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

References

• Pappa S, Ntella V, Giannakas T, et al. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Brain Behav Immun. 2020;88:901–907. doi:10.1016/j.bbi.2020.05.026
   PubMed Web of Science ®Google Scholar
• da Silva ML, Rocha RSB, Buheji M, et al. A systematic review of the prevalence of anxiety symptoms during coronavirus epidemics. J Health Psychol. 2021;26(1):115–125. doi:10.1177/1359105320951620
   PubMed Web of Science ®Google Scholar
• Al Maqbali M, Al Sinani M, Al-Lenjawi B. Prevalence of stress, depression, anxiety and sleep disturbance among nurses during the COVID-19 pandemic: a systematic review and meta-analysis. J Psychosom Res. 2021;141:110343. doi:10.1016/j.jpsychores.2020.110343
   PubMed Web of Science ®Google Scholar
• Jahrami H, BaHammam AS, Bragazzi NL, et al. Sleep problems during the COVID-19 pandemic by population: a systematic review and meta-analysis. J Clin Sleep Med. 2021;17(2):299–313. doi:10.5664/jcsm.8930
   PubMed Web of Science ®Google Scholar
• Zhang C, Yang L, Liu S, et al. Survey of insomnia and related social psychological factors among medical staff involved in the 2019 novel coronavirus disease outbreak. Front Psychiatry. 2020;11:306. doi:10.3389/fpsyt.2020.00306
   PubMed Web of Science ®Google Scholar
• Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020;3(3):e203976. doi:10.1001/jamanetworkopen.2020.3976
   PubMed Web of Science ®Google Scholar
• Jahrami HA, Alhaj OA, Humood AM, et al. Sleep disturbances during the COVID-19 pandemic: a systematic review, meta-analysis, and meta-regression. Sleep Med Rev. 2022;62:101591. doi:10.1016/j.smrv.2022.101591
   PubMed Web of Science ®Google Scholar
• Zhang SX, Chen RZ, Xu W, et al. A systematic review and meta-analysis of symptoms of anxiety, depression, and insomnia in Spain in the COVID-19 crisis. Int J Environ Res Public Health. 2022;19(2):1018. doi:10.3390/ijerph19021018
   PubMed Web of Science ®Google Scholar
• Johnson EO, Roth T, Breslau N. The association of insomnia with anxiety disorders and depression: exploration of the direction of risk. J Psychiatr Res. 2006;40(8):700–708. doi:10.1016/j.jpsychires.2006.07.008
   PubMed Web of Science ®Google Scholar
• Alvaro PK, Roberts RM, Harris JK. A systematic review assessing bidirectionality between sleep disturbances, anxiety, and depression. Sleep. 2013;36(7):1059–1068. doi:10.5665/sleep.2810
   PubMed Web of Science ®Google Scholar
• Murphy M, Peterson MJ. Sleep disturbances in depression. Sleep Med Clin. 2015;10(1):17. doi:10.1016/j.jsmc.2014.11.009
   PubMed Web of Science ®Google Scholar
• Alimoradi Z, Broström A, Tsang HWH, et al. Sleep problems during COVID-19 pandemic and its’ association to psychological distress: a systematic review and meta-analysis. EClinicalMedicine. 2021;36:100916. doi:10.1016/j.eclinm.2021.100916
   PubMedGoogle Scholar
• Baglioni C, Spiegelhalder K, Lombardo C, et al. Sleep and emotions: a focus on insomnia. Sleep Med Rev. 2010;14(4):227–238. doi:10.1016/j.smrv.2009.10.007
   PubMed Web of Science ®Google Scholar
• McNally RJ, Robinaugh DJ, Wu GWY, et al. Mental disorders as causal systems: a network approach to posttraumatic stress disorder. Clin Psychol Sci. 2015;3(6):836–849. doi:10.1177/2167702614553230
   Web of Science ®Google Scholar
• Osborn TL, Campbell S, Ndetei D, Weisz J. Network analysis reveals central symptoms of adolescent depression and anxiety in sub-Saharan Africa. 2020.
   Google Scholar
• Cai H, Bai W, Liu H, et al. Network analysis of depressive and anxiety symptoms in adolescents during the later stage of the COVID-19 pandemic. Transl Psychiatry. 2022;12(1):1–8. doi:10.1038/s41398-022-01838-9
   PubMed Web of Science ®Google Scholar
• Zavlis O, Butter S, Bennett K, et al. How does the COVID-19 pandemic impact on population mental health? A network analysis of COVID influences on depression, anxiety and traumatic stress in the UK population. Psychol Med. 2021;1–9. doi:10.1017/S0033291721000635
   PubMed Web of Science ®Google Scholar
• Ren L, Wang Y, Wu L, et al. Network structure of depression and anxiety symptoms in Chinese female nursing students. BMC Psychiatry. 2021;21(1):1–12. doi:10.1186/s12888-021-03276-1
   PubMed Web of Science ®Google Scholar
• Zhao N, Li W, Zhang S-F, et al. Network analysis of depressive symptoms among residents of Wuhan in the later stage of the CoViD-19 pandemic. Front Psychiatry. 2021;12. doi:10.3389/fpsyt.2021.735973
   Web of Science ®Google Scholar
• Beard C, Millner AJ, Forgeard MJC, et al. Network analysis of depression and anxiety symptom relationships in a psychiatric sample. Psychol Med. 2016;46(16):3359–3369. doi:10.1017/S0033291716002300
   PubMed Web of Science ®Google Scholar
• Fried EI, Epskamp S, Nesse RM, et al. What are’good’depression symptoms? Comparing the centrality of DSM and non-DSM symptoms of depression in a network analysis. J Affect Disord. 2016;189:314–320. doi:10.1016/j.jad.2015.09.005
   PubMed Web of Science ®Google Scholar
• Park S-C, Kim D. The centrality of depression and anxiety symptoms in major depressive disorder determined using a network analysis. J Affect Disord. 2020;271:19–26. doi:10.1016/j.jad.2020.03.078
   PubMed Web of Science ®Google Scholar
• Price M, Legrand AC, Brier ZMF, et al. The symptoms at the center: examining the comorbidity of posttraumatic stress disorder, generalized anxiety disorder, and depression with network analysis. J Psychiatr Res. 2019;109:52–58. doi:10.1016/j.jpsychires.2018.11.016
   PubMed Web of Science ®Google Scholar
• Jones PJ, Mair P, Riemann BC, et al. A network perspective on comorbid depression in adolescents with obsessive-compulsive disorder. J Anxiety Disord. 2018;53:1–8. doi:10.1016/j.janxdis.2017.09.008
   PubMed Web of Science ®Google Scholar
• Wang S, Sit HF, Garabiles MR, et al. A network analysis investigation of the comorbidity between sleep dysfunction and PTSD symptomatology among Filipino domestic workers in Macao (SAR) China. J Psychiatr Res. 2021;140:337–345. doi:10.1016/j.jpsychires.2021.05.040
   PubMed Web of Science ®Google Scholar
• Kaiser T, Herzog P, Voderholzer U, et al. Unraveling the comorbidity of depression and anxiety in a large inpatient sample: network analysis to examine bridge symptoms. Depress Anxiety. 2021;38(3):307–317. doi:10.1002/da.23136
   PubMed Web of Science ®Google Scholar
• Spoormaker VI, van den Bout J. Depression and anxiety complaints; relations with sleep disturbances. Eur Psychiatry. 2005;20(3):243–245. doi:10.1016/j.eurpsy.2004.11.006
   PubMed Web of Science ®Google Scholar
• Barthel AL, Pinaire MA, Curtiss JE, et al. Anhedonia is central for the association between quality of life, metacognition, sleep, and affective symptoms in generalized anxiety disorder: a complex network analysis. J Affect Disord. 2020;277:1013–1021. doi:10.1016/j.jad.2020.08.077
   PubMed Web of Science ®Google Scholar
• Robinaugh DJ, Hoekstra RHA, Toner ER, et al. The network approach to psychopathology: a review of the literature 2008–2018 and an agenda for future research. Psychol Med. 2020;50(3):353–366. doi:10.1017/S0033291719003404
   PubMed Web of Science ®Google Scholar
• Sun D, Yang D, Li Y, et al. Psychological impact of 2019 novel coronavirus (2019-nCoV) outbreak in health workers in China. Epidemiol Infect. 2020;148:e96. doi:10.1017/S0950268820001090
   PubMed Web of Science ®Google Scholar
• Wu W, Zhang Y, Wang P, et al. Psychological stress of medical staffs during outbreak of COVID-19 and adjustment strategy. J Med Virol. 2020;92(10):1962–1970. doi:10.1002/jmv.25914
   PubMed Web of Science ®Google Scholar
• Kroenke K, Spitzer RL, Williams JBW, et al. The patient health questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. Gen Hosp Psychiatry. 2010;32(4):345–359. doi:10.1016/j.genhosppsych.2010.03.006
   PubMed Web of Science ®Google Scholar
• World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. J Am Coll Dent. 2014;81(3):14–18.
   PubMedGoogle Scholar
• Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613. doi:10.1046/j.1525-1497.2001.016009606.x
   PubMed Web of Science ®Google Scholar
• Zhang YL, Liang W, Chen Z-M, et al. Validity and reliability of Patient Health Questionnaire-9 and Patient Health Questionnaire-2 to screen for depression among college students in China. Asia Pac Psychiatry. 2013;5(4):268–275. doi:10.1111/appy.12103
   PubMed Web of Science ®Google Scholar
• Spitzer RL, Kroenke K, Williams JBW, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–1097. doi:10.1001/archinte.166.10.1092
   PubMed Web of Science ®Google Scholar
• He XY, Li CB, Qian J, Cui HS, Wu WY. Reliability and validity of a generalized anxiety disorder scale in general hospital outpatients (in Chinese). Shanghai Archiv Psychiatry. 2010;22(4):200–203.
   Google Scholar
• Bastien C. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2(4):297–307. doi:10.1016/S1389-9457(00)00065-4
   PubMed Web of Science ®Google Scholar
• Bai JD, Chen LX, Li L, Wang CX. Reliability and validity of Insomnia Severity Index in clinical insomnia patients(in Chinese). Chin J Pract Nurs. 2018;34(28):2182–2186.
   Google Scholar
• Smith MT, Wegener ST. Measures of sleep: the Insomnia Severity Index, Medical Outcomes Study (MOS) Sleep Scale, Pittsburgh Sleep Diary (PSD), and Pittsburgh Sleep Quality Index (PSQI). Arthritis Rheum. 2003;49(S5):S184–S196. doi:10.1002/art.11409
   Google Scholar
• Skevington SM, Lotfy M, O’Connell KA, et al. The World Health Organization’s WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res. 2004;13(2):299–310. doi:10.1023/B:QURE.0000018486.91360.00
   PubMed Web of Science ®Google Scholar
• Cheung YB, Yeo KK, Chong KJ, et al. Measurement equivalence of the English, Chinese and Malay versions of the World Health Organization quality of life (WHOQOL-BREF) questionnaires. Health Qual Life Outcomes. 2019;17(1):67. doi:10.1186/s12955-019-1130-0
   PubMed Web of Science ®Google Scholar
• R Core Team. R: a language and environment for statistical computing; 2020. Available from: https://www.R-project.org/. Accessed July 20, 2022.
   Google Scholar
• Epskamp S, Borsboom D, Fried EI. Estimating psychological networks and their accuracy: a tutorial paper. Behav Res Methods. 2018;50(1):195–212. doi:10.3758/s13428-017-0862-1
   PubMed Web of Science ®Google Scholar
• Robinaugh DJ, Millner AJ, McNally RJ. Identifying highly influential nodes in the complicated grief network. J Abnorm Psychol. 2016;125(6):747. doi:10.1037/abn0000181
   PubMed Web of Science ®Google Scholar
• Cramer AOJ, Waldorp LJ, van der Maas HLJ, et al. Complex realities require complex theories: refining and extending the network approach to mental disorders. Behav Brain Sci. 2010;33(2–3):178–193. doi:10.1017/S0140525X10000920
   Web of Science ®Google Scholar
• Payton J. Tools for identifying important nodes in networks; 2020. Available from: https://cran.r-project.org/web/packages/networktools/index.html. Accessed July 20, 2022.
   Google Scholar
• Jones PJ, Ma R, McNally RJ. Bridge centrality: a network approach to understanding comorbidity. Multivariate Behav Res. 2019;2019:1–15.
   Google Scholar
• Haslbeck JMB, Waldorp LJ. mgm: estimating time-varying mixed graphical models in high-dimensional data. J Stat Softw. 2020;1(8). doi:10.18637/jss.v093.i08
   Web of Science ®Google Scholar
• Zhang WR, Wang K, Yin L, et al. Mental health and psychosocial problems of medical health workers during the COVID-19 epidemic in China. Psychother Psychosom. 2020;89(4):242–250. doi:10.1159/000507639
   PubMed Web of Science ®Google Scholar
• van Borkulo CD, van Bork R, Boschloo L, et al. Comparing network structures on three aspects: a permutation test. 2017.
   Google Scholar
• Cai Q, Feng H, Huang J, et al. The mental health of frontline and non-frontline medical workers during the coronavirus disease 2019 (COVID-19) outbreak in China: a case-control study. J Affect Disord. 2020;275:210–215. doi:10.1016/j.jad.2020.06.031
   PubMed Web of Science ®Google Scholar
• Chew NWS, Lee GKH, Tan BYQ, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun. 2020;88:559–565. doi:10.1016/j.bbi.2020.04.049
   PubMed Web of Science ®Google Scholar
• Beck AT. The evolution of the cognitive model of depression and its neurobiological correlates. Am J Psychiatry. 2008;165(8):969–977. doi:10.1176/appi.ajp.2008.08050721
   PubMed Web of Science ®Google Scholar
• Shekleton JA, Flynn-Evans EE, Miller B, et al. Neurobehavioral performance impairment in insomnia: relationships with self-reported sleep and daytime functioning. Sleep. 2014;37(1):107–116. doi:10.5665/sleep.3318
   PubMed Web of Science ®Google Scholar
• Altena E, Vrenken H, Van Der Werf YD, et al. Reduced orbitofrontal and parietal gray matter in chronic insomnia: a voxel-based morphometric study. Biol Psychiatry. 2010;67(2):182–185. doi:10.1016/j.biopsych.2009.08.003
   PubMed Web of Science ®Google Scholar
• Kline C. Sleep quality. Encyclopedia Behav Med. 2013;2013:1811–1813.
   Google Scholar
• Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey. Psychiatry Res. 2020;288:112954. doi:10.1016/j.psychres.2020.112954
   PubMed Web of Science ®Google Scholar
• Peterson MJ, Benca RM. Sleep in mood disorders. Sleep Med Clin. 2008;3(2):231–249. doi:10.1016/j.jsmc.2008.01.009
   Google Scholar
• Bos SC, Macedo AF. Literature review on insomnia (2010–2016). Biol Rhythm Res. 2019;50(1):94–163. doi:10.1080/09291016.2017.1413766
   Web of Science ®Google Scholar
• Baldwin DS, Papakostas GI. Symptoms of fatigue and sleepiness in major depressive disorder. J Clin Psychiatry. 2006;67:6.
   Web of Science ®Google Scholar
• Stahl SM, Zhang L, Damatarca C, Grady M. Brain circuits determine destiny in depression: a novel approach to the psychopharmacology of wakefulness, fatigue, and executive dysfunction in major depressive disorder. J Clin Psychiatry. 2003;64:6–17.
   Web of Science ®Google Scholar
• Demyttenaere K, De Fruyt J, Stahl SM. The many faces of fatigue in major depressive disorder. Int J Neuropsychopharmacol. 2005;8(1):93–105. doi:10.1017/S1461145704004729
   PubMed Web of Science ®Google Scholar
• Ferguson M, Dennehy EB, Marangell LB, et al. Impact of fatigue on outcome of selective serotonin reuptake inhibitor treatment: secondary analysis of STAR* D. Curr Med Res Opin. 2014;30(10):2109–2118. doi:10.1185/03007995.2014.936553
   PubMed Web of Science ®Google Scholar
• Sahebi A, Abdi K, Moayedi S, et al. The prevalence of insomnia among health care workers amid the COVID-19 pandemic: an umbrella review of meta-analyses. J Psychosom Res. 2021;149:110597. doi:10.1016/j.jpsychores.2021.110597
   PubMed Web of Science ®Google Scholar
• Sahebi A, Nejati-Zarnaqi B, Moayedi S, et al. The prevalence of anxiety and depression among healthcare workers during the COVID-19 pandemic: an umbrella review of meta-analyses. Prog Neuropsychopharmacol Biol Psychiatry. 2021;107:110247. doi:10.1016/j.pnpbp.2021.110247
   PubMed Web of Science ®Google Scholar
• Folkman S, Greer S. Promoting psychological well‐being in the face of serious illness: when theory, research and practice inform each other. Soc Behav Dimensions Cancer. 2000;9(1):11–19.
   Google Scholar
• Xiang Y-T, Yang Y, Li W, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry. 2020;7(3):228–229. doi:10.1016/S2215-0366(20)30046-8
   PubMed Web of Science ®Google Scholar
• Jimenez AL, Della CD, Arcenas AMA, et al. Examining the competency of Filipino mental health professionals in psychodynamic psychotherapy. Asia-Pacific Psychiatry. 2021;13(1):e12441. doi:10.1111/appy.12441
   PubMed Web of Science ®Google Scholar
• Orsolini L, Jatchavala C, Noor IM, et al. Training and education in digital psychiatry: a perspective from Asia-Pacific region. Asia-Pacific Psychiatry. 2021;13(4):e12501. doi:10.1111/appy.12501
   PubMed Web of Science ®Google Scholar
• Riemann D, Baglioni C, Bassetti C, et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017;26(6):675–700. doi:10.1111/jsr.12594
   PubMed Web of Science ®Google Scholar
• Rawtaer I, Mahendran R, Chan HY, et al. A nonpharmacological approach to improve sleep quality in older adults. Asia-Pacific Psychiatry. 2018;10(2):e12301. doi:10.1111/appy.12301
   PubMed Web of Science ®Google Scholar
• Caruso CC, Arbour MW, Berger AM, et al. Research priorities to reduce risks from work hours and fatigue in the healthcare and social assistance sector. Am J Ind Med. 2022. doi:10.1002/ajim.23363
   PubMed Web of Science ®Google Scholar
• Chen W-C, Chen S-J, Zhong B-L. Sense of alienation and its associations with depressive symptoms and poor sleep quality in older adults who experienced the lockdown in Wuhan, China, during the COVID-19 pandemic. J Geriatr Psychiatry Neurol. 2022;35:215–222.
   PubMed Web of Science ®Google Scholar
• Ismail M, Lee KY, Sutrisno Tanjung A, et al. The prevalence of psychological distress and its association with coping strategies among medical interns in Malaysia: a national-level cross-sectional study. Asia-Pacific Psychiatry. 2021;13(2):e12417. doi:10.1111/appy.12417
   Web of Science ®Google Scholar