31.6% of adolescents reported between depression and anxiety.
The network model analyzing depression and anxiety in adolescents was found to be highly stable.
Strongest connections in the depression-anxiety community were identified between 'Control worry' and 'Too much worry', 'Restless' and 'Irritable', and 'Anhedonia' and 'Sad mood'.
'Sad mood' and 'Too much worry' emerged as core symptoms within their respective networks.
'Nervous', 'Guilt', and 'Restless' were identified as key symptoms linking the comorbidity of depression and anxiety.
'Too much worry' had the highest strength value, while 'Nervous' demonstrated the highest bridge strength and expected influence.
Simplified
OBJECTIVES: This study employed to investigate the model between depression and anxiety among Chinese adolescents during the normalization phase of COVID-19 pandemic prevention and control.
METHODS: From October to December 2021, a total of 22 868 adolescents were selected from 27 schools in 8 cities of China by multistage cluster sampling. Depressive symptoms and anxiety symptoms of adolescents were evaluated by the Patient Health Questionnaire 9 (PHQ-9) and the Generalized Anxiety Disorder scale 7 (GAD-7), respectively. The network structure between depression and anxiety was explored using the Extended Bayesian Information Criterion (EBIC) and the graphical Least Absolute Shrinkage and Selection Operator (LASSO) method. The centrality of nodes, stability, accuracy, central symptoms, bridging symptoms, and network comparison were analyzed.
RESULTS: In the present study, 7 236 (31.6%) participants reported with depression-anxiety comorbidity. The obtained network model was highly stable. The edges between 'Control worry' and 'Too much worry', between 'Restless' and 'Irritable', and between 'Anhedonia' and 'Sad mood' were the three strongest positive edges in the anxiety and depression community. The edges between 'Motor' and 'Restless', between 'Guilt' and 'Nervous', and between 'Suicide' and 'Afraid' were the three strongest positive edges in the comorbidity community. 'Sad mood' and 'Too much worry' were the core symptoms within the 'depression' network and 'anxiety' network. 'Nervous', 'Guilt', and 'Restless' were three crucial bridge symptoms linking the comorbidity of depression and anxiety networks. Furthermore, 'Too much worry' (strength index = 1.087) has the highest strength value. 'Nervous' (bridge strength index = 0.51, expected influence (1-step) = 0.51, expected influence (2-step) = 0.93) not only demonstrated the highest bridge strength but also exhibited the highest bridge expected influence. At last, we found that there were no significant differences between genders.
CONCLUSIONS: In this study, 'Nervous', 'Guilt', and 'Restless' were identified as three crucial bridge symptoms linking the comorbidity of depression and anxiety networks. Timely and multilevel interventions targeting these bridge symptoms may help alleviate the comorbidity of depression and anxiety in Chinese adolescents.
CLINICAL TRIAL NUMBER: Not applicable.
Key numbers
7 236 of 22 868
Rate
Proportion of adolescents with both depression and anxiety symptoms.
3
Key Bridge Symptoms
Number of crucial bridge symptoms linking depression and anxiety.
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Declarations. Ethics approval and consent to participate: The Ethics Committee of Anhui Medical University approved this study (NO: 20200573). Both the adult participants and the parent(s)/guardian(s) of all under-16s received written informed consent. All data procedures were carried out in accordance with relevant ethical guidelines and regulations associated with the declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
