Symptom networks of common mental disorders in public versus private healthcare settings in India

We present a series of network analyses aiming to uncover the symptom constellations of depression, anxiety and somatization among 2,796 adult primary health care attendees in Goa, India, a low- and middle-income country (LMIC). Depression and anxiety are the leading neuropsychiatric causes of disability. Yet, the diagnostic boundaries and the characteristics of their dynamically intertwined symptom constellations remain obscure, particularly in non-Western settings. Regularized partial correlation networks were estimated and the diagnostic boundaries were explored using community detection analysis. The global and local connectivity of network structures of public versus private healthcare settings and treatment responders versus nonresponders were compared with a permutation test. Overall, depressed mood, panic, fatigue, concentration problems and somatic symptoms were the most central. Leveraging the longitudinal nature of the data, our analyses revealed baseline networks did not differ across treatment responders and nonresponders. The results did not support distinct illness subclusters of the CMDs. For public healthcare settings, panic was the most central symptom, whereas in private, fatigue was the most central. Findings highlight varying mechanism of illness development across socioeconomic backgrounds, with potential implications for case identification and treatment. This is the first study directly comparing the symptom constellations of two socioeconomically different groups in an LMIC.