Prevalence and inter-relationship of depressive symptoms, anxiety symptoms and poor sleep quality and their associations with quality of life in patients with coronary heart disease: findings from a large nationwide survey

Abstract

Patients with coronary heart disease (CHD) commonly experience depressive and anxiety symptoms, poor sleep quality, and low health-related quality of life (HRQoL). However, inter-relationships between such mental health problems at a symptom level and their associations with HRQoL among patients with CHD remain unclear. This study compared the prevalence and network structure of psychiatric symptoms between participants with and without CHD and examined the associations between these symptoms and HRQoL. We conducted a cross-sectional nationwide survey and applied propensity score matching (PSM) to balance demographic characteristics between the CHD and non-CHD groups. The study used standardized instruments for depressive and anxiety symptoms, sleep quality, and HRQoL, and employed network analysis to identify central and bridge symptoms. The analyses included a total of 1,027 patients with CHD and 2,048 matched controls. The CHD group showed significantly higher prevalence of depressive symptoms (71.9%, 95% CI: 69.0%–74.6%), anxiety symptoms (60.9%, 95% CI: 57.8%−63.9%), and poor sleep quality (43.8%, 95% CI: 40.8%−46.9%) compared to the non-CHD group (depressive symptoms: 52.1%, 95% CI: 49.9%–54.2%; anxiety symptoms: 42.2%, 95% CI: 40.1%–44.4%; poor sleep quality: 29.6%, 95% CI: 27.7%–31.7%; all p < 0.001). HRQoL was significantly lower in the CHD group ( p < 0.001) than the non-CHD group. Network analysis revealed that “Feeling afraid” (GAD7) had the highest expected influence in both groups. In the CHD group, “Sleep efficiency” (PSQI3) also showed high expected influence, while “Suicidal ideation” (PHQ9) and “Feeling afraid” (GAD7) were identified as key bridge symptoms. In the non-CHD group, “Restlessness” (GAD5) and “Sad mood” (PHQ2) were the key bridge symptoms. In both groups, “Night awakenings” (PSQI2) and “Sleep quality” (PSQI1) were strongly linked to reduced HRQoL. Network comparison tests showed no significant group differences in either the depressive–anxiety–sleep symptom networks or the HRQoL–symptom networks. Participants with CHD showed more severe depressive and anxiety symptoms, poorer sleep quality, and lower HRQoL than those without CHD. No significant group differences were observed in either the symptom networks or the HRQoL–symptom networks, indicating broadly comparable symptom-level patterns across CHD status. These findings may inform psychological and sleep-related assessment and symptom monitoring in CHD populations, but longitudinal and interventional studies are needed to establish their predictive and clinical relevance.