Network analysis of item-level neuroticism in recurrent major depression among Korean women

Abstract

Background: Neuroticism is a core personality trait strongly associated with Major Depressive Disorder (MDD), influencing both its onset and recurrence, and suggesting a persistent vulnerability to depression. Methods: The study included 2997 women with recurrent MDD and 3046 female controls. Neuroticism was assessed using the Neuroticism scale of the Eysenck Personality Questionnaire. Networks were estimated using the Ising model, community structures derived through Exploratory Graph Analysis, and stability tested via bootstrapping. Network Comparison Tests evaluated structural and connectivity differences between groups, with sensitivity analyses excluding zero-scoring participants. Results: Both groups exhibited a four-community configuration, including tension/agitation, hyperarousal and sleep disturbance, interpersonal sensitivity, and cognitive distress. "Being sensitive" emerged as the most central node, strongly linked to insomnia. Although the network structure was similar, the MDD group showed signif-icantly lower global strength. Bootstrapped analyses confirmed the stability of centrality indices. No significant network differences were found within the MDD group based on episode frequency, melancholia, or suicide risk. Sensitivity analyses showed that excluding zero-scoring controls led to lower global strength in the control group. Limitations: The study focused exclusively on women, which limits the generalizability of the findings to all genders, and relied on self-report questionnaires, which may introduce biases. Conclusion: Neuroticism exhibited a stable structure in both groups, but global connectivity was lower in the MDD group. "Being sensitive" emerged as the central node, suggesting its potential as a target for intervention.