Comorbidity network characteristics of depressive and anxiety symptoms and their associations with quality…

Cross-sectionalFrontiers in psychiatry· 2026

Comorbidity network characteristics of depressive and anxiety symptoms and their associations with quality of life in patients with spinal cord injury: a cross-sectional study.

Lu Lu, Xinyuan Qiu, Yiqi Lai … Rongbin Chen

Spinal Cord Injury RehabilitationCross-sectionalDiagnosisQ1IF 3.5

Guilt was the most central symptom in depression-anxiety networks after spinal cord injury

Comorbidity network characteristics of depressive and anxiety symptoms and their associations with quality of life in patients with spinal cord injury: a cross-sectional study.

Lu Lu … Rongbin Chen

Frontiers in psychiatry · 2026 · Q1 in Psychiatry

Purpose

To examine the topological structure of the comorbidity network of depressive and anxiety symptoms in patients with subacute spinal cord injury (spinal cord injury), identify core and bridge symptoms, and explore the independent associations between specific symptoms and quality-of-life outcomes.

Methods

A total of 316 patients with subacute spinal cord injury were assessed using the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), and the World Health Organization Quality of Life Brief Version (WHOQOL-BREF).

n = 316 patients

Results

guilt was the single most influential symptom driving the network

1.257EI

Guilt (PHQ.6)

1.096EI

Irritability (GAD.6)

1.006EI

Psychomotor changes (P

More results

The strongest edges in the network were PHQ.9-PHQ.8 (weight = 0.396), PHQ.5-PHQ.4 (weight = 0.395), and PHQ.8-GAD.5 (weight = 0.384).

Network comparison tests results showed no significant differences in network structure or global strength across sex or injury severity subgroups (P > 0.05).

More results

Bootstrap analyses supported acceptable network stability.

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Conclusion · 1 of 2

The depression-anxiety comorbidity network in patients with spinal cord injury appears to be organized around a limited number of highly influential symptoms, particularly guilt, irritability, and psychomotor abnormalities.

Conclusion · 2 of 2

Moving beyond total questionnaire scores, prioritizing symptoms with high centrality, strong bridge effects, and close links to quality-of-life outcomes may help refine psychological assessment and intervention planning in spinal cord injury rehabilitation.

Comorbidity network characteristics of depressive and anxiety symptoms and their associations with quality of life in patients with spinal cord injury: a cross-sectional study.

Comorbidity network characteristics of depressive and anxiety symptoms and their associations with quality of life in patients with spinal cord injury: a cross-sectional study.

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