What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Heart failure (n=277). Primary outcome: Central and bridge symptoms in the network of anxiety and depressive symptoms.

What does this research mean for the field?

In patients with heart failure, feeling down, depressed, or hopeless, inability to concentrate, and difficulty relaxing are the most central symptoms in the anxiety and depression network. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

November 14, 2024BMC Psychiatry13 citationsOpen Access

Network analysis of anxiety and depressive symptoms among patients with heart failure

QZQiuge ZhaoWeifang Medical University XSXiaofei SunHarbin Institute of Technology YZYanting ZhangFujian Agriculture and Forestry University

Key Result

In patients with heart failure, feeling down, depressed, or hopeless, inability to concentrate, and difficulty relaxing were the most central symptoms in the anxiety and depression network.

Study Design

Type

Cross-Sectional (n=277)

Multicenter

Yes

Structured PICO

Population

277 adults (≥18 years) with heart failure, mean age 63.60, 59.6% male, from four tertiary hospitals in China. Key inclusion: HF diagnosis according to international guidelines. Key exclusion: acute myocardial infarction within the past month, serious complications (malignant tumors, liver/kidney/lung failure, mental disorders).

Outcome

Central and bridge symptoms in the network of anxiety (measured by GAD-7) and depressive symptoms (measured by PHQ-9)patient reported

Network analysis identifies feeling down/depressed, inability to concentrate, and difficulty relaxing as central symptoms linking anxiety and depression in heart failure patients, offering potential targets for psychological interventions.

Limitations

Cross-sectional study cannot determine causal relationships
Anxiety and depressive symptoms were measured using self-report scales, which may have caused recall bias
Focused on the Chinese population with HF, limiting generalizability to other populations
Covariates or confounding factors were not included in the network analysis

Abstract

BACKGROUND: Anxiety and depressive symptoms are common among patients with heart failure (HF). Physical limitations, lifestyle changes, and uncertainties related to HF can result in the development or exacerbating of anxiety and depressive symptoms. However, the central and bridge symptoms of anxiety and depressive symptoms network among patients with HF remain unclear. Network analysis is a statistical method that can discover and visualize complex relationships between multiple variables. This study aimed to establish a network of anxiety and depressive symptoms and identify the central and bridge symptoms in this network among patients with HF. METHODS: This study employed a cross-sectional study design and convenience sampling to recruit patients with HF. This study followed the Helsinki Declaration and was approved by the Research Ethics Committee of Hospital. The Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire (PHQ-9) were administered to evaluate anxiety and depressive symptoms among patients with HF, respectively. Network analysis of anxiety and depressive symptoms was performed using R. RESULTS: In the anxiety and depressive symptoms network, PHQ2 (feeling down, depressed, or hopeless), PHQ7 (inability to concentrate), and GAD4 (difficulty relaxing) were the most central symptoms. Anxiety and depressive symptoms were linked by PHQ2 (feeling down, depressed, or hopeless), GAD6 (becoming easily annoyed or impatient), GAD5 (unable to sit still because of anxiety), GAD7 (feeling afraid that something terrible is about to happen), and PHQ6 (feeling bad or like a failure, or disappointing oneself or family). CONCLUSIONS: This study identified the central and bridge symptoms in a network of anxiety and depressive symptoms. Targeting these symptoms can contribute to interventions for patients with HF at risk of-or suffering from-anxiety and depressive symptoms, which can be effective in reducing the comorbidity of anxiety and depression.

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