Network analysis of anxiety and depressive symptoms among nursing students during the COVID-19 pandemic✰

Wei Bai; Hai Tao Xi; Qianqian Zhu; Mengmeng Ji; Hongyan Zhang; Bing Xiang Yang; Hong Cai; Rui Liu; Yan Jie Zhao; Li Chen; Zong Mei Ge; Zhiwen Wang; Lin Han; Pan Chen; Shuo Liu; Teris Cheung; Yi Lang Tang; Todd Jackson; Fengrong An; Yu Tao Xiang

doi:10.1016/j.jad.2021.07.072

Network analysis of anxiety and depressive symptoms among nursing students during the COVID-19 pandemic^✰

Wei Bai, Hai Tao Xi, Qianqian Zhu, Mengmeng Ji, Hongyan Zhang, Bing Xiang Yang, Hong Cai, Rui Liu, Yan Jie Zhao, Li Chen, Zong Mei Ge, Zhiwen Wang, Lin Han, Pan Chen, Shuo Liu, Teris Cheung, Yi Lang Tang, Todd Jackson, Fengrong An, Yu Tao Xiang

Research output: Journal article publication › Journal article › Academic research › peer-review

73 Citations (Scopus)

Abstract

Background: The 2019 coronavirus disease (COVID-19) pandemic has impacted the mental health and well-being of medical personnel, including nursing students. Network analysis provides a deeper characterization of symptom-symptom interactions in mental disorders. The aim of this study was to elucidate characteristics of anxiety and depressive symptom networks of Chinese nursing students during the COVID-19 pandemic.

Method: A total of 932 nursing students were included. Anxiety and depressive symptom were measured using the seven-item Generalized Anxiety Disorder Scale (GAD-7) and two-item Patient Health Questionnaire (PHQ-2), respectively. Central symptoms and bridge symptoms were identified via centrality indices and bridge centrality indices, respectively. Network stability was examined using the case-dropping procedure.

Results: Irritability, Uncontrollable worry, Trouble relaxing, and Depressed mood had the highest centrality values. Three bridge symptoms (Depressed mood, Nervousness, and Anhedonia) were also identified. Neither gender nor region of residence was associated with network global strength, distribution of edge weights or individual edge weights.

Limitations: Data were collected in a cross-sectional study design, therefore, causal relations and dynamic changes between anxiety and depressive symptoms over time could not be inferred. Generalizability of findings may be limited to Chinese nursing students during a particular phase of the current pandemic.

Conclusions: Irritability, Uncontrollable worry, Trouble relaxing, and Depressed mood constituted central symptoms maintaining the anxiety-depression network structure of Chinese nursing students during the pandemic. Timely, systemic multi-level interventions targeting central symptoms and bridge symptoms may be effective in alleviating co-occurring experiences of anxiety and depression in this population.

Original language	English
Pages (from-to)	753-760
Number of pages	8
Journal	Journal of Affective Disorders
Volume	294
DOIs	https://doi.org/10.1016/j.jad.2021.07.072
Publication status	Published - 1 Nov 2021

Keywords

Anxiety
COVID-19
Depression
Network analysis
Nursing students

ASJC Scopus subject areas

Clinical Psychology
Psychiatry and Mental health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

More information

10.1016/j.jad.2021.07.072

Cite this

Bai, W., Xi, H. T., Zhu, Q., Ji, M., Zhang, H., Yang, B. X., Cai, H., Liu, R., Zhao, Y. J., Chen, L., Ge, Z. M., Wang, Z., Han, L., Chen, P., Liu, S., Cheung, T., Tang, Y. L., Jackson, T., An, F., & Xiang, Y. T. (2021). Network analysis of anxiety and depressive symptoms among nursing students during the COVID-19 pandemic^✰. Journal of Affective Disorders, 294, 753-760. https://doi.org/10.1016/j.jad.2021.07.072

@article{633720ed87b9460d864e4ed1ddbb3806,

title = "Network analysis of anxiety and depressive symptoms among nursing students during the COVID-19 pandemic✰",

abstract = "Background: The 2019 coronavirus disease (COVID-19) pandemic has impacted the mental health and well-being of medical personnel, including nursing students. Network analysis provides a deeper characterization of symptom-symptom interactions in mental disorders. The aim of this study was to elucidate characteristics of anxiety and depressive symptom networks of Chinese nursing students during the COVID-19 pandemic.Method: A total of 932 nursing students were included. Anxiety and depressive symptom were measured using the seven-item Generalized Anxiety Disorder Scale (GAD-7) and two-item Patient Health Questionnaire (PHQ-2), respectively. Central symptoms and bridge symptoms were identified via centrality indices and bridge centrality indices, respectively. Network stability was examined using the case-dropping procedure. Results: Irritability, Uncontrollable worry, Trouble relaxing, and Depressed mood had the highest centrality values. Three bridge symptoms (Depressed mood, Nervousness, and Anhedonia) were also identified. Neither gender nor region of residence was associated with network global strength, distribution of edge weights or individual edge weights. Limitations: Data were collected in a cross-sectional study design, therefore, causal relations and dynamic changes between anxiety and depressive symptoms over time could not be inferred. Generalizability of findings may be limited to Chinese nursing students during a particular phase of the current pandemic. Conclusions: Irritability, Uncontrollable worry, Trouble relaxing, and Depressed mood constituted central symptoms maintaining the anxiety-depression network structure of Chinese nursing students during the pandemic. Timely, systemic multi-level interventions targeting central symptoms and bridge symptoms may be effective in alleviating co-occurring experiences of anxiety and depression in this population.",

keywords = "Anxiety, COVID-19, Depression, Network analysis, Nursing students",

author = "Wei Bai and Xi, {Hai Tao} and Qianqian Zhu and Mengmeng Ji and Hongyan Zhang and Yang, {Bing Xiang} and Hong Cai and Rui Liu and Zhao, {Yan Jie} and Li Chen and Ge, {Zong Mei} and Zhiwen Wang and Lin Han and Pan Chen and Shuo Liu and Teris Cheung and Tang, {Yi Lang} and Todd Jackson and Fengrong An and Xiang, {Yu Tao}",

note = "Funding Information: The study was supported by the National Science and Technology Major Project for investigational new drug (2018ZX09201–014), the Beijing Municipal Science & Technology Commission (No. Z181100001518005), the 2020 Higher Education Teaching Achievement Cultivation Project of Gansu Province, the Fundamental Research Funds for the Central Universities (2020YJ065) and the University of Macau (MYRG2019–00066-FHS). Publisher Copyright: {\textcopyright} 2021",

year = "2021",

month = nov,

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doi = "10.1016/j.jad.2021.07.072",

language = "English",

volume = "294",

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Bai, W, Xi, HT, Zhu, Q, Ji, M, Zhang, H, Yang, BX, Cai, H, Liu, R, Zhao, YJ, Chen, L, Ge, ZM, Wang, Z, Han, L, Chen, P, Liu, S, Cheung, T, Tang, YL, Jackson, T, An, F & Xiang, YT 2021, 'Network analysis of anxiety and depressive symptoms among nursing students during the COVID-19 pandemic^✰', Journal of Affective Disorders, vol. 294, pp. 753-760. https://doi.org/10.1016/j.jad.2021.07.072

TY - JOUR

T1 - Network analysis of anxiety and depressive symptoms among nursing students during the COVID-19 pandemic✰

AU - Bai, Wei

AU - Xi, Hai Tao

AU - Zhu, Qianqian

AU - Ji, Mengmeng

AU - Zhang, Hongyan

AU - Yang, Bing Xiang

AU - Cai, Hong

AU - Liu, Rui

AU - Zhao, Yan Jie

AU - Chen, Li

AU - Ge, Zong Mei

AU - Wang, Zhiwen

AU - Han, Lin

AU - Chen, Pan

AU - Liu, Shuo

AU - Cheung, Teris

AU - Tang, Yi Lang

AU - Jackson, Todd

AU - An, Fengrong

AU - Xiang, Yu Tao

N1 - Funding Information: The study was supported by the National Science and Technology Major Project for investigational new drug (2018ZX09201–014), the Beijing Municipal Science & Technology Commission (No. Z181100001518005), the 2020 Higher Education Teaching Achievement Cultivation Project of Gansu Province, the Fundamental Research Funds for the Central Universities (2020YJ065) and the University of Macau (MYRG2019–00066-FHS). Publisher Copyright: © 2021

PY - 2021/11/1

Y1 - 2021/11/1

N2 - Background: The 2019 coronavirus disease (COVID-19) pandemic has impacted the mental health and well-being of medical personnel, including nursing students. Network analysis provides a deeper characterization of symptom-symptom interactions in mental disorders. The aim of this study was to elucidate characteristics of anxiety and depressive symptom networks of Chinese nursing students during the COVID-19 pandemic.Method: A total of 932 nursing students were included. Anxiety and depressive symptom were measured using the seven-item Generalized Anxiety Disorder Scale (GAD-7) and two-item Patient Health Questionnaire (PHQ-2), respectively. Central symptoms and bridge symptoms were identified via centrality indices and bridge centrality indices, respectively. Network stability was examined using the case-dropping procedure. Results: Irritability, Uncontrollable worry, Trouble relaxing, and Depressed mood had the highest centrality values. Three bridge symptoms (Depressed mood, Nervousness, and Anhedonia) were also identified. Neither gender nor region of residence was associated with network global strength, distribution of edge weights or individual edge weights. Limitations: Data were collected in a cross-sectional study design, therefore, causal relations and dynamic changes between anxiety and depressive symptoms over time could not be inferred. Generalizability of findings may be limited to Chinese nursing students during a particular phase of the current pandemic. Conclusions: Irritability, Uncontrollable worry, Trouble relaxing, and Depressed mood constituted central symptoms maintaining the anxiety-depression network structure of Chinese nursing students during the pandemic. Timely, systemic multi-level interventions targeting central symptoms and bridge symptoms may be effective in alleviating co-occurring experiences of anxiety and depression in this population.

AB - Background: The 2019 coronavirus disease (COVID-19) pandemic has impacted the mental health and well-being of medical personnel, including nursing students. Network analysis provides a deeper characterization of symptom-symptom interactions in mental disorders. The aim of this study was to elucidate characteristics of anxiety and depressive symptom networks of Chinese nursing students during the COVID-19 pandemic.Method: A total of 932 nursing students were included. Anxiety and depressive symptom were measured using the seven-item Generalized Anxiety Disorder Scale (GAD-7) and two-item Patient Health Questionnaire (PHQ-2), respectively. Central symptoms and bridge symptoms were identified via centrality indices and bridge centrality indices, respectively. Network stability was examined using the case-dropping procedure. Results: Irritability, Uncontrollable worry, Trouble relaxing, and Depressed mood had the highest centrality values. Three bridge symptoms (Depressed mood, Nervousness, and Anhedonia) were also identified. Neither gender nor region of residence was associated with network global strength, distribution of edge weights or individual edge weights. Limitations: Data were collected in a cross-sectional study design, therefore, causal relations and dynamic changes between anxiety and depressive symptoms over time could not be inferred. Generalizability of findings may be limited to Chinese nursing students during a particular phase of the current pandemic. Conclusions: Irritability, Uncontrollable worry, Trouble relaxing, and Depressed mood constituted central symptoms maintaining the anxiety-depression network structure of Chinese nursing students during the pandemic. Timely, systemic multi-level interventions targeting central symptoms and bridge symptoms may be effective in alleviating co-occurring experiences of anxiety and depression in this population.

KW - Anxiety

KW - COVID-19

KW - Depression

KW - Network analysis

KW - Nursing students

UR - http://www.scopus.com/inward/record.url?scp=85111604849&partnerID=8YFLogxK

U2 - 10.1016/j.jad.2021.07.072

DO - 10.1016/j.jad.2021.07.072

M3 - Journal article

C2 - 34375200

AN - SCOPUS:85111604849

SN - 0165-0327

VL - 294

SP - 753

EP - 760

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

ER -