Network Analysis of Comorbid Anxiety and Insomnia Among Clinicians with Depressive Symptoms During the Late Stage of the COVID-19 Pandemic: A Cross-Sectional Study

(1) Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao Special Administrative Region, People's Republic of China; (2) Centre for Cognitive and Brain Sciences, University of Macau, Macao Special Administrative Region, People's Republic of China; (3) Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao Special Administrative Region, People's Republic of China; (4) The National Clinical Research Center for Mental Disorder & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People's Republic of China; (5) School of Nursing, Hong Kong Polytechnic University, Hong Kong Special Administrative Region, People's Republic of China; (6) School of Public Health, Southeast University, Nanjing, China, Nanjing, People's Republic of China; (7) Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA USA; (8) Atlanta VA Medical Center, Decatur, GA, USA; 'Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Victoria, Australia These authors contributed equally to this work Correspondence: Sha Sha, The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, People's Republic of China, Email sarahbon@163.com; Chee H Ng, Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Victoria, Australia, Email cng@unimelb.edu.au Background: A high proportion of clinicians experienced common anxiety, insomnia and depression during the COVID-19 pandemic. This study examined the item-level association of comorbid anxiety and insomnia symptoms among clinicians who suffered from depressive symptoms during the late stage of the COVID-19 pandemic using network analysis (NA). Methods: Clinicians with depressive symptoms (with a Patients Health Questionnaire (PHQ-9) total score of 5 and above) were included in this study. Anxiety and insomnia symptoms were measured using the Generalized Anxiety Disorder Scale - 7-item (GAD-7) and Insomnia Severity Index (ISI), respectively. Network analysis was conducted to