# The relationship between anxiety and depression symptoms in insomnia patients: a network analysis

## TL;DR

This study explores how anxiety and depression symptoms are connected in people with insomnia using a network analysis approach.

## Contribution

The study applies network analysis to reveal specific symptom-level relationships between anxiety and depression in insomnia patients.

## Key findings

- The strongest correlation in the network was between sleep duration and habitual sleep efficiency.
- Cognitive disturbance and hopelessness showed a notable connection in the symptom network.
- Sleep duration was identified as the most central symptom in the network.

## Abstract

Anxiety and depressive symptoms are both common in insomnia patients, and they share a critical bidirectional relationship. The available research suggests that transitioning from a disorder-level analysis to a symptom-level analysis may provide a clearer understanding of these relationships. A total of 1571 insomnia patients were enrolled in this study. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), anxiety symptoms were evaluated using the Hamilton Rating Scale for Anxiety (HAM-A), and depressive symptoms were evaluated using the Hamilton Rating Scale for Depression (HAM-D). Subsequently, a network analysis was conducted for the statistical analysis. Among the present sample, the prevalences of depression and anxiety were 87.1% and 88.0%, respectively. We found that the strongest regularized partial correlations existed in the network between “C3: Sleep duration” and “C4: Habitual sleep efficiency” (r = 0.91). Two other strong regularized partial correlations were observed between “B3: Cognitive disturbance” - “B7: Hopelessness” (r = 0.36), “A2: Psychic anxiety” - “B5: Retardation” (r = 0.28). In addition, the item “C3: Sleep duration” had the highest strength centrality in the network, followed by “C1: Subjective sleep quality”, “C4: Habitual sleep efficiency”, “A2: Psychic anxiety”, “B1: Anxiety/Somatization”. The findings highlight the crucial role of the strongest regularized partial correlations and bridge symptoms in relation to depression and anxiety. Targeted interventions for clinical control of anxiety and depressive symptoms in insomnia patients are promising.

The online version contains supplementary material available at 10.1038/s41598-025-09746-w.