A network analysis of post-traumatic stress disorder, anxiety, and depression in women with pregnancy loss

Pregnancy loss represents a significant public health concern within the realm of female reproductive health. In the current landscape of research, post-traumatic stress disorder (PTSD), anxiety, and depression are often investigated as an undifferentiated whole. However, this approach overlooks the unique symptomatic relationships and nuances that may exist among these mental health conditions in women who have endured pregnancy loss. This study aimed to dissect the symptomatic interconnections among PTSD, anxiety, and depression in women who have experienced pregnancy loss. A cross-sectional study was carried out at a tertiary hospital in Zhengzhou, China. Women with pregnancy loss were surveyed using a general information questionnaire, the Posttraumatic Stress Disorder Checklist-Civilian Version, and the Hospital Anxiety and Depression Scale. Network analysis was performed using R software to examine pairwise associations among symptoms, identify core symptoms (i.e., key nodes with the strongest connectivity within the network), and detect bridge symptoms (i.e., symptoms that link post-traumatic stress, anxiety, and depressive symptom clusters). We also evaluated the accuracy and stability of the estimated network structure. Of the 691 women with pregnancy loss included in the analyses, PTSD entry 6 (Try to avoid thoughts and feelings that remind you of it) and PTSD entry 7 (Make an effort to avoid conversations, people, places and activities that remind you of the matter) had the strongest association, with a regularized partial correlation coefficient of 0.485. PTSD entry 7 was the most central symptom in the network, with a centrality strength of 1.748. Entry 5 (Muscle tension, shortness of breath, rapid heartbeat, dry mouth, and stomach cramps) had the strongest bridging effect. The accuracy and stability of the network was tested to be better, and the network model was more reliable. Through the innovative application of network analysis, this study successfully explored the associations between PTSD items and symptoms of anxiety and depression in women with pregnancy loss. By identifying the core and bridging symptoms, it provides valuable insights into the underlying mechanisms of these co-occurring mental health conditions.