Network analysis of anxiety and depressive symptoms among nursing students during the COVID-19 pandemic

Aug 10, 2021Journal of affective disorders

How Anxiety and Depression Symptoms Are Connected in Nursing Students During COVID-19

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Abstract

A total of 932 nursing students were included in the analysis of anxiety and depressive symptoms during the COVID-19 pandemic.

Irritability, Uncontrollable worry, Trouble relaxing, and Depressed mood were identified as the most central symptoms in the anxiety-depression network.
Three bridge symptoms—Depressed mood, Nervousness, and Anhedonia—were also recognized, indicating connections between anxiety and depression.
No associations were found between gender or region of residence and the overall strength or distribution of symptoms in the network.
The study's cross-sectional design limits the ability to infer causal relationships or changes in symptoms over time.

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BACKGROUND: The 2019 coronavirus disease (COVID-19) pandemic has impacted the mental health and well-being of medical personnel, including nursing students. Network analysis provides a deeper characterization of symptom-symptom interactions in mental disorders. The aim of this study was to elucidate characteristics of anxiety and depressive symptom networks of Chinese nursing students during the COVID-19 pandemic.

METHOD: A total of 932 nursing students were included. Anxiety and depressive symptom were measured using the seven-item Generalized Anxiety Disorder Scale (GAD-7) and two-item Patient Health Questionnaire (PHQ-2), respectively. Central symptoms and bridge symptoms were identified via centrality indices and bridge centrality indices, respectively. Network stability was examined using the case-dropping procedure.

RESULTS: Irritability, Uncontrollable worry, Trouble relaxing, and Depressed mood had the highest centrality values. Three bridge symptoms (Depressed mood, Nervousness, and Anhedonia) were also identified. Neither gender nor region of residence was associated with network global strength, distribution of edge weights or individual edge weights.

LIMITATIONS: Data were collected in a cross-sectional study design, therefore, causal relations and dynamic changes between anxiety and depressive symptoms over time could not be inferred. Generalizability of findings may be limited to Chinese nursing students during a particular phase of the current pandemic.

CONCLUSIONS: Irritability, Uncontrollable worry, Trouble relaxing, and Depressed mood constituted central symptoms maintaining the anxiety-depression network structure of Chinese nursing students during the pandemic. Timely, systemic multi-level interventions targeting central symptoms and bridge symptoms may be effective in alleviating co-occurring experiences of anxiety and depression in this population.

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Network analysis of anxiety and depressive symptoms among nursing students during the COVID-19 pandemic

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