Network Analysis of Comorbid Anxiety and Insomnia Among Clinicians with Depressive Symptoms During the Late Stage of the COVID-19 Pandemic: A Cross-Sectional Study

Aug 12, 2022Nature and science of sleep

How Anxiety and Insomnia Are Connected in Clinicians with Depression Late in the COVID-19 Pandemic

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Abstract

Of 1729 clinicians studied, 76.8% experienced comorbid anxiety symptoms during the late stage of the COVID-19 pandemic.

The mean total scores were 8.42 for depressive symptoms, 6.45 for anxiety symptoms, and 8.23 for insomnia symptoms.
Comorbid insomnia symptoms were present in 43.8% of the clinicians.
The most influential symptoms identified were 'Interference with daytime functioning,' 'Sleep dissatisfaction,' and 'Noticeability of sleep problem by others.'
Key bridge symptoms included 'Sleep' and 'Fatigue,' which connect anxiety and insomnia with depressive symptoms.
The experience of caring for COVID-19 patients significantly influenced the network structure of symptoms.

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BACKGROUND: A high proportion of clinicians experienced common anxiety, insomnia and depression during the COVID-19 pandemic. This study examined the item-level association of comorbid anxiety and insomnia symptoms among clinicians who suffered from depressive symptoms during the late stage of the COVID-19 pandemic using (NA).

METHODS: Clinicians with depressive symptoms (with a Patients Health Questionnaire (PHQ-9) total score of 5 and above) were included in this study. Anxiety and insomnia symptoms were measured using the Generalized Anxiety Disorder Scale - 7-item (GAD-7) and Insomnia Severity Index (ISI), respectively. Network analysis was conducted to investigate the network structure, central symptoms, bridge symptoms, and network stability of these disturbances. Expected influence (EI) was used to measure the centrality of index.

RESULTS: Altogether, 1729 clinicians were included in this study. The mean age was 37.1 [standard deviation (SD)=8.04 years], while the mean PHQ-9 total score was 8.42 (SD=3.33), mean GAD-7 total score was 6.45 (SD=3.13) and mean ISI total score was 8.23 (SD=5.26). Of these clinicians, the prevalence of comorbid anxiety symptoms (GAD-7≥5) was 76.8% (95% CI 74.82-78.80%), while the prevalence of comorbid insomnia symptoms (ISI≥8) was 43.8% (95% CI: 41.50-46.18%). NA revealed that nodes ISI7 ("Interference with daytime functioning") (EI=1.18), ISI4 ("Sleep dissatisfaction") (EI=1.08) and ISI5 ("Noticeability of sleep problem by others") (EI=1.07) were the most central (influential) symptoms in the network model of comorbid anxiety and insomnia symptoms in clinicians. Bridge symptoms included nodes PHQ3 ("Sleep") (bridge EI=0.55) and PHQ4 ("Fatigue") (bridge EI=0.49). Gender did not significantly influence the network structure, but "having the experience of caring for COVID-19 patients" significantly influenced the network structure.

CONCLUSION: Central symptoms and key bridge symptoms identified in this NA should be targeted in the treatment and preventive measures for clinicians suffering from comorbid anxiety, insomnia and depressive symptoms during the late stage of the COVID-19 pandemic.

Key numbers

76.8%

Prevalence of Comorbid Anxiety Symptoms

Among clinicians with depressive symptoms.

43.8%

Prevalence of Comorbid Insomnia Symptoms

Among clinicians with depressive symptoms.

37.1

Mean Age of Participants

Of the 1729 clinicians included.

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Network Analysis of Comorbid Anxiety and Insomnia Among Clinicians with Depressive Symptoms During the Late Stage of the COVID-19 Pandemic: A Cross-Sectional Study

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