Network Analysis of Depression, Anxiety, and Social Participation in Individuals with Traumatic Brain Injury

Research Objectives: To investigate the relationship between anxiety symptoms, depression symptoms, and social participation in individuals with traumatic brain injury (TBI) at one-year post-injury.

Design: We used network analysis in a cross-sectional sample of individuals with TBI to understand the complexity of relationships between anxiety symptoms, depression symptoms, and social participation. In this approach, each variable represents a node and edges represent the link between nodes. Network models are based on partial correlations, which measure the association between different variables while controlling for all other variables in the network.

Setting: General community.

Participants: 3,621 participants from the Traumatic Brain Injury Model System national database (https://osf.io/a4xzb/) who completed the one-year follow-up after their hospitalization.

Interventions: Not applicable.

Main Outcome Measures: The primary outcome measures were the nine depression symptoms measured by the Patient Health Questionnaire-9 (PHQ-9), the seven anxiety symptoms measured by the Generalized Anxiety Disorder-7 (GAD-7), and four social participation factors measured by social sub-domain in Participation Assessment with Recombined Tools – Objective (PART-O).

Results: There was a strong relationship between the GAD-7 items, “Not being able to stop or control worrying” and “Worrying too much about different things”. We also found a strong relationship between the PHQ-9 items, “Feeling down, depressed, or hopeless” and “Feeling bad about yourself - or that you are a failure”. There was moderate relationship between the PART-O items “Amount of times socialized with friends in a week” and “Amount of times Internet was used for communication in a week” and “Amount of times socialized with family in a week” and “Amount of times socialized with friends in a week”. However, there was weak to no relationship between items across the anxiety, depression, and social participation domains.

Conclusions: Results suggest that specific depression and anxiety symptoms are differently associated with each other. This highlights the importance of analyzing individual symptoms rather than focusing on the aggregate of depression and anxiety symptoms. Future directions involve investigating how symptoms of anxiety and depression and social participation interact at different time points post-injury.

Author(s) Disclosures: None.