A network analysis of depressive and anxiety symptoms and their associations with quality of life among patients with adolescent idiopathic scoliosis

Abstract Background Depressive and anxiety symptoms are mental disorders common in patients with adolescent idiopathic scoliosis (AIS). Severe mental disorders result in a diminished quality of life (QOL). This study investigated the network structure of depressive and anxiety symptoms and explored how these symptoms are connected with QOL among patients with AIS. Methods A cross-sectional study was conducted from April 2021 to February 2023. Patients aged 10 to 16 years who had been diagnosed with AIS (Cobb angle ≥ 10°) at the Spine Health Centre of Shenzhen Second People’s Hospital were included. The 9-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder Scale (GAD-7), and the 12-item Short-Form Health Survey (SF-12) were used to assess depressive and anxiety symptoms, and QOL, respectively. A network analysis was performed to explore central symptoms, bridge symptoms and their associations with QOL. Sex differences in the structure and connectivity were identified by the network comparison test (NCT). Results A total of 811 patients with AIS (205 males [25.3%]) and 606 females ([74.7%]) aged 10 to 16 years (mean [SD], 13.51 [1.7] years) participated. The prevalence of depressive and anxiety symptoms among patients diagnosed with AIS was 36.3% and 34.6%, respectively, while a comorbidity rate of 26.8% was observed. Network analysis revealed that “Sad mood”, “Excessive worry” and “Fatigue” were identified as the central symptoms in the whole depressive and anxiety symptoms network, while “Sad mood” and “Irritability” served as bridge symptoms. “Uncontrollable worry” exhibited the most robust direct association with physical QOL, while “Irritability”, “Anhedonia” and “Sad mood” were directly associated with mental QOL. Gender did not exert a discernible influence on the global strength and network structure of the depressive and anxiety symptoms network. Conclusions The central and bridge symptoms identified within the network may serve as potential targets for intervention in depressive and anxiety symptoms and the comorbidity among patients with AIS. Interventions that target specific symptoms directly related to QOL are necessary to mitigate depressive and anxiety symptoms and improve the QOL of patients with AIS.