{
    "abstract": "Insomnia, depression, anxiety, and stigma are prevalent and often coexist in patients with Tuberculosis (TB), potentially exacerbating one another. However, the complex intrinsic associations among these four disorders remain unclear, particularly concerning the role of stigma in relation to the other disorders.\nA cross-sectional study was conducted at West China Hospital and the Fourth People's Hospital of Guangxi from November 2023 to June 2024. The levels of insomnia, depression, anxiety, and stigma among TB patients were assessed using the Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the TB-Related Stigma Scale (TRSS). Network analysis was used to identify the central and bridge symptoms and explore the role of stigma within the insomnia-depression-anxiety-stigma network.\nPHQ1 (anhedonia), GAD1 (nervousness), GAD5 (restlessness), and PHQ3 (sleep problems) are central to the network. Bridge symptoms, including PHQ3 (sleep problems), PSQI5 (sleep disturbances), and GAD5 (restlessness) link the depression, insomnia, and anxiety communities. TRSS1 (family's negative perception) of the stigma community exhibited the highest betweenness and second highest bridge betweenness in the network, highlighting the mediating role of family support across insomnia and psychological symptoms. Additionally, the global strength invariance test indicates that gender, age and education level do not significantly impact the network structure.\nDepression (anhedonia and sleep problems) and anxiety (nervousness and restlessness) are the primary concerns requiring intervention in TB patients. In addition, sleep problems act as a bridge in the overall network. Stigma, particularly negative perceptions from family, may play a crucial mediating role in sustaining the entire symptom network. Consequently, these symptoms could represent potential targets for intervention.",
    "authors": [
        {
            "affiliation": "Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.",
            "firstname": "Xiangmin",
            "initials": "X",
            "lastname": "Liu"
        },
        {
            "affiliation": "Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.",
            "firstname": "Xue",
            "initials": "X",
            "lastname": "Qiu"
        },
        {
            "affiliation": "Department of Intensive Care Unit, The Fourth People Hospital of Nanning, Nanning, China.",
            "firstname": "Huizhen",
            "initials": "H",
            "lastname": "Lan"
        },
        {
            "affiliation": "Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.",
            "firstname": "LiuYue",
            "initials": "L",
            "lastname": "Diao"
        },
        {
            "affiliation": "Chengdu Center for Disease Control and Prevention, Chengdu, China.",
            "firstname": "Wei",
            "initials": "W",
            "lastname": "Huang"
        },
        {
            "affiliation": "Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.",
            "firstname": "Yan",
            "initials": "Y",
            "lastname": "Wen"
        },
        {
            "affiliation": "Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.\nNursing Key Laboratory of Sichuan Province, Chengdu, China.",
            "firstname": "Mei",
            "initials": "M",
            "lastname": "Feng"
        },
        {
            "affiliation": "Mental Health Center/Neurobiology Monitoring Center, West China Hospital, Chengdu, China.",
            "firstname": "Xiangdong",
            "initials": "X",
            "lastname": "Tang"
        }
    ],
    "conclusions": "Depression (anhedonia and sleep problems) and anxiety (nervousness and restlessness) are the primary concerns requiring intervention in TB patients. In addition, sleep problems act as a bridge in the overall network. Stigma, particularly negative perceptions from family, may play a crucial mediating role in sustaining the entire symptom network. Consequently, these symptoms could represent potential targets for intervention.",
    "copyrights": "Copyright \u00a9 2025 Liu, Qiu, Lan, Diao, Huang, Wen, Feng and Tang.",
    "doi": "10.3389/fpsyt.2024.1513524\n10.3389/fpubh.2022.1047425\n10.5588/ijtld.15.0318\n10.4103/ipj.ipj_58_23\n10.1186/s12991-020-00281-8\n10.1002/jlb.Mr0119-023r\n10.1016/j.ijtb.2019.02.007\n10.1186/s12889-020-10055-2\n10.5588/ijtld.12.0654\n10.1186/s12888-019-2042-6\n10.1186/s12879-022-07946-7\n10.1186/1745-0179-4-4\n10.1038/s41398-021-01738-4\n10.1007/s10803-022-05620-0\n10.1016/j.jad.2024.05.091\n10.3389/fpubh.2023.1223429\n10.1186/s12888-022-04088-7\n10.1186/s12879-021-06284-4\n10.1186/s40249-020-00762-8\n10.1126/sciadv.abm9737\n10.3389/fpsyt.2018.00618\n10.1146/annurev-clinpsy-050212-185608\n10.1177/1745691617705892\n10.1002/erv.2832\n10.1016/j.jad.2022.05.061\n10.1016/j.janxdis.2017.09.008\n10.1016/j.jad.2021.07.072\n10.1176/appi.ajp.2020.20050653\n10.1002/pchj.331\n10.1002/da.22490\n10.1016/j.jad.2024.05.131\n10.1016/j.eclinm.2023.102084\n10.5498/wjp.v12.i5.722\n10.1038/ncomms10448\n10.1016/j.jad.2021.04.047\n10.1016/j.jad.2024.01.260\n10.1136/bmjopen-2018-026502\n10.1155/2013/489865\n10.1177/0020872814547436\n10.1007/s00406-017-0773-2\n10.3233/jad-201004\n10.1080/13811118.2016.1275993",
    "journal": "Frontiers in psychiatry",
    "keywords": [
        "anxiety",
        "depression",
        "insomnia",
        "stigma",
        "symptom network analysis",
        "tuberculosis"
    ],
    "methods": null,
    "publication_date": "2025-02-07",
    "pubmed_id": "39917380\n36684994\n26970151\n38853803\n32419837\n31254317\n30878069\n33397334\n23407228\n30823918\n36550493\n18302758\n34921138\n35752729\n38777272\n37575111\n35790936\n34118910\n33092636\n35235345\n30534088\n23537483\n28873325\n33949742\n35594975\n29125957\n34375200\n33653118\n31845536\n27699943\n38810787\n37528846\n35663298\n26835600\n34004404\n38302062\n31133584\n23691305\n28188369\n33185610\n28010177",
    "results": "PHQ1 (anhedonia), GAD1 (nervousness), GAD5 (restlessness), and PHQ3 (sleep problems) are central to the network. Bridge symptoms, including PHQ3 (sleep problems), PSQI5 (sleep disturbances), and GAD5 (restlessness) link the depression, insomnia, and anxiety communities. TRSS1 (family's negative perception) of the stigma community exhibited the highest betweenness and second highest bridge betweenness in the network, highlighting the mediating role of family support across insomnia and psychological symptoms. Additionally, the global strength invariance test indicates that gender, age and education level do not significantly impact the network structure.",
    "title": "Symptom network analysis of insomnia-depression-anxiety-stigma in tuberculosis patients.",
    "xml": "<Element 'PubmedArticle' at 0x7885028f2110>"
}