Network Analysis of Insomnia in Chinese Mental Health Professionals During the COVID-19 Pandemic: A Cross-Sectional Study

Bai, Wei; Zhao, Yan; An, Feng-Rong; Zhang, Qinge; Sha, Sha; Cheung, Teris; Cheng, Calvin Pak-Wing; Ng, Chee H.; Xiang, Yu‐Tao

doi:10.2147/nss.s326880

Cited by 24 publications

(26 citation statements)

References 53 publications

(77 reference statements)

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“…The central symptoms can also be intervention targets in treating the disorder. While a positive edge between two symptoms represents the co-occurrence between them and a strong edge indicates that both symptoms may be strongly connected, targeting either of them can improve the other symptom ( 15 , 37 ).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Hypomanic Symptoms Between Bipolar I and Bipolar II Disorders: A Network Perspective

et al. 2022

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BackgroundHypomanic symptoms between bipolar-I disorder (BD-I) and bipolar-II disorder (BD-II) are often indistinguishable in clinical practice. This study compared the network structure of hypomanic symptoms between patients with BD-I and BD-II.MethodsThe 32-item Hypomania Checklist (HCL-32) was used to assess hypomanic symptoms. Network model was generated in BD-I and BD-II patients. Centrality index of strength was used to quantify the importance of each symptom in the network. The Network Comparison Test (NCT) was used to assess the differences in hypomanic symptoms between BD-I and BD-II patients.ResultsAltogether, 423 patients with BD (BD-I: 191 and BD-II: 232) were included. The most central symptom was HCL17 “I am more flirtatious and/or am more sexually active” (strength BD–I = 5.21) and HCL12 “I have more ideas, I am more creative” (strength BD–II = 6.84) in BD-I and BD-II samples, respectively. The results of NCT showed that four nodes (HCL12 “I have more ideas, I am more creative,” HCL17 “I am more flirtatious and/or am more sexually active,” HCL23 “My thoughts jump from topic to topic,” and HCL31 “I drink more alcohol”) were significantly different between the BD-I and BD-II samples. Two edges (HCL3 “I am more self-confident”–HCL17 “I am more flirtatious and/or am more sexually active,” and HCL10 “I am physically more active (sport, etc.)”–HCL24 “I do things more quickly and/or more easily”) were significantly stronger in BD-I compared to BD-II patients.ConclusionThe network structure of hypomanic symptoms is different between BD-I and BD-II patients. Interventions targeting the respective central symptoms and edges should be developed for BD-I and BD-II separately.

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Section: Discussionmentioning

confidence: 99%

Comparison of Hypomanic Symptoms Between Bipolar I and Bipolar II Disorders: A Network Perspective

et al. 2022

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“…11 A number of other studies have explored sleep in relation to depression in specific contexts, for instance, low energy and difficulty maintaining sleep/earlymorning awakening were identified as bridge symptoms in Wenchuan earthquake survivors at a 10-year follow-up 12 ; sleep problems were identified to have the highest clinical relevance in a study in psychiatric healthcare professionals during the COVID-19 pandemic. 13 Insomnia symptoms were most strongly associated with neuroticism and conscientiousness in a network of personality traits. 14 Cognitive therapy (CT) and behavioural therapy (BT) for insomnia show different symptom-specific effects (sleep efficiency; difficulty maintaining sleep; dissatisfaction with sleep for BT, and interference with daily functioning; difficulty initiating sleep; early morning awakenings; and worry about sleep for CT) 15 while, in a separate study, sleep related behaviours were associated with BT, and worry; impaired quality of life (QOL); dysfunctional beliefs; monitoring sleep-related threats for CT. 16 To our knowledge, only one prior published network analysis has investigated insomnia symptoms discretely in relation to both depression and anxiety symptoms.…”

Section: Introductionmentioning

confidence: 98%

Insomnia, depression, and anxiety symptoms interact and individually impact functioning: A network and relative importance analysis in the context of insomnia

Bard¹,

O’Driscoll²,

Miller³

et al. 2022

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Study Objectives. Insomnia, depression, and anxiety show high rates of comorbidity and functional impairment. Transdiagnostic symptom interactions may be implicated in this comorbidity. This network analysis sought to assess how symptoms of insomnia, depression, and anxiety may interact and individuallypredict impairment across several domains for individuals with insomnia.Methods. Baseline psychometric data from a randomised controlled trial were analysed (N = 1,711). A regularised partial correlation network was estimated from the symptom data. Centrality (symptom connectivity), community structure (symptom clustering), and bridging (inter-community connectivity) wereassessed. The replicability of the network model was assessed via confirmatory analyses in a holdout sample. Separately, Shapley values were estimated to determine the relative importance of each symptom in predicting functioning (i.e., psychological wellbeing, psychosocial functioning, and physical healthimpairment).Results. The most connected nodes were uncontrollable worrying; trouble relaxing; and depressed mood/hopelessness. Five communities were identified with trouble relaxing identified as the bridge symptom between communities. The model showed good fit in the holdout sample. Low energy and depressive affectsymptoms (feelings of failure/guilt; depressed mood/hopelessness; anhedonia) were key predictors in the relative importance analysis across multiple domains of impairment.Conclusion. Trouble relaxing may be of clinical and transdiagnostic significance in the context of insomnia. In terms of how symptoms relate to functioning, it was clear that, while low energy and feelings of failure/guilt were prominent predictors, a range of symptoms are associated with functional impairment.Consideration of both symptoms and functional impairment across domains may be useful in determining targets for treatment.

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“…Although several studies using the network approach have probed the association patterns of various psychiatric conditions among different subpopulations during the COVID-19 pandemic ( Bai et al, 2021 ; Di Blasi et al, 2021 ; Li et al, 2022 ; Wang et al, 2020 ), few have focused on tourism-dependent areas like Macao. Previous studies revealed that the network structure of mental health symptoms in various subpopulations might differ by age, gender, or health status ( Hartung et al, 2019 ; Shim et al, 2020 ; Wang et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

The backbone symptoms of depression: a network analysis after the initial wave of the COVID-19 pandemic in Macao

Zhao

Bai

Cai

et al. 2022

PeerJ

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Background The coronavirus disease 2019 (COVID-19) pandemic disrupted the working lives of Macau residents, possibly leading to mental health issues such as depression. The pandemic served as the context for this investigation of the network structure of depressive symptoms in a community sample. This study aimed to identify the backbone symptoms of depression and to propose an intervention target. Methods This study recruited a convenience sample of 975 Macao residents between 20th August and 9th November 2020. In an electronic survey, depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9). Symptom relationships and centrality indices were identified using directed and undirected network estimation methods. The undirected network was constructed using the extended Bayesian information criterion (EBIC) model, and the directed network was constructed using the Triangulated Maximally Filtered Graph (TMFG) method. The stability of the centrality indices was evaluated by a case-dropping bootstrap procedure. Wilcoxon signed rank tests of the centrality indices were used to assess whether the network structure was invariant between age and gender groups. Results Loss of energy, psychomotor problems, and guilt feelings were the symptoms with the highest centrality indices, indicating that these three symptoms were backbone symptoms of depression. The directed graph showed that loss of energy had the highest number of outward projections to other symptoms. The network structure remained stable after randomly dropping 50% of the study sample, and the network structure was invariant by age and gender groups. Conclusion Loss of energy, psychomotor problems and guilt feelings constituted the three backbone symptoms during the pandemic. Based on centrality and relative influence, loss of energy could be targeted by increasing opportunities for physical activity.

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Network Analysis of Insomnia in Chinese Mental Health Professionals During the COVID-19 Pandemic: A Cross-Sectional Study

Cited by 24 publications

References 53 publications

Comparison of Hypomanic Symptoms Between Bipolar I and Bipolar II Disorders: A Network Perspective

Comparison of Hypomanic Symptoms Between Bipolar I and Bipolar II Disorders: A Network Perspective

Insomnia, depression, and anxiety symptoms interact and individually impact functioning: A network and relative importance analysis in the context of insomnia

The backbone symptoms of depression: a network analysis after the initial wave of the COVID-19 pandemic in Macao

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