A sample of 1,049 patients identified 'Anxiousness' as the most central symptom in .
'Anxiousness' (EI = 2.39) was found to be the most influential symptom, followed by 'Fear' (EI = 2.30) and 'Panic' (EI = 2.15).
The symptom 'Interest loss' (EI = 1.21) was also noted as significant in the symptom network.
Key transdiagnostic links were identified, including 'Daily dysfunction' (bridge EI = 1.56) and 'Sleep efficiency' (bridge EI = 1.47).
The analysis did not reveal significant gender-based differences in the overall symptom network structure.
This research highlights the interconnectedness of depressive, anxiety, and sleep symptoms in individuals with subthreshold depression.
Simplified
BACKGROUND: (SD) represents a critical public health concern, marked by clinically significant depressive symptoms below the diagnostic threshold for major depressive disorder. Despite frequent comorbidity with anxiety and insomnia, the symptom-level interactions remain poorly understood. offers a novel framework to examine these dynamic relationships and identify central symptoms that may drive SD's psychopathology. We hypothesize that the symptom network of SD may exhibit specific patterns of interconnectivity, with certain central and bridge symptoms potentially playing a key role in the development and maintenance of the disorder.
METHODS: This study included a sample of 1,049 patients with SD. Zung Self-Rating Depression Scale (SDS), Zung Self-Rating Anxiety Scale (SAS), and Pittsburgh Sleep Quality Index (PSQI) were used to assess depression, anxiety and insomnia symptoms, respectively. Network analysis was used to estimate the symptom network, with centrality (expected influence, EI) and bridge symptoms (bridge EI) calculated to identify core and bridge symptoms. Additionally, the Network Comparison Test (NCT) was performed to examine potential gender-based differences.
RESULTS: The results showed that SAS.1 "Anxiousness" emerged as the most central node (EI = 2.39), followed by SAS.2 "Fear" (EI = 2.30), SAS.3 "Panic" (EI = 2.15), and SDS.20 "Interest loss" (EI = 1.21). Bridge analysis identified PSQI.7 "Daily dysfunction" (bridge EI = 1.56) and PSQI.4 "Sleep efficiency" (bridge EI = 1.47) as key transdiagnostic links. Gender did not significantly affect the overall network structure.
CONCLUSION: This network analysis of SD represents the first comprehensive examination of depressive, anxiety, and sleep symptoms simultaneously within this population. The findings identify "Anxiousness", "Fear", "Panic", and "Interest loss" as central symptoms and sleep-related dysfunction as a potential bridge between symptom domains. These symptoms may represent candidate targets for future longitudinal and intervention studies aimed at alleviating the symptom burden of SD.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12888-025-07437-4.
Key numbers
2.39
Centrality of Anxiousness
Expected Influence score for anxiousness in the symptom network.
1,049
Sample Size
Total number of patients diagnosed with .
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Declarations. Ethics approval and consent to participate: This study was executed in compliance with the Declaration of Helsinki and granted ethical approval by the Ethics Committee of the Affiliated Brain Hospital of Guangzhou Medical University (Approval No. AF/SC-07/02.2). Furthermore, the study protocol was registered and approved by the Chinese Clinical Trial Registry (i.e., ChiCTR1900028530 on 26 December, 2019, with URL: https://www.chictr.org.cn ). Written informed consent was obtained from all enrolled participants after comprehensive explanation of the study objectives and procedures. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
