster 3, respectively. The blue circle represents PHQ-9 symptoms, while the yellow one represents GAD-7 symptoms. Blue and red edges reflect positive and negative associations, respectively. (d-f): The EI centrality of Cluster 1, Cluster 2, and Cluster 3, respectively. The y-axis represents each symptom of PHQ-9 and GAD-7. The x-axis represents the node standardization results of EI
See this image and copyright information in PMC

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