Network analysis of comorbidity between anxiety symptoms and insomnia in adults
Keywords:
comorbidity, anxiety, insomnia, mental health, adult.Abstract
Introduction: Comorbidity between anxiety and insomnia symptoms is frequent and often it is understood because the symptoms share a common cause. Network theory conceptualizes emotional disorders at symptoms level and is a contemporary alternative for comprehend psychopathological comorbidity.Objective: To explore the comorbidity between anxiety and insomnia symptoms in Peruvian adults.
Methods: The sample was made up of 567 adults (75,1 % women) who responded to self-reports of anxiety and insomnia. A Gaussian graphical network was estimated with measures of centrality, predictability, stability, precision and comparative. To identify symptoms driving comorbidity, bridge symptoms were analyzed in the network structure.
Results: All network connections were positive. Trouble relaxing and general sleep quality were identified as the bridge symptoms between anxiety and insomnia. The highest centrality and predictability scores for anxiety were trouble relaxing and worrying, while for insomnia it was overall sleep quality and sleep duration. The network was robust and stable (CS = 0,672).
Conclusions: Trouble relaxing and overall sleep quality were identified as bridge symptoms between anxiety and insomnia. Further research is needed to test whether intervention in those symptoms could decrease comorbidity between both emotional disorders.
Downloads
Download data is not yet available.
References
1. Khan IW, Juyal R, Shikha D, Gupta R. Generalized Anxiety disorder but not depression is associated with insomnia: a population-based study. Sleep Sci. 2018; 11(3):166-73. DOI: 10.5935/1984-0063.20180031
2. Rogers AH, Wieman ST, Baker AW. Anxiety Comorbidities: Mood Disorders, Substance Use Disorders, and Chronic Medical Illness. En: Bui E, Charney ME, Baker AW. Clinical Handbook of Anxiety Disorders: From Theory to Practice. Berlin: Springer; 2020. p. 77-103.
3. Fabres L, Moya P. Sueño: conceptos generales y su relación con la calidad de vida. Rev med Clín Las Condes. 2021; 32(5):527-34. DOI: 10.1016/j.rmclc.2021.09.001
4. Bar M, Schrieber G, Gueron-Sela N, Shahar G, Tikotzky L. Role of Self-Criticism, Anxiety, and Depressive Symptoms in Young Adults' Insomnia. Int J Cogn Ther. 2020; 13:15-29. DOI: 10.1007/s41811-019-00058-2
5. Baños-Chaparro J. Síntomas depresivos en adultos peruanos: un análisis de redes. Rev virtual Soc Parag Med Int.2021; 8(2):1-12. DOI: 10.18004/rvspmi/2312-3893/2021.08.02.11
6. Baños-Chaparro J, Ynquillay-Lima P, Lamas Delgado F, Fuster Guillen FG. Análisis de redes de las conductas suicidas en adultos peruanos. Rev Cubana Med Milit. 2021 [acceso: 02/02/2022]; 50(3):e02101450. Disponible en: http://revmedmilitar.sld.cu/index.php/mil/article/view/1450/1004
7. Ramos-Vera C, Baños-Chaparro J, Ogundokun RO. The network structure of depressive symptomatology in Peruvian adults with arterial hypertension. F1000Research. 2021; 10:19. DOI: 10.12688/f1000research.27422.2
8. Borsboom D, Deserno MK, Rhemtulla M, Epskamp S, Fried EI, McNally RJ, et al. Network analysis of multivariate data in psychological science. Nat Rev Methods Primers. 2021; 1:58. DOI: 10.1038/s43586-021-00055-w
9. Fried EI, van Borkulo CD, Cramer AO, Boschloo L, Schoevers RA, Borsboom D. Mental disorders as networks of problems: a review of recent insights. Soc Psychiatry Psychiatr Epidemiol. 2017; 52:1-10. DOI: 10.1007/s00127-016-1319-z
10. Garabiles MR, Lao CK, Xiong Y, Hall BJ. Exploring comorbidity between anxiety and depression among migrant Filipino domestic workers: A network approach. J Affect Disord. 2019; 250:85-93. DOI: 10.1016/j.jad.2019.02.062
11. Karim MA, Ouanes S, Reagu SM, Alabdulla M. Network analysis of anxiety and depressive symptoms among quarantined individuals: cross-sectional study. BJPsych Open. 2021; 7(6):e222. DOI: 10.1192/bjo.2021.1060
12. Barthel AL, Pinaire MA, Curtiss JE, Baker AW, Brown ML, Hoeppner SS, et al. Anhedonia is Central for the Association between Quality of Life, Metacognition, Sleep, and Affective Symptoms in Generalized Anxiety Disorder: A Network Analysis. J Affect Disord. 2020; 277:1013-21. DOI: 10.1016/j.jad.2020.08.077
13. McElroy E, McIntyre JC, Bentall RP, Wilson T, Holt K, Kullu C, et al. Mental Health, Deprivation, and the Neighborhood Social Environment: A Network Analysis. Clin Psychol Sci. 2019; 7(4):719-34. DOI: 10.1177/2167702619830640
14. Nyer M, Farabaugh A, Fehling K, Soskin D, Holt D, Papakostas GI, et al. Relationship between sleep disturbance and depression, anxiety, and functioning in college students. Depress Anxiety. 2013; 30(9):873-80. DOI: 10.1002/da.22064
15. McGrath JJ, Lim CC, Plana-Ripoll O, Holtz Y, Agerbo E, Momen NC, et al. Comorbidity within mental disorders: a comprehensive analysis based on 145 990 survey respondents from 27 countries. Epidemiol Psychiatr Sci. 2020; 29:e153. DOI: 10.1017/S2045796020000633
16. Zhong QY, Gelaye B, Zazlavsky AM, Fann JR, Rondon MB, Sánchez SE, et al. Diagnostic Validity of the Generalized Anxiety Disorder - 7 (GAD-7) among Pregnant Women. PLoS ONE. 2015; 10(4):e0125096. DOI: 10.1371/journal.pone.0125096
17. Baños-Chaparro J, Fuster Guillen FG, Marín-Contreras J. Escala de Insomnio de Atenas: evidencias psicométricas en adultos peruanos. Liberabit. 2021; 27(1):e458. DOI: 10.24265/liberabit.2021.v27n1.07
18. Colegio de Psicólogos del Perú. Código de ética y deontología. 2017 [acceso: 04/02/2022]. Disponible en: http://api.cpsp.io/public/documents/codigo_de_etica_y_deontologia.pdf
19. Jones PJ. Networktools: Tools for identifying important nodes in networks. R package version 1.4.0. 2021 [acceso: 04/02/2022]. Disponible en: https://CRAN.R-project.org/package=networktools
20. Epskamp S, Borsboom D, Fried EI. Estimating psychological networks and their accuracy: A tutorial paper. Behav Res. 2018; 50:195-212. DOI: 10.3758/s13428-017-0862-1
21. Jones PJ, Ma R, McNally RJ. Bridge Centrality: A Network Approach to Understanding Comorbidity. Multivar Behav Res. 2021; 56(2):353-67. DOI: 10.1080/00273171.2019.1614898
22. Haslbeck JM, Waldorp LJ. How well do network models predict observations? On the importance of predictability in network models. Behav Res. 2018; 50:853-61. DOI: 10.3758/s13428-017-0910-x
23. Mamun MA, Akter S, Hossain I, Thanvir M, Faisal H, Rahman A, et al. Financial threat, hardship and distress predict depression, anxiety and stress among the unemployed youths: A Bangladeshi multi-city study. J Affect Disord. 2020; 276:1149-58. DOI: 10.1016/j.jad.2020.06.075
24. Mirchandaney R, Barete R, Asarnow LD. Moderators of Cognitive Behavioral Treatment for Insomnia on Depression and Anxiety Outcomes. Curr Psychiatry Rep. 2022; 24:1-8. DOI: 10.1007/s11920-022-01326-3
2. Rogers AH, Wieman ST, Baker AW. Anxiety Comorbidities: Mood Disorders, Substance Use Disorders, and Chronic Medical Illness. En: Bui E, Charney ME, Baker AW. Clinical Handbook of Anxiety Disorders: From Theory to Practice. Berlin: Springer; 2020. p. 77-103.
3. Fabres L, Moya P. Sueño: conceptos generales y su relación con la calidad de vida. Rev med Clín Las Condes. 2021; 32(5):527-34. DOI: 10.1016/j.rmclc.2021.09.001
4. Bar M, Schrieber G, Gueron-Sela N, Shahar G, Tikotzky L. Role of Self-Criticism, Anxiety, and Depressive Symptoms in Young Adults' Insomnia. Int J Cogn Ther. 2020; 13:15-29. DOI: 10.1007/s41811-019-00058-2
5. Baños-Chaparro J. Síntomas depresivos en adultos peruanos: un análisis de redes. Rev virtual Soc Parag Med Int.2021; 8(2):1-12. DOI: 10.18004/rvspmi/2312-3893/2021.08.02.11
6. Baños-Chaparro J, Ynquillay-Lima P, Lamas Delgado F, Fuster Guillen FG. Análisis de redes de las conductas suicidas en adultos peruanos. Rev Cubana Med Milit. 2021 [acceso: 02/02/2022]; 50(3):e02101450. Disponible en: http://revmedmilitar.sld.cu/index.php/mil/article/view/1450/1004
7. Ramos-Vera C, Baños-Chaparro J, Ogundokun RO. The network structure of depressive symptomatology in Peruvian adults with arterial hypertension. F1000Research. 2021; 10:19. DOI: 10.12688/f1000research.27422.2
8. Borsboom D, Deserno MK, Rhemtulla M, Epskamp S, Fried EI, McNally RJ, et al. Network analysis of multivariate data in psychological science. Nat Rev Methods Primers. 2021; 1:58. DOI: 10.1038/s43586-021-00055-w
9. Fried EI, van Borkulo CD, Cramer AO, Boschloo L, Schoevers RA, Borsboom D. Mental disorders as networks of problems: a review of recent insights. Soc Psychiatry Psychiatr Epidemiol. 2017; 52:1-10. DOI: 10.1007/s00127-016-1319-z
10. Garabiles MR, Lao CK, Xiong Y, Hall BJ. Exploring comorbidity between anxiety and depression among migrant Filipino domestic workers: A network approach. J Affect Disord. 2019; 250:85-93. DOI: 10.1016/j.jad.2019.02.062
11. Karim MA, Ouanes S, Reagu SM, Alabdulla M. Network analysis of anxiety and depressive symptoms among quarantined individuals: cross-sectional study. BJPsych Open. 2021; 7(6):e222. DOI: 10.1192/bjo.2021.1060
12. Barthel AL, Pinaire MA, Curtiss JE, Baker AW, Brown ML, Hoeppner SS, et al. Anhedonia is Central for the Association between Quality of Life, Metacognition, Sleep, and Affective Symptoms in Generalized Anxiety Disorder: A Network Analysis. J Affect Disord. 2020; 277:1013-21. DOI: 10.1016/j.jad.2020.08.077
13. McElroy E, McIntyre JC, Bentall RP, Wilson T, Holt K, Kullu C, et al. Mental Health, Deprivation, and the Neighborhood Social Environment: A Network Analysis. Clin Psychol Sci. 2019; 7(4):719-34. DOI: 10.1177/2167702619830640
14. Nyer M, Farabaugh A, Fehling K, Soskin D, Holt D, Papakostas GI, et al. Relationship between sleep disturbance and depression, anxiety, and functioning in college students. Depress Anxiety. 2013; 30(9):873-80. DOI: 10.1002/da.22064
15. McGrath JJ, Lim CC, Plana-Ripoll O, Holtz Y, Agerbo E, Momen NC, et al. Comorbidity within mental disorders: a comprehensive analysis based on 145 990 survey respondents from 27 countries. Epidemiol Psychiatr Sci. 2020; 29:e153. DOI: 10.1017/S2045796020000633
16. Zhong QY, Gelaye B, Zazlavsky AM, Fann JR, Rondon MB, Sánchez SE, et al. Diagnostic Validity of the Generalized Anxiety Disorder - 7 (GAD-7) among Pregnant Women. PLoS ONE. 2015; 10(4):e0125096. DOI: 10.1371/journal.pone.0125096
17. Baños-Chaparro J, Fuster Guillen FG, Marín-Contreras J. Escala de Insomnio de Atenas: evidencias psicométricas en adultos peruanos. Liberabit. 2021; 27(1):e458. DOI: 10.24265/liberabit.2021.v27n1.07
18. Colegio de Psicólogos del Perú. Código de ética y deontología. 2017 [acceso: 04/02/2022]. Disponible en: http://api.cpsp.io/public/documents/codigo_de_etica_y_deontologia.pdf
19. Jones PJ. Networktools: Tools for identifying important nodes in networks. R package version 1.4.0. 2021 [acceso: 04/02/2022]. Disponible en: https://CRAN.R-project.org/package=networktools
20. Epskamp S, Borsboom D, Fried EI. Estimating psychological networks and their accuracy: A tutorial paper. Behav Res. 2018; 50:195-212. DOI: 10.3758/s13428-017-0862-1
21. Jones PJ, Ma R, McNally RJ. Bridge Centrality: A Network Approach to Understanding Comorbidity. Multivar Behav Res. 2021; 56(2):353-67. DOI: 10.1080/00273171.2019.1614898
22. Haslbeck JM, Waldorp LJ. How well do network models predict observations? On the importance of predictability in network models. Behav Res. 2018; 50:853-61. DOI: 10.3758/s13428-017-0910-x
23. Mamun MA, Akter S, Hossain I, Thanvir M, Faisal H, Rahman A, et al. Financial threat, hardship and distress predict depression, anxiety and stress among the unemployed youths: A Bangladeshi multi-city study. J Affect Disord. 2020; 276:1149-58. DOI: 10.1016/j.jad.2020.06.075
24. Mirchandaney R, Barete R, Asarnow LD. Moderators of Cognitive Behavioral Treatment for Insomnia on Depression and Anxiety Outcomes. Curr Psychiatry Rep. 2022; 24:1-8. DOI: 10.1007/s11920-022-01326-3
Published
2022-04-30
How to Cite
1.
Baños-Chaparro J, Lamas Delgado F, Ynquillay-Lima P, Jacobi-Romero DJ, Fuster Guillen FG. Network analysis of comorbidity between anxiety symptoms and insomnia in adults. Rev Cubana Med Milit [Internet]. 2022 Apr. 30 [cited 2025 May 13];51(2):e02201891. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/1891
Issue
Section
Research Article
License
Authors who have publications with this Journal accept the following terms:
- The authors will retain their copyright and guarantee the Journal the right of first publication of their work, which will simultaneously be subject to the Creative Commons Attribution License. The content presented here can be shared, copied and redistributed in any medium or format; Can be adapted, remixed, transformed or created from the material, using the following terms: Attribution (giving appropriate credit to the work, providing a link to the license, and indicating if changes have been made); non-commercial (you cannot use the material for commercial purposes) and share-alike (if you remix, transform or create new material from this work, you can distribute your contribution as long as you use the same license as the original work).
- The authors may adopt other non-exclusive license agreements for the distribution of the published version of the work (for example: depositing it in an institutional electronic archive or publishing it in a monographic volume) as long as the initial publication in this Journal is indicated.
- Authors are allowed and recommended to disseminate their work through the Internet (e.g., in institutional electronic archives or on their website) before and during the submission process, which can produce interesting exchanges and increase citations. of the published work.
