The central symptoms of depression, anxiety, and somatization: a network analysis

Depression, anxiety and somatization are the most common mental disorders in primary health care. Previous studies have shown that depression, anxiety and somatization are highly comorbid. The study population included 939 depression patients from outpatient and inpatient departments. All patients were assessed with the Patient Health Questionnaire-9 (PHQ-9), the 7-item Generalized Anxiety Disorder Scale (GAD-7) and the 15-item Patient Health Questionnaire Somatic Symptom Severity Scale (PHQ-15). We estimated the network and centrality of depressive, anxiety and somatic symptoms in patients with depression. Feeling tired or having little energy and feeling down, hopeless were the central symptoms of depression in each network. Low interest or pleasure was not the central symptom. Education was negatively correlated with suicidal ideation. The importance of feeling down, hopeless and fatigue as central symptoms of each network is emphasized. Fatigue symptoms are particularly common in people with depression, and their influence at the center of the depression network may be underestimated. In addition, low interest or pleasure was not the central symptom for each network and education was negatively correlated with suicidal ideation.