Depression and Anxiety in Hospice Patients: A Combination of Network Analysis and Latent Class Analysis

Depression and anxiety are prevalent among hospice patients. A detailed understanding of the symptom comorbidity and key symptoms of depression and anxiety among Chinese hospice patients can promote targeted interventions. This study investigates the depression and anxiety symptom network and compares networks in different symptom groups in 388 Chinese hospice patients. Patient Health Questionnaire-9 and the Seven-Item Generalized Anxiety Disorder Scale were used to measure depression and anxiety. Psychometric network analysis and latent class analysis were conducted using R and MPLUS. Hopelessness and anhedonia in depression and excessive worry and nervousness in anxiety symptoms were identified as the most central symptoms. Hopelessness, nervousness, and irritability were identified as the bridging symptoms. Latent class analysis identified two groups based on sixteen symptoms: "mild-symptom" and "moderately-severe-symptom." Significant global strength differences were found between the networks of the mild-symptom group and the moderately-severe-symptom group. In the mild-symptom network, hopelessness, excessive worry, uncontrollable worry, and anhedonia were the central symptoms, while hopelessness, worthlessness, and uncontrollable worry were the bridging symptoms. In the moderately-severe-symptom network, nervousness, difficulty relaxing, fatigue, impending doom, and uncontrollable worry were the central symptoms, while hopelessness and nervousness were the bridging symptoms. These findings suggest that hopelessness should be a primary intervention target to reduce overall depression and anxiety symptoms. Additional focus should be placed on anhedonia, excessive worry, and nervousness. Intervening in hopelessness, nervousness, and irritability helps reduce the concurrence between depression and anxiety. Nuanced intervention strategies should be implemented based on the severity of symptoms among hospice patients.