Depression and anxiety among Macau residents during the COVID-19 outbreak: A network analysis perspective

He-Li Sun; Pen Chen; Yuan Feng; Tong Leong Si; Mei Ieng Lam; Ka-In Lok; Ines Hang Iao Chow; Zhaohui Su; Teris Cheung; Yi-Lang Tang; Todd Jackson; Sha Sha; Yu-Tao Xiang

doi:10.3389/fpsyt.2023.1159542

Depression and anxiety among Macau residents during the COVID-19 outbreak: A network analysis perspective

Front Psychiatry. 2023 Apr 26:14:1159542. doi: 10.3389/fpsyt.2023.1159542. eCollection 2023.

Authors

He-Li Sun^{1

2}, Pen Chen^{1

2}, Yuan Feng³, Tong Leong Si^{1

2}, Mei Ieng Lam⁴, Ka-In Lok⁵, Ines Hang Iao Chow^{1

2}, Zhaohui Su⁶, Teris Cheung⁷, Yi-Lang Tang^{8

9}, Todd Jackson¹⁰, Sha Sha³, Yu-Tao Xiang^{1

2}

Affiliations

¹ Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macau SAR,, China.
² Centre for Cognitive and Brain Sciences, University of Macau, Taipa, Macau SAR, China.
³ The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
⁴ Kiang Wu Nursing College of Macau, Macau, Macau SAR, China.
⁵ Faculty of Health Sciences and Sports, Macao Polytechnic University, Macau, Macau SAR, China.
⁶ School of Public Health, Southeast University, Nanjing, China.
⁷ School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.
⁸ Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States.
⁹ Atlanta VA Medical Center, Atlanta, GA, United States.
¹⁰ Department of Psychology, University of Macau, Macau, Macau SAR, China.

Abstract

Background: The 2019 novel coronavirus disease (COVID-19) outbreak affected people's lifestyles and increased their risk for depressive and anxiety symptoms (depression and anxiety, respectively hereafter). We assessed depression and anxiety in residents of Macau during "the 6.18 COVID-19 outbreak" period and explored inter-connections of different symptoms from the perspective of network analysis.

Methods: In this cross-sectional study, 1,008 Macau residents completed an online survey comprising the nine-item Patient Health Questionnaire (PHQ-9) and seven-item Generalized Anxiety Disorder Scale (GAD-7) to measure depression and anxiety, respectively. Central and bridge symptoms of the depression-anxiety network model were evaluated based on Expected Influence (EI) statistics, while a bootstrap procedure was used to test the stability and accuracy of the network model.

Results: Descriptive analyses indicated the prevalence of depression was 62.5% [95% confidence interval (CI) = 59.47-65.44%], the prevalence of anxiety was 50.2% [95%CI = 47.12-53.28%], and 45.1% [95%CI = 42.09-48.22%] of participants experienced comorbid depression and anxiety. "Nervousness-Uncontrollable worry" (GADC) (EI = 1.15), "Irritability" (GAD6) (EI = 1.03), and "Excessive worry" (GAD3) (EI = 1.02) were the most central symptoms, while "Irritability" (GAD6) (bridge EI = 0.43), "restlessness" (GAD5) (bridge EI = 0.35), and "Sad Mood" (PHQ2) (bridge EI = 0.30) were key bridge symptoms that emerged in the network model.

Conclusion: Nearly half of residents in Macau experienced comorbid depression and anxiety during the 6.18 COVID-19 outbreak. Central and bridge symptoms identified in this network analysis are plausible, specific targets for treatment and prevention of comorbid depression and anxiety related to this outbreak.

Keywords: Macau; anxiety; comorbidity; depression; network analysis.