Symptom interactions of insomnia, anxiety, and depression in early pregnancy: a network analysis perspective

Background Pregnancy is a unique phase involving significant physical, social, and psychological changes, increasing vulnerability to anxiety, depression, and insomnia. These conditions are interrelated and often overlap, yet their symptom-symptom relationships during early pregnancy remain underexplored. Methods A total of 1,830 women in early pregnancy (≤12 weeks) who attended the Children's Hospital of Shanxi Province /Shanxi Maternal and Child Health Hospital, China, between 2021 and 2024 were included. Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale (HADS), and insomnia with the Athens Insomnia Scale (AIS). Regularized partial correlation networks (EBICglasso applied to polychoric correlations) were estimated to examine the connections among symptoms of anxiety, depression, and insomnia; node centrality and bridge symptoms connecting the three symptom clusters were examined, and the accuracy and stability of the estimates were assessed with bootstrapping. Results In total, 148 women (8.09%) screened positive for depression, 115 (6.28%) for anxiety, and 316 (17.27%) for insomnia. In the symptom network, the symptoms with the highest point estimates of strength centrality were ‘I feel as if I am slowed down’ (depression), a reduced sense of well-being during the day (insomnia), and ‘I feel cheerful’ (depression, reverse-scored); these symptoms did not differ reliably from one another or from several other symptoms in bootstrapped difference tests. The same symptoms, together with ‘worrying thoughts go through my mind’ (anxiety) and ‘I can sit at ease and feel relaxed’ (anxiety, reverse-scored), showed the highest bridge strength, and this set of five bridge symptoms was identical across all four correlation and estimation methods examined. Bridge expected influence, which retains the direction of the associations, identified the slowed-down item and the worry item as the strongest bridge symptoms. Conclusion Anxiety, depression, and insomnia are common, interconnected concerns in early pregnancy. Targeting the core and bridge symptoms identified here may enhance intervention effectiveness; however, causal inferences require longitudinal or experimental validation.