Interconnected Mental Health Symptoms: Network Analysis of Depression, Anxiety, Stress, and Burnout Among Psychiatric Nurses in the Context of the COVID-19 Pandemic

Overview

Journal Front Psychiatry

Specialty Psychiatry

Date 2024 Nov 12

PMID 39529901

Authors

Rui Tao

Song Wang

Qingfang Lu

Yunxiao Liu

Lei Xia

Daming Mo

Feng Geng

Tingfang Liu

Yuanli Liu

Feng Jiang

Huan-Zhong Liu

Yi-Lang Tang

Affiliations

Soon will be listed here.

Abstract

Background: Mental health symptoms such as anxiety, depression, stress, and burnout are common among healthcare workers. However, the interconnections among them remain under-explored. This study aimed to address the interrelationships among these symptoms in psychiatric nurses.

Methods: We conducted a nationwide survey in the early stage of the COVID-19 pandemic (January to March 2021) to investigate the interconnectedness of depression, anxiety, stress, and burnout among psychiatric nurses. Using network analysis, we identified central symptoms, important bridge symptoms, and the correlations among these central symptoms.

Results: Of the 9,224 psychiatric nurses (79.2% female) included in the statistical analyses, 27.6% reported clinically significant depression, 31.2% anxiety, 14.5% stress, and 23.8% burnout. Network analysis revealed that stress had the highest expected influence (EI) value (0.920) and the highest strength among all nodes. The node for depression scored the highest in both closeness and betweenness. Emotional exhaustion (EE) had the highest bridge expected influence (BEI) of 0.340, with the strongest intergroup association between EE and depression. No significant differences were found in gender or frontline work experience (all p > 0.05).

Conclusions: Burnout, depression, anxiety, and stress are relatively common among psychiatric nurses in the context of the COVID-19 pandemic. While anxiety was the most prevalent, stress emerged as the core symptom, and depression as an important bridging node. Interventions targeting the core symptoms and bridging nodes may improve the mental health of psychiatric nurses.

Citing Articles

Stress, Anxiety and Depressive Symptoms, Burnout and Insomnia Among Greek Nurses One Year After the End of the Pandemic: A Moderated Chain Mediation Model.

Pachi A, Sikaras C, Melas D, Alikanioti S, Soultanis N, Ivanidou M J Clin Med. 2025; 14(4).

PMID: 40004676 PMC: 11856992. DOI: 10.3390/jcm14041145.

References

Van Borkulo C, Boschloo L, Borsboom D, Penninx B, Waldorp L, Schoevers R . Association of Symptom Network Structure With the Course of [corrected] Depression. JAMA Psychiatry. 2015; 72(12):1219-26. DOI: 10.1001/jamapsychiatry.2015.2079. View

Collett G, Korszun A, Gupta A . Potential strategies for supporting mental health and mitigating the risk of burnout among healthcare professionals: insights from the COVID-19 pandemic. EClinicalMedicine. 2024; 71:102562. PMC: 11015336. DOI: 10.1016/j.eclinm.2024.102562. View

Jiang C, Jiang W, Yue Y, Li L, Sun T, Chen G . The trends of psychosomatic symptoms and perceived stress among healthcare workers during the COVID-19 pandemic in China: Four cross-sectional nationwide surveys, 2020-2023. Psychiatry Res. 2023; 326:115301. PMC: 10276499. DOI: 10.1016/j.psychres.2023.115301. View

Chen R, Wang K, Chen Q, Zhang M, Yang H, Zhang M . Weekend warrior physical activity pattern is associated with lower depression risk: Findings from NHANES 2007-2018. Gen Hosp Psychiatry. 2023; 84:165-171. DOI: 10.1016/j.genhosppsych.2023.07.006. View

Liu B, Jia C . The associations of physical activity and lifetime depression with all-cause and cause-specific mortality: evidence from a prospective cohort study. Psychiatry Res. 2023; 324:115206. DOI: 10.1016/j.psychres.2023.115206. View

Chen M, Chen P, An F, Sha S, Feng Y, Su Z . Depression, anxiety and suicidality among Chinese mental health professionals immediately after China's dynamic zero-COVID policy: A network perspective. J Affect Disord. 2024; 352:153-162. DOI: 10.1016/j.jad.2024.01.270. View

Kim H, Jung J, Han K, Shin D, Jeon H . Changes in physical activity and the risk of heart failure in newly diagnosed patients with depression: A nationwide cohort study. Gen Hosp Psychiatry. 2023; 86:85-91. DOI: 10.1016/j.genhosppsych.2023.12.007. View

Santabarbara J, Lasheras I, Lipnicki D, Bueno-Notivol J, Perez-Moreno M, Lopez-Anton R . Prevalence of anxiety in the COVID-19 pandemic: An updated meta-analysis of community-based studies. Prog Neuropsychopharmacol Biol Psychiatry. 2020; 109:110207. PMC: 7834650. DOI: 10.1016/j.pnpbp.2020.110207. View

Lee E, Moon S, Cho M, Park E, Kim S, Han J . The 21-Item and 12-Item Versions of the Depression Anxiety Stress Scales: Psychometric Evaluation in a Korean Population. Asian Nurs Res (Korean Soc Nurs Sci). 2018; 13(1):30-37. DOI: 10.1016/j.anr.2018.11.006. View

10.

Sherman M, Klinenberg E . Beyond burnout: Moral suffering among healthcare workers in the first COVID-19 surge. Soc Sci Med. 2023; 340:116471. DOI: 10.1016/j.socscimed.2023.116471. View

11.

Wang X, Wu Y, Chen Y, Gao Q, Liu W, Xu J . Network analysis for inter-relationships of the suboptimal health status with depression and anxiety during the COVID-19 pandemic: A perspective of predictive, preventive, and personalized health. J Affect Disord. 2024; 356:155-161. DOI: 10.1016/j.jad.2024.04.032. View

12.

Martin B, Kaminski-Ozturk N, OHara C, Smiley R . Examining the Impact of the COVID-19 Pandemic on Burnout and Stress Among U.S. Nurses. J Nurs Regul. 2023; 14(1):4-12. PMC: 10074070. DOI: 10.1016/S2155-8256(23)00063-7. View

13.

Phillips G, Kendino M, Brolan C, Herron L, Krver S, Motofaga S . Women on the frontline: exploring the gendered experience for Pacific healthcare workers during the COVID-19 pandemic. Lancet Reg Health West Pac. 2023; 42:100961. PMC: 10658397. DOI: 10.1016/j.lanwpc.2023.100961. View

14.

Dong Q, Yang Y, Ma M, Ou W, Lv G, Huang M . Posttraumatic stress symptoms in healthcare workers during the COVID-19 pandemic: A four-wave longitudinal study. Psychiatry Res. 2023; 327:115406. DOI: 10.1016/j.psychres.2023.115406. View

15.

Ge M, Hu F, Jia Y, Tang W, Zhang W, Zhao D . COVID-19 pandemic increases the occurrence of nursing burnout syndrome: an interrupted time-series analysis of preliminary data from 38 countries. Nurse Educ Pract. 2023; 69:103643. PMC: 10088401. DOI: 10.1016/j.nepr.2023.103643. View

16.

Wang L, Wang Q, Gao G . Interpreting COVID-19 data from China: a call for caution - Authors' reply. Lancet. 2024; 403(10422):144-145. DOI: 10.1016/S0140-6736(23)01744-0. View

17.

Szabo M . The short version of the Depression Anxiety Stress Scales (DASS-21): factor structure in a young adolescent sample. J Adolesc. 2009; 33(1):1-8. DOI: 10.1016/j.adolescence.2009.05.014. View

18.

Fond G, Smith L, Tran B, Lucas G, Nguyen T, Yon D . Unmasking the triad of burnout, absenteeism, and poor sleep among healthcare workers during the third wave of COVID-19 pandemics. Results from the national AMADEUS study. J Affect Disord. 2024; 355:247-253. DOI: 10.1016/j.jad.2024.03.157. View

19.

Jin Y, Sha S, Tian T, Wang Q, Liang S, Wang Z . Network analysis of comorbid depression and anxiety and their associations with quality of life among clinicians in public hospitals during the late stage of the COVID-19 pandemic in China. J Affect Disord. 2022; 314:193-200. PMC: 9242942. DOI: 10.1016/j.jad.2022.06.051. View

20.

Sun H, Zhao Y, Sha S, Li X, Si T, Liu Y . Depression and anxiety among caregivers of psychiatric patients during the late stage of the COVID-19 pandemic: A perspective from network analysis. J Affect Disord. 2023; 344:33-40. DOI: 10.1016/j.jad.2023.09.034. View