Network analysis of social isolation, loneliness, depression and anxiety among post-discharge rehabilitation patients.

BACKGROUND: Patients undergoing inpatient or outpatient rehabilitation frequently experience substantial changes in physical functioning, social roles, and daily routines, which may increase vulnerability to social disconnection and psychological distress. This study applied network analysis to explore the interrelationships among social isolation, loneliness, anxiety, and depression in post-discharge rehabilitation patients. AIMS: This study aimed to characterize two network models of social isolation, loneliness, depressive symptoms, and anxiety symptoms among post-discharge rehabilitation patients. METHODS: A cross-sectional study was conducted among patients discharged from the rehabilitation department of a tertiary hospital in China during outpatient follow-up between August 2024 and June 2025. Data on social isolation, loneliness, depressive symptoms and anxiety symptoms were collected from participants. Network structures were estimated using a Graphical Gaussian Model and a Directed Acyclic Graph. RESULTS: A total of 340 patients discharged from the rehabilitation department were included, with a mean age of 62.1 years. The Graphical Gaussian Model identified a moderately dense network with strong connections between social isolation and loneliness, as well as between several anxiety and depressive symptoms. Fear of awful events, anhedonia, and fatigue emerged as the most central symptoms within the network. The Directed Acyclic Graph analysis suggested that fatigue and fear of awful events functioned as upstream symptoms influencing other emotional and social symptoms. CONCLUSIONS: Among post-discharge rehabilitation patients, social isolation and loneliness in are embedded within a complex network of anxiety and depressive symptoms. The identified central and bridge symptoms may serve as hypothesis-generating candidates for future psychosocial intervention studies. Network analysis provides a useful framework for examining psychological distress in rehabilitation settings.