A simulation-based network analysis of intervention targets for comorbid symptoms of depression and anxiety in Chinese healthcare workers in the post-dynamic zero-COVID policy era.

Abstract

Background: After the official end of the dynamic zero-COVID policy in China, healthcare workers continued to heavy workloads and psychological stress. In this new phase, concerns related to work and family, rather than infection, may have become new sources of psychological issues such as depression and anxiety among healthcare workers, leading to new patterns of comorbidity. However, few studies have addressed these issues. To fill this gap, this study used network analysis to examine new features and mechanisms of comorbidity between depression and anxiety symptoms, and simulated symptom-specific interventions to identify effective targets for intervention.

Methods: A total of 708 Chinese healthcare workers (71.2% females; Age: M = 37.55, SD = 9.37) were recruited and completed the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). This study first calculated the incidence rates of anxiety, depression, and their comorbidity, and then constructed the comorbid Ising network. Central and bridge symptoms were identified with expected influence (EI) and bridge EI, respectively. The NodeIdentifyR algorithm (NIRA) was then used to simulate interventions within the network, examining the effects of alleviating or aggravating specific symptoms on the network's severity.

Results: 48.2% of Chinese healthcare workers reported experiencing depression (19.8%), anxiety (11.7%), or both (16.2%). In the anxiety-depression network, "guilt" and "appetite changes" were identified as the central symptoms, and "guilt" and "excessive worry" were identified as the bridge symptoms. Simulated interventions suggested that alleviating "Anhedonia" can the most reduce the overall severity of the network, while aggravating "guilt" can the most increase the overall severity. These two symptoms were considered the key target for treatment and prevention, respectively.

Conclusions: Chinese healthcare workers still face high risk of depression, anxiety, and comorbidity in the post-dynamic zero-COVID policy era. Our findings highlight the key roles of guilt, appetite changes, and excessive worry in the network of depression and anxiety symptoms. Future research should apply the results of the simulated interventions, develop intervention strategies targeting anhedonia, and focus on preventing guilt to improve the healthcare workers' mental health.

Trial registration: Not applicable.