Network analysis of MHD patients revealed that fatigue is the core symptom, while the beliefs dimension of mental health literacy and sleep problems are the key bridging symptoms linking mental health literacy to depressive/anxiety symptoms, with significant gender differences in network structure.
Mental health literacy total score significantly negatively correlates with both depressive symptoms and anxiety in maintenance hemodialysis patients.
PHQ4 (Feeling tired or having little energy) and GAD4 (Trouble relaxing) showed the highest strength centrality in the symptom network.
The beliefs dimension of MHL (MHL2) showed the highest strength centrality within the MHL cluster and the highest bridge strength overall.
PHQ3 (Trouble falling or staying asleep, or sleeping too much) was identified as a key bridge symptom between depression/anxiety symptoms and mental health literacy.
A statistically significant difference in network structure was observed between male and female MHD patients.
The study recruited 757 maintenance hemodialysis patients from multiple centers to construct the network model.
This research suggests that among patients who undergo regular kidney dialysis (maintenance hemodialysis), understanding mental health — called mental health literacy — is meaningfully linked to lower levels of depression and anxiety. The researchers used a statistical technique called network analysis to map how different symptoms and aspects of mental health literacy connect to one another in a group of 757 dialysis patients across six hospitals in China. This approach goes beyond simple correlations by showing which symptoms are most central to the overall network and which ones act as bridges connecting different clusters of symptoms. The study found that fatigue (feeling tired or having little energy) was the most central symptom in the network, meaning it was most strongly connected to other symptoms. Difficulty relaxing was also highly central. Importantly, the 'beliefs' dimension of mental health literacy — which reflects how people think about and understand mental health conditions — was the strongest bridge connecting mental health literacy to depression and anxiety symptoms. Sleep problems (difficulty falling or staying asleep, or sleeping too much) also served as a key bridge between these symptom clusters. Additionally, the network structure differed significantly between men and women, suggesting that the way these symptoms and knowledge factors relate to each other may not be the same across genders. This research suggests that interventions for dialysis patients experiencing depression or anxiety might be most effective if they target fatigue management, sleep quality, and efforts to improve mental health beliefs and knowledge. The finding of gender differences further suggests that treatment approaches may need to be tailored differently for men and women. Because dialysis patients already face significant physical burdens, identifying these specific psychological targets could help clinicians prioritize support strategies for this vulnerable population.
Xue G, Li Y, Ling Z, Zhang X, Yuan L, Lin X, et al.. (2026). Network analysis of mental health literacy and depressive/anxiety symptoms in patients under maintenance hemodialysis: a cross-sectional study of multicenter data.. Scientific reports. https://doi.org/10.1038/s41598-026-65455-y