Network analysis of depression symptoms and physical activity levels before and after menopause

Abstract

Background Previous research has established connections between pre- and postmenopause, physical activity, and depression. This study aims to delve deeper into the network structure of depressive symptoms and specific manifestations of these symptoms at different levels of physical activity during pre- and postmenopause, utilizing network analysis as a tool. Methods Our research utilized data samples from the National Health and Nutrition Examination Survey (NHANES) spanning from 2009 to 2018. We assessed depression symptoms through the Patient Health Questionnaire-9, while categorizing physical activity based on the Metabolic Equivalent of Task (MET) values recommended by NHANES and the U.S. physical activity guidelines. We conducted an analysis of the depression symptoms network across varying levels of physical activity, both pre and post-menopause, to identify core symptoms within the network using ‘strength’ statistics. Furthermore, we evaluated the stability of the network structure via network stability and edge weight difference tests. Results Within the network model of depressive symptoms, both pre- and post-menopause, ‘Sad Mood’ emerged as the most central symptom, positioning itself as the core of the network. Furthermore, there was a noticeable decrease in the correlation between depressive symptoms and a reduced stability in the network structure during periods of high physical activity compared to those of low physical activity (88.9% → 66.7%, 80.5% → 72.2%). Notably, no significant structural differences were observed between the pre-menopausal and post-menopausal network models, regardless of physical activity levels (PS > 0.05, PM > 0.05). Conclusion The symptom of ‘Sad Mood’ is pivotal in the network of depressive symptoms observed in both pre- and post-menopausal women. Engaging in high levels of physical activity may diminish the centrality of this symptom within the network, thereby weakening its association with other symptoms. Prioritizing attention to ‘Sad Mood’ symptoms during the pre- and post-menopausal phases could be instrumental in mitigating and forestalling the exacerbation of depressive distress.