Symptom network structure of anxiety, depression, and their impact on quality of life in patients undergoing percutaneous coronary intervention: a cross-sectional study

Abstract Aims Although anxiety and depression are frequently linked to coronary heart disease, a network analysis of comorbid anxiety and depression and their association with quality of life (QoL) in patients undergoing percutaneous coronary intervention (PCI) remains unclear from the perspective of symptom interactions. We aimed to investigate the network structure and symptom patterns of anxiety and depression, and their relationship with QoL in patients undergoing PCI. Methods and results This study included 528 patients undergoing PCI. The seven-item Generalized Anxiety Disorder Scale, nine-item Patient Health Questionnaire, and World Health Organization Quality of Life Questionnaire-Brief Version were used as measurement tools. The R software was used to construct and interpret the network structure. The symptoms ‘sleep disturbance,’ ‘irritability,’ and ‘uncontrollable worry’ showed the highest expected influence centrality. Three bridge symptoms were identified: ‘sleep disturbance,’ ‘excessive worry,’ and ‘trouble relaxing.’ Among the three strongest edges, two were associated with anxiety and depressive symptoms. Ten symptoms were directly associated with QoL, with ‘fatigue’ showing the strongest relationship. In the network comparison test, significant differences in global strength were observed between the male and female groups. Conclusion ‘Sleep disturbance,’ plays a critical role in the current network, while ‘excessive worry,’ ‘trouble relaxing,’ and ‘fatigue’ were identified as key priorities owing to their high correlation with ‘sleep disturbance’ and QoL. Focusing on these symptoms may help mitigate the risk of multiple-symptom interactions and provide tailored intervention measures for patients undergoing PCI. Registration Chinese Clinical Trial Registry: ChiCTR230007581