Central Symptoms of Insomnia in Relation to Depression and COVID-19 Anxiety in General Population: A Network Analysis

Abstract

Background: Insomnia is prevalent among the general population, and studies have shown an increase in insomnia symptoms during the novel coronavirus (COVID-19) pandemic. Despite numerous studies of insomnia, few studies have investigated insomnia symptoms in detail. In this study, we used network analysis to investigate interactions between insomnia symptoms in the general population. Furthermore, given the effect of COVID-19 on mental health, we also investigated how anxiety response to COVID-19 and depression related to insomnia symptoms. Methods: Data from 785 non-infected participants were used. The Insomnia Severity Index (ISI), Stress and Anxiety to Viral Epidemics—6 Scale (SAVE-6), and Patient Health Questionnaire—9 (PHQ-9) were used to measure insomnia symptoms, anxiety response to COVID-19, and depression, respectively. Network analysis was performed using R Studio. Centrality indices and edge weights were obtained, and each index was evaluated using bootstrapping methods. Results: The network revealed ISI7 (worry about current sleep pattern) to be the most central insomnia symptom. ISI7 was strongly connected to SAVE-6 total score, and ISI2 (difficulty staying asleep) was strongly connected to PHQ-9 total score. Conclusion: High centrality of ISI7 supports the role of dysfunctional cognitions in etiological models of insomnia and thus the cognitive behavioral therapy for insomnia. The relationship between ISI7 and SAVE-6 is explained by transposition of worry and fear of contracting COVID-19 to worry about sleep patterns. The link between ISI2 and PHQ-9 necessitate further investigations of whether specific symptoms of insomnia are more associated with depression.

The Inter-Relationships Between Depressive Symptoms and Suicidality Among Macau Residents After the “Relatively Static Management” COVID-19 Strategy: A Perspective of Network Analysis

“…134 Moreover, concern about current sleeping patterns was the central symptom of depression and insomnia network among the Korean general population during the COVID 19 pandemic. 135 In this study, "SI", "SP" and "Fatigue" were identified as central symptoms in the depression and suicidality network mode, which are the most influential symptoms that could be targeted in treatment. 40 Thus, early screening and treatment that target SI and SP, as well as those that address lack of energy, should be prioritized for Macau residents in need.…”

“… 134 Moreover, concern about current sleeping patterns was the central symptom of depression and insomnia network among the Korean general population during the COVID 19 pandemic. 135 …”

Machine Learning and Bayesian Network Analyses Identifies Psychiatric Disorders and Symptom Associations with Insomnia in a national sample of 31,285 Treatment-Seeking College Students

“…Extant studies include examining insomnia's network structure itself [18][19][20][21][22][23][24] but also the relationships between single disorders, such as major depressive disorder (MDD) [25][26][27][28], post-traumatic stress disorder (PTSD) [29], psychosis [30], and schizophrenia [31], or between transdiagnostic factors, such as hyperarousal [32] or personality traits [33]. However, cross-sectional networks have also been developed between insomnia and multiple disorders, most commonly between MDD and generalized anxiety disorder (GAD) [11,[34][35][36][37][38][39] or with the further addition of PTSD [40], but also between prolonged grief disorder (PGD) and PTSD [41]. Most studies utilized the Graphical Gaussian Model (GGM), in other words, an undirected network of partial correlation coe cients, along with the graphical LASSO (Least Absolute Shrinkage and Selection Operator [42]), as a regularization technique to avoid spurious, false-positive edges.…”

Prevalence of insomnia and its association with quality of life in caregivers of psychiatric inpatients during the COVID-19 pandemic: a network analysis

“…To date, network analysis of insomnia symptoms has already been applied to general populations [26,27] and mental health professionals [28]. However, no network analysis studies on insomnia symptoms among caregivers of psychiatric inpatients have been published.…”