Symptom interactions of insomnia, anxiety, and depression in early pregnancy: a network analysis perspective
- 1Department of Psychiatry, Children's Hospital of Shanxi Province /Shanxi Maternal and Child Health Hospital
Abstract
Background: Pregnancy is a unique phase involving significant physical, social, and psychological changes, increasing vulnerability to anxiety, depression, and insomnia. These conditions are interrelated and often overlap, yet their symptom-symptom relationships during early pregnancy remain underexplored.
Methods: A total of 1,830 women in early pregnancy (≤12 weeks) who attended the Children's Hospital of Shanxi Province /Shanxi Maternal and Child Health Hospital, China, between 2021 and 2024 were included. Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale (HADS), and insomnia with the Athens Insomnia Scale (AIS). Regularized partial correlation networks (EBICglasso applied to polychoric correlations) were estimated to examine the connections among symptoms of anxiety, depression, and insomnia; node centrality and bridge symptoms connecting the three symptom clusters were examined, and the accuracy and stability of the estimates were assessed with bootstrapping.
Results: In total, 148 women (8.09%) screened positive for depression, 115 (6.28%) for anxiety, and 316 (17.27%) for insomnia. In the symptom network, the symptoms with the highest point estimates of strength centrality were ‘I feel as if I am slowed down’ (depression), a reduced sense of well-being during the day (insomnia), and ‘I feel cheerful’ (depression, reverse-scored); these symptoms did not differ reliably from one another or from several other symptoms in bootstrapped difference tests. The same symptoms, together with ‘worrying thoughts go through my mind’ (anxiety) and ‘I can sit at ease and feel relaxed’ (anxiety, reverse-scored), showed the highest bridge strength, and this set of five bridge symptoms was identical across all four correlation and estimation methods examined. Bridge expected influence, which retains the direction of the associations, identified the slowed-down item and the worry item as the strongest bridge symptoms.
Conclusion: Anxiety, depression, and insomnia are common, interconnected concerns in early pregnancy. Targeting the core and bridge symptoms identified here may enhance intervention effectiveness; however, causal inferences require longitudinal or experimental validation.
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BibTeX
@article{li2026symptom,
title = {{Symptom interactions of insomnia, anxiety, and depression in early pregnancy: a network analysis perspective}},
author = {Yijiang Li and Lu Jiao and Junqiang Cui and Jiabin Cui and Luyao Huo and Yunqiao Zhang and Liang Niu and Yi Niu and Xiaoying Bai and Daming Zhang},
journal = {Frontiers in Psychiatry},
year = {2026},
month = nov,
doi = {10.3389/fpsyt.2026.1957627},
url = {https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1957627/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Symptom interactions of insomnia, anxiety, and depression in early pregnancy: a network analysis perspective
AU - Yijiang Li
AU - Lu Jiao
AU - Junqiang Cui
AU - Jiabin Cui
AU - Luyao Huo
AU - Yunqiao Zhang
AU - Liang Niu
AU - Yi Niu
AU - Xiaoying Bai
AU - Daming Zhang
PY - 2026
DA - 2026/11/03
JO - Frontiers in Psychiatry
DO - 10.3389/fpsyt.2026.1957627
UR - https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1957627/full
AB - Background: Pregnancy is a unique phase involving significant physical, social, and psychological changes, increasing vulnerability to anxiety, depression, and insomnia. These conditions are interrelated and often overlap, yet their symptom-symptom relationships during early pregnancy remain underexplored. Methods: A total of 1,830 women in early pregnancy (≤12 weeks) who attended the Children's Hospital of Shanxi Province /Shanxi Maternal and Child Health Hospital, China, between 2021 and 2024 were included. Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale (HADS), and insomnia with the Athens Insomnia Scale (AIS). Regularized partial correlation networks (EBICglasso applied to polychoric correlations) were estimated to examine the connections among symptoms of anxiety, depression, and insomnia; node centrality and bridge symptoms connecting the three symptom clusters were examined, and the accuracy and stability of the estimates were assessed with bootstrapping. Results: In total, 148 women (8.09%) screened positive for depression, 115 (6.28%) for anxiety, and 316 (17.27%) for insomnia. In the symptom network, the symptoms with the highest point estimates of strength centrality were ‘I feel as if I am slowed down’ (depression), a reduced sense of well-being during the day (insomnia), and ‘I feel cheerful’ (depression, reverse-scored); these symptoms did not differ reliably from one another or from several other symptoms in bootstrapped difference tests. The same symptoms, together with ‘worrying thoughts go through my mind’ (anxiety) and ‘I can sit at ease and feel relaxed’ (anxiety, reverse-scored), showed the highest bridge strength, and this set of five bridge symptoms was identical across all four correlation and estimation methods examined. Bridge expected influence, which retains the direction of the associations, identified the slowed-down item and the worry item as the strongest bridge symptoms. Conclusion: Anxiety, depression, and insomnia are common, interconnected concerns in early pregnancy. Targeting the core and bridge symptoms identified here may enhance intervention effectiveness; however, causal inferences require longitudinal or experimental validation.
SN - 1664-0640
ER -