Network structure of sleep quality and its bridging association with anhedonia in adolescent major depression disorder

Abstract

Background

Major depressive disorder (MDD) is a leading cause of disease burden in adolescents, with persistently rising prevalence. Anhedonia, core symptom of adolescent MDD, is associated with suicidality and poor clinical outcomes. Impaired sleep quality is proven to be a significant risk factor for adolescent MDD and potentially influence anhedonia symptoms. Understanding the interplay between sleep quality and anhedonia is crucial for early intervention and treatment.

Methods

This cross-sectional study recruited 200 drug-naïve adolescent MDD patients from Xijing Hospital. Depression, anhedonia and sleep quality were assessed during outpatient visits, using the Hamilton Depression Rating Scale, Snaith-Hamilton Pleasure Scale, and Pittsburgh Sleep Quality Index, respectively. Network analysis was applied to construct sleep quality network and its co-occurrence network with anhedonia. Centrality indices were computed to indicate central symptoms.

Results

Adolescent MDD patients exhibited moderate depression and anhedonia levels, and are heavily accompanied with sleep complaints. The sleep quality network identified “subjective sleep quality” as the most central factor, mainly due to prolonged “sleep latency” and shortened “sleep duration”. In the co-occurrence network, “sleep disturbances” had prominent bridging connection with anhedonia, suggesting its critical role in activating anhedonia symptoms.

Conclusions

Subjective sleep quality was the most central sleep complaints in adolescent MDD, while sleep disturbances were prominently associated with anhedonia. These findings underscore the importance of reducing sleep disturbances to alleviate anhedonia symptoms under clinical settings. Network analysis provides a nuanced understanding of the complex relationship of sleep quality and its association with anhedonia in adolescent MDD.