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

Prevalence and network structure of depression, insomnia and suicidality among mental health professionals who recovered from COVID-19: a national survey in China

Psychiatric syndromes are common following recovery from Coronavirus Disease 2019 (COVID-19) infection. This study investigated the prevalence and the network structure of depression, insomnia, and suicidality among mental health professionals (MHPs) who recovered from COVID-19. Depression and insomnia were assessed with the Patient Health Questionnaire (PHQ-9) and Insomnia Severity Index questionnaire (ISI7) respectively. Suicidality items comprising suicidal ideation, suicidal plan and suicidal attempt were evaluated with binary response (no/yes) items. Network analyses with Ising model were conducted to identify the central symptoms of the network and their links to suicidality. A total of 9858 COVID-19 survivors were enrolled in a survey of MHPs. The prevalence of depression and insomnia were 47.10% (95% confidence interval (CI) = 46.09-48.06%) and 36.2% (95%CI = 35.35-37.21%), respectively, while the overall prevalence of suicidality was 7.8% (95%CI = 7.31-8.37%). The key central nodes included "Distress caused by the sleep difficulties" (ISI7) (EI = 1.34), "Interference with daytime functioning" (ISI5) (EI = 1.08), and "Sleep dissatisfaction" (ISI4) (EI = 0.74). "Fatigue" (PHQ4) (Bridge EI = 1.98), "Distress caused by sleep difficulties" (ISI7) (Bridge EI = 1.71), and "Motor Disturbances" (PHQ8) (Bridge EI = 1.67) were important bridge symptoms. The flow network indicated that the edge between the nodes of "Suicidality" (SU) and "Guilt" (PHQ6) showed the strongest connection (Edge Weight= 1.17, followed by "Suicidality" (SU) - "Sad mood" (PHQ2) (Edge Weight = 0.68)). The network analysis results suggest that insomnia symptoms play a critical role in the activation of the insomnia-depression-suicidality network model of COVID-19 survivors, while suicidality is more susceptible to the influence of depressive symptoms. These findings may have implications for developing prevention and intervention strategies for mental health conditions following recovery from COVID-19.

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

Background

Suicidality is a global public health problem which has increased considerably during the coronavirus disease 2019 (COVID-19) pandemic. This study examined the inter-relationships between depressive symptoms and suicidality using network analysis among Macau residents after the "relatively static management" COVID-19 strategy.

Methods

An assessment of suicidal ideation (SI), suicide plan (SP), suicide attempt (SA) and depressive symptoms was conducted with the use of individual binary response items (yes/no) and Patient Health Questionnaire (PHQ-9). In the network analysis, central and bridge symptoms were identified in the network through "Expected Influence" and "Bridge Expected Influence", and specific symptoms that were directly associated with suicidality were identified via the flow function. Network Comparison Tests (NCT) were conducted to examine the gender differences in network characteristics.

Results

The study sample included a total of 1008 Macau residents. The prevalence of depressive symptoms and suicidality were 62.50% (95% CI = 59.4-65.5%) and 8.9% (95% CI = 7.2-10.9%), respectively. A network analysis of the sample identified SI ("Suicidal ideation") as the most central symptom, followed by SP ("Suicide plan") and PHQ4 ("Fatigue"). SI ("Suicidal ideation") and PHQ6 ("Guilt") were bridge nodes connecting depressive symptoms and suicidality. A flow network revealed that the strongest connection was between S ("Suicidality") and PHQ6 ("Guilt"), followed by S ("Suicidality") and PHQ 7 ("Concentration"), and S ("Suicidality") and PHQ3 ("Sleep").

Conclusion

The findings indicated that reduction of specific depressive symptoms and suicidal thoughts may be relevant in decreasing suicidality among adults. Further, suicide assessment and prevention measures should address the central and bridge symptoms identified in this study.

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

BACKGROUND

Studies on sleep problems among caregivers of psychiatric patients, especially during the COVID-19 pandemic, are limited. This study examined the prevalence and correlates of insomnia symptoms (insomnia hereafter) among caregivers of psychiatric inpatients during the COVID-19 pandemic as well as the association with quality of life (QoL) from a network analysis perspective.

METHODS

A multi-center cross-sectional study was conducted on caregivers of inpatients across seven tertiary psychiatric hospitals and psychiatric units of general hospitals. Network analysis explored the structure of insomnia using the R program. The centrality index of "Expected influence" was used to identify central symptoms in the network, and the "flow" function was adopted to identify specific symptoms that were directly associated with QoL.

RESULTS

A total of 1,101 caregivers were included. The overall prevalence of insomnia was 18.9% (n = 208; 95% CI = 16.7-21.3%). Severe depressive (OR = 1.185; P < 0.001) and anxiety symptoms (OR = 1.099; P = 0.003), and severe fatigue (OR = 1.320; P < 0.001) were associated with more severe insomnia. The most central nodes included ISI2 ("Sleep maintenance"), ISI7 ("Distress caused by the sleep difficulties") and ISI1 ("Severity of sleep onset"), while "Sleep dissatisfaction" (ISI4), "Distress caused by the sleep difficulties" (ISI7) and "Interference with daytime functioning" (ISI5) had the strongest negative associations with QoL.

CONCLUSION

The insomnia prevalence was high among caregivers of psychiatric inpatients during the COVID-19 pandemic, particularly in those with depression, anxiety and fatigue. Considering the negative impact of insomnia on QoL, effective interventions that address insomnia and alteration of sleep dissatisfaction should be developed.

Relationships between childhood trauma and mental health during the COVID-19 pandemic: a network analysis

Background

Childhood trauma has been found to have an important impact on mental health. However, little is known regarding the intercorrelations between childhood trauma and mental health during the COVID-19 pandemic. This study aimed to investigate such complex interplay between childhood trauma, depression, anxiety, post-traumatic stress level during the COVID-19 pandemic, and fear of COVID-19 using network analysis.

Methods

A total of 1,247 college students were recruited and were asked to complete a series of questionnaires, including the Childhood Trauma Questionnaire, Patient Health Questionnaire, Generalized Anxiety Disorder Scale, Post-traumatic Stress Checklist-Civilian version, and Fear of COVID-19 Scale. The Gaussian graphical model with the scores of the questionnaires as nodes was estimated. The partial correlations between nodes were calculated as edges. Moreover, network comparison tests were conducted to compare the network patterns between participants with high levels of childhood trauma and low levels of childhood trauma.

Results

Childhood trauma was found to be connected to depression, anxiety, and post-traumatic stress level. The node of childhood trauma exhibited the strongest strength and the highest expected influence in the network. Participants with high levels of childhood trauma and participants with low levels of childhood trauma showed comparable network structure and global strength.

Conclusion

Our findings revealed a complex network pattern between childhood trauma and different mental health problems, indicating that childhood trauma might be a risk factor for mental health during the COVID-19 pandemic.

Special Issue "Sleep Disorders: From Clinical Research to Daily Practice"

Healthy sleep is indissolubly linked to both physical and mental health, as pointed out by evidence showing the negative impact of poor sleep on neurological, psychiatric, cardiovascular, respiratory, metabolic, and immune systems, among others [...].

[Insomnia in the context of affective disorders]

The article analyzes the current literature on the relationship of insomnia with affective disorders, in particular with depression and anxiety. Research shows that there is a strong multi-channel relationship between insomnia, depression, and anxiety, with insomnia being considered a risk factor for mood disorders more often than vice versa. The so-called insomnia paradox of bipolar disorder is described, the essence of which is that in manic episodes the frequency of insomnia is higher than in depressive episodes. The data of a network meta-analysis, which found an evidence base for the use of a variety of drugs used for the pharmacological treatment of insomnia in adults, are presented. Efficiency and convenience in taking the drug Valocordin-Doxylamine are noted.

Prevalence and Risk Factors Associated with Mental Health in Adolescents from Northern Chile in the Context of the COVID-19 Pandemic

The COVID-19 pandemic has affected the world population; however, there is limited knowledge about its impact on adolescents. The aim of this study was to estimate the prevalence and risk factors associated with mental health in the context of the COVID-19 pandemic in young people in northern Chile. The sample consisted of 1315 young people between the ages of 14 and 18. Univariate analysis and multiple logistic regression were performed to identify the risk factors associated to the considered symptomatology. Depressive symptomatology was reported at 36.3%, anxiety at 6%, and social phobia at 27.8%. Adolescent females reported a higher probability of presenting depressive (OR, 3.409), anxious (OR, 3.949), and social phobia (OR, 3.027) symptomatology. Young women between the ages of 17 and 18 were more likely to present anxiety (OR, 2.172); moreover, being a migrant was related to lower odds of presenting anxiety (OR, 0.259) and depression (OR, 0.662). Having a family member diagnosed with COVID-19 was associated with depressive symptomatology (OR, 1.369). The COVID-19 pandemic can have serious repercussions on the mental health of adolescents. It is important to generate interventions to meet the needs of youth during the post-confinement period.