Network and Factor Structure of Depression and Anxiety Symptoms in Telemental Healthcare Patients From Bangladesh: Evidence for Precision Mental Healthcare

Background Identifying core mental health symptoms is crucial for precision‐targeted interventions, especially in resource‐limited settings. However, symptom structures among individuals actively seeking telemental healthcare remain underexplored in Bangladesh and similar contexts. This study aimed to map symptom severity, factor structures, and interrelationships between depressive and anxiety symptoms to inform precision‐driven mental healthcare approaches. Methods We conducted an observational study among 4,900 patients who attended a health facility‐based telemental healthcare in Bangladesh from January 2023 to July 2024. We assessed depression using PHQ‐9 and anxiety using GAD‐7 and applied exploratory factor analysis and network analysis. Results Overall, 84% (95% CI: 83–86) screened positive for depressive symptoms, 85% (95% CI: 83–86) screened positive for anxiety symptoms, and 77% (95% CI: 76–78) presented co‐occurring symptoms. Commonly reported symptoms included fatigue (57%), anhedonia (42%), sleep disturbance (42%), nervousness (70%), and uncontrollable worrying (66%). Factor analysis revealed “depressed mood” (λ = 0.58) and “anhedonia” (λ = 0.51) as core depressive features, and “uncontrollable worry” (λ = 0.68) and “nervousness” (λ = 0.61) as core anxiety features. Network analysis revealed strong associations between “anhedonia” and “depressed mood” in depression and “trouble relaxing” and “restlessness” in anxiety. “Uncontrollable worrying” showed the highest centrality, and “sleep disturbance” and “trouble relaxing” served as important bridge symptoms linking depression and anxiety domains. Conclusions Depressive and anxiety symptoms in people seeking telemental healthcare cluster around a small number of key and connecting symptoms, rather than contributing equally to overall distress. Precision mental healthcare in resource‐limited settings can use this structure to direct limited time and resources toward the symptoms that matter most. Protocol Registration: Institutional Review Board (IRB) of https://www.icddrb.org/ . Protocol number: PR‐22103.