Mapping Connection and Direction Among Symptoms of Sleep Disturbance and Perceived Stress in Firefighters: Embracing the Network Analysis Perspective

Bin Liu,1,* Mingxuan Zou,1,2,* Lin Liu,3,4,* Zhongying Wu,1 Yinchuan Jin,1 Yuting Feng,1 Qiannan Jia,1 Mengze Li,1 Lei Ren,5,6 Qun Yang1 1Department of Military Medical Psychology, Air Force Medical University, Xi’an, People’s Republic of China; 2Public Health School, Shaanxi University of Chinese Medicine, Xi’an, People’s Republic of China; 3Department of Emergency, Xijing Hospital of Air Force Medical University, Xi’an, People’s Republic of China; 4Department of Emergency, Honghui Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China; 5Military Psychology Section, Logistics University of PAP, Tianjin, People’s Republic of China; 6Military Mental Health Services & Research Center, Tianjin, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qun Yang, Department of Military Medical Psychology, Air Force Medical University, Xi’an, 710032, People’s Republic of China, Tel +8613709241788, Email [email protected]: There is an intricate relationship between sleep disturbances and perceived stress in firefighters. Network analysis offers novel perspectives for examining the interactions between diseases. Hence, this study aimed to elucidate the relationship between sleep disturbances and perceived stress in firefighters through network analysis approaches.Methods: A total of 786 Chinese firefighters were included in this study. Two methodologies, the regularized partial correlation network (RPCN) and the directed acyclic graph (DAG), were employed to perform network analysis.Results: Within the RPCN, P2 “Unable to control important things” and P7 “Unable to control irritations in life” were identified as central symptoms that simultaneously maintained sleep disturbances and perceived stress among firefighters. S7 “Daytime dysfunction” and P3 “Felt nervous and stressed” were classified as bridge symptoms, connecting sleep disturbances with perceived stress and perpetuating their comorbid nature. From a probabilistic priority perspective, the DAG demonstrated that the bidirectional spiral between sleep disturbances and perceived stress might be attributed to the fact that the upstream symptom S7 “Daytime dysfunction” influenced the perceived self-efficacy dimension of perceived stress, which in turn influenced other sleep disturbance symptoms.Conclusion: Our findings not only provided innovative insights into further understanding the relationship between sleep disturbances and perceived stress among firefighters, but also identified potential targets for ameliorating these symptoms, such as the central, bridge, and upstream symptoms. Future intervention programs should prioritize these potential targets. Through the implementation of interventions like mindfulness-based stress reduction, cognitive behavioral therapy, and group psychotherapy, tailored to address these targeted symptoms, it is feasible to effectively mitigate both sleep disturbances and perceived stress in firefighters, and ultimately improve the mental health of this particular occupational group.Keywords: sleep disturbances, perceived stress, network analysis, firefighters