The Inter-Relationships Between Depressive Symptoms and Suicidality Among Macau Residents After the “Relatively Static Management” COVID-19 Strategy: A Perspective of Network Analysis

Mei Ieng Lam,1,2 Hong Cai,2,3 Pan Chen,2,3 Ka-In Lok,4 Ines Hang Iao Chow,2 Tong Leong Si,2 Zhaohui Su,5 Chee H Ng,6 Feng-Rong An,7 Yu-Tao Xiang2,3 1Education Department, Kiang Wu Nursing College of Macau, Macau SAR, People’s Republic of China; 2Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, University of Macau, Macao SAR, People’s Republic of China; 3Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, People’s Republic of China; 4Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, People’s Republic of China; 5School of Public Health, Southeast University, Nanjing, People’s Republic of China; 6Department of Psychiatry, The Melbourne Clinic and St Vincent’s Hospital, University of Melbourne, Richmond, Victoria, Australia; 7Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Chee H Ng, Department of Psychiatry, The Melbourne Clinic and St Vincent’s Hospital, University of Melbourne, Richmond, Victoria, Australia, Email cng@unimelb.edu.au Yu-Tao Xiang, Faculty of Health Sciences, University of Macau, 1/F, Building E12, Macau, People’s Republic of China, Email xyutly@gmail.comBackground: Suicidality is a global public health problem which has increased considerably during the coronavirus disease 2019 (COVID-19) pandemic. This study examined the inter-relationships between depressive symptoms and suicidality using network analysis among Macau residents after the “relatively static management” COVID-19 strategy.Methods: An assessment of suicidal ideation (SI), suicide plan (SP), suicide attempt (SA) and depressive symptoms was conducted with the use of individual binary response items (yes/no) and Patient Health Questionnaire (PHQ-9). In the network analysis, central and bridge symptoms were identified in the network through “Expected Influence” and “Bridge Expected Influence”, and specific symptoms that were directly associated with suicidality were identified via the flow function. Network Comparison Tests (NCT) were conducted to examine the gender differences in network characteristics.Results: The study sample included a total of 1008 Macau residents. The prevalence of depressive symptoms and suicidality were 62.50% (95% CI = 59.4– 65.5%) and 8.9% (95% CI = 7.2– 10.9%), respectively. A network analysis of the sample identified SI (“Suicidal ideation”) as the most central symptom, followed by SP (“Suicide plan”) and PHQ4 (“Fatigue”). SI (“Suicidal ideation”) and PHQ6 (“Guilt”) were bridge nodes connecting depressive symptoms and suicidality. A flow network revealed that the strongest connection was between S (“Suicidality”) and PHQ6 (“Guilt”), followed by S (“Suicidality”) and PHQ 7 (“Concentration”), and S (“Suicidality”) and PHQ3 (“Sleep”).Conclusion: The findings indicated that reduction of specific depressive symptoms and suicidal thoughts may be relevant in decreasing suicidality among adults. Further, suicide assessment and prevention measures should address the central and bridge symptoms identified in this study.Keywords: COVID-19, depression, suicidality, adults, network analysis