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

Abstract

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 network analysis (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.

Keywords:

• depression
• anxiety
• sleep
• network analysis
• health personnel

Data Sharing Statement

Stringent restrictions apply in making the research dataset and the R codes of the clinical studies publicly available according to the regulation of the ethics committee of the Beijing Anding Hospital, Capital Medical University. Readers and all interested researchers may contact Dr. YT Xiang (Email address: [email protected]) to apply for exemptions from the Beijing Anding Hospital, Capital Medical University if appropriate.

Acknowledgments

We thank the trade union of Beijing Municipal Administration of Hospitals and all staff who supplied this study. Meanwhile, we would like to thank Mr. Changshun Xu, deputy director of Beijing Hospital Authority, Mr. Cunliang Wang, vice chairman of the trade union of Beijing Municipal Administration of Hospitals, and Mr. Yan Li, the trade union of Beijing Municipal Administration of Hospitals for their work to this study.

Author Contributions

All authors made a significant contribution to the work reported: whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; and gave final approval of the version to be published; All authors agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was supported by the Beijing Municipal Administration of Hospitals Incubating Program (PX2018063).