Network analysis of depressive and anxiety symptoms in adolescents during the later stage of the COVID-19 pandemic

Which should be targeted first? The comorbidity of sleep disturbances and anxiety symptoms among adolescents: Cross-sectional and longitudinal network analyses

BACKGROUND

The comorbidity of sleep disturbances and anxiety is well-established, but which symptoms to prioritize for intervention remains unclear. Academic stress, a key factor worsening both, is common among adolescents facing growing academic demands. Understanding how it affects both comorbidities from a symptomatology perspective is crucial for developing targeted interventions.

METHODS

The longitudinal survey of 34,494 adolescents was conducted twice (Mage = 12.89 [1.76] years). Adolescents were categorized into three groups based on academic stress scores' mean ± 1 standard deviation. Then, we examined the moderating effect of academic stress on the relationship between sleep disturbances and anxiety symptoms longitudinally by comparing groups' network structures, where nodes represent symptoms, and edge thickness reflects the associations' strength.

RESULTS

In the cross-sectional network, at both time points, the key bridge symptom is "sleep quality" (bridge Expected Influence (bEI) at T1 = 0.21; bEI at T2 = 0.20). In the longitudinal network, "irritability" (bEI = 0.21) and "sleep quality" (bEI = 0.21) are key bridge symptoms in the whole sample, with "sleep quality" (bEI = 0.36) most prominent in the high stress group. In the low stress group, it's "difficulty initiating sleep" (bEI = 0.14). Additionally, compared to the low group, adolescents with high academic stress possess more tightly connected relationships (edge weights ≥0.05) not only within single disorder symptom networks but also between two disorder symptom networks (number of edges: 2 vs 34).

CONCLUSION

These findings highlight the moderating role of academic stress, offering insights for targeted interventions to improve adolescent mental health.

The role of psychotic-like experiences, depressive symptoms, and anxiety symptoms in suicide ideation among college students with self-injurious behavior

OBJECTIVE

Suicide is associated with a myriad of psychiatric symptoms, including psychotic-like experiences, depressive symptoms, and anxiety symptoms. However, few studies have simultaneously explored the specific role of these symptoms in different aspects of suicide behavior. This study aimed to reveal differential associations between various psychopathological symptoms and both the frequency of suicidal ideation and severity of suicidal ideation during self-injury through network analysis.

METHODS

Using logistic regression and network analysis approach, the present study examined the association between psychotic-like experiences (PLEs), anxiety symptoms, depressive symptoms, the frequency of suicidal ideation (SF), and the severity of suicidal ideation during self-injury (SS) in a sample of college students with self-injurious behavior (n = 651, age 16-23, 65.1%female).

RESULT

Logistic regression results showed that depressive symptoms were associated with the frequency of suicidal ideation (OR = 11.66, 95%CI:7.45-18.25), while psychotic-like experiences (OR = 1.57, 95%CI:1.15-2.72) and anxiety symptoms were associated with the severity of suicidal ideation during self-injury (OR = 1.77, 95%CI:1.01-2.43). The results of the network analysis further indicated that the item "persecutory ideation" of the PLEs community was the key bridge symptom linking SS, while self-reproach is the key bridge symptom linking SF.

CONCLUSIONS

Although psychotic-like experiences, depressive symptoms, and anxiety symptoms were all predictors of suicide, they may play distinct roles in suicidal ideation and suicidal behavior, which require further research to verify their relationship as well as to explore the potential mechanisms.

Moral Injury, Mental Disorders, and Suicidal Behavior Among Health Professionals During the COVID-19 Pandemic: A Network Analysis

During extreme conditions such as the COVID-19 pandemic, health professionals were susceptible to mental health issues. A series of network analyses were performed to explore the relationship between moral injury and depressive symptoms, anxiety symptom, PTSD symptom, and suicidal behaviors in 14,993 health professionals. Depressive symptoms were identified as the main pathway through which moral injury led to suicidal behavior, and betrayal was the most significant bridge symptom for moral injury with PTSD, anxiety, and depressive symptoms. The symptom profiles of MI associated with the common mental outcomes included betrayal, self-condemnation, and feeling punished by God. The most central mental symptoms of health professionals were irritability, nervousness, and feeling afraid. It is crucial to implement targeted measures addressing the bridge symptoms of moral injury and the core symptoms of anxiety to prevent and treat mental health consequences among health professionals.

Anxiety, depressive and insomnia symptoms among patients with depression: a network perspective

BACKGROUND

The aim of this study was to utilize network analysis to explore the interconnections among anxiety, depressive, and insomnia symptoms in depressed patients in China.

METHODS

The study included two surveys, the baseline survey was conducted from May 18, 2020 to June 18, 2020, and the follow-up survey was conducted 5 months later. A total of 4476 patients completed the baseline survey, and 1877 of them completed the follow-up survey. Depression symptoms were evaluated using the 9-item Patient Health Questionnaire-9 (PHQ-9), anxiety symptoms were evaluated using the 7-item Generalized Anxiety Disorder (GAD-7), and insomnia symptoms were evaluated using the 7-item Insomnia Severity Index (ISI). The centrality indices are utilized in the network analysis, and using Network Comparison Test (NCT) to evaluate the differences between the network structures at two different time points.

RESULTS

Network analysis revealed that the central symptom value was ISI5 ("Interfere with your daily functioning") in the baseline networks and ISI4 ("Worried/distressed") in the follow-up networks, the symptom with the bridge symptom value in both networks was PHQ9-3 ("Sleep"). The NCT results revealed no significant differences in edge weights and global strength among participants who completed both baseline and follow-up surveys.

CONCLUSIONS

Our results suggest that central symptom (e.g., "Interfere with your daily functioning","Worried/distressed") and bridge symptom PHQ9-3 ("Sleep") can be prioritized as a target for intervention and treatment in patients with depression.

The development of depressive symptoms in subthreshold depression adolescents with a history of childhood maltreatment: A longitudinal network analysis

BACKGROUND

Emerging evidence suggests that adolescents with subthreshold depression and a history of childhood maltreatment are at an elevated risk for developing depression and experiencing suboptimal treatment outcomes. Traditional studies often rely on sum scores to analyze depression, overlooking the intricate symptomatic relationships that can be revealed through the analysis of evolving depressive symptom networks.

METHODS

This study involved 5020 adolescents from four public schools in China, screened for a history of childhood maltreatment and subthreshold depression. A subset of 421 participants, identified with subthreshold depression and a history of childhood maltreatment, was selected. The longitudinal study comprised three assessment waves-baseline, T1, and T2-with follow-ups every six months over a year. Participants completed the CESD scale at each wave. Network analysis was employed for statistical analysis.

RESULTS

The results showed that central symptoms, including absence of positive affect, depressed affect and somatic symptoms, consistently emerged as central across time points, highlighting their critical roles within the network. Notably strong associations were observed between specific symptoms (e.g., interpersonal problems, depressed affect and absence of positive affect), along with significant temporal changes in an increasing relationship between somatic symptoms.

CONCLUSIONS

The findings reveal dynamic elements within the depressive symptom network, including strong symptom associations and significant changes in symptom connections over time. These insights suggest potential targets for focused therapeutic interventions, emphasizing the importance of understanding symptom interrelations in subthreshold depression among adolescents with a history of childhood maltreatment.

Advances in the prevalence and treatment of depression for adolescents: a review

Background

Depression is a psychological condition in adolescents caused by various factors. Many serious consequences can be associated with depression, such as irritability, emotional instability, and suicide. Meanwhile, the incidence of depression and suicide among adolescents was also affected during the pandemic of COVID-19 in 2019. This phenomenon of adolescent depression should be drawn extensive concern by the community, which affects their physical and mental health.

Main body

This review describes the epidemiology, high-risk factors, and treatment of adolescent depression. The onset of depression is probably attributable to preterm birth, growth environment, genetic. We also identify that the COVID-19 pandemic, initiated in late 2019,affects adolescent mental health. Antidepressants and psychotherapy are conventional treatments for depressive disorders. However, it is controversial whether antidepressants are as effective and safer as psychotherapy, and a combination of the two could provide more benefit to this population than antidepressants alone. We also summarize some antidepressants developed for novel targets. Improving the efficacy and safety of treatment to reduce the suicide rate among adolescents is the primary goal of clinical research. Existing treatment modalities and drugs are not sufficient to achieve clinical demands, so that new therapeutic targets will be promising for such patients.

Conclusion

A variety of factors can contribute to depression in adolescents. Adolescent depression should be mainly treated with non-pharmacological. A combination of guideline-recommended antidepressants should be used if uncontrolled with non-pharmacological, but adverse drug reactions and suicidal ideation should be closely monitored.

A simulation-based network analysis of intervention targets for comorbid symptoms of depression and anxiety in Chinese healthcare workers in the post-dynamic zero-COVID policy era

BACKGROUND

After the official end of the dynamic zero-COVID policy in China, healthcare workers continued to heavy workloads and psychological stress. In this new phase, concerns related to work and family, rather than infection, may have become new sources of psychological issues such as depression and anxiety among healthcare workers, leading to new patterns of comorbidity. However, few studies have addressed these issues. To fill this gap, this study used network analysis to examine new features and mechanisms of comorbidity between depression and anxiety symptoms, and simulated symptom-specific interventions to identify effective targets for intervention.

METHODS

A total of 708 Chinese healthcare workers (71.2% females; Age: M = 37.55, SD = 9.37) were recruited and completed the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). This study first calculated the incidence rates of anxiety, depression, and their comorbidity, and then constructed the comorbid Ising network. Central and bridge symptoms were identified with expected influence (EI) and bridge EI, respectively. The NodeIdentifyR algorithm (NIRA) was then used to simulate interventions within the network, examining the effects of alleviating or aggravating specific symptoms on the network's severity.

RESULTS

48.2% of Chinese healthcare workers reported experiencing depression (19.8%), anxiety (11.7%), or both (16.2%). In the anxiety-depression network, "guilt" and "appetite changes" were identified as the central symptoms, and "guilt" and "excessive worry" were identified as the bridge symptoms. Simulated interventions suggested that alleviating "Anhedonia" can the most reduce the overall severity of the network, while aggravating "guilt" can the most increase the overall severity. These two symptoms were considered the key target for treatment and prevention, respectively.

CONCLUSIONS

Chinese healthcare workers still face high risk of depression, anxiety, and comorbidity in the post-dynamic zero-COVID policy era. Our findings highlight the key roles of guilt, appetite changes, and excessive worry in the network of depression and anxiety symptoms. Future research should apply the results of the simulated interventions, develop intervention strategies targeting anhedonia, and focus on preventing guilt to improve the healthcare workers' mental health.

TRIAL REGISTRATION

Not applicable.

Network structure of common mental health problems and life satisfaction in a Japanese population

Poor life-satisfaction, feelings of loneliness, depression, and anxiety are commonly reported in the Japanese general population. The aim of this study was to examine the network structure of these common mental health problems in a Japanese sample and to explore differences between males and females. Participants (N = 476; 235 males, 241 females) were recruited from a Japanese general population and completed questionnaires to measure levels of depression, anxiety, loneliness, and life satisfaction. A psychometric network analysis was conducted using a Gaussian Graphical Model, and a network comparison test (NCT) was performed to evaluate overall consistency and differences in global network connectivity. The network analysis identified problems relaxing, sad mood, feelings of isolation, and poor life satisfaction as central nodes in the overall network. The NCT revealed no significant differences between the male and female networks in the global network structure as well as connectivity. However, the strength values for restlessness and tiredness were significantly higher in the network for males than in the network for females. There were no differences in the global network structure and connectivity of mental health psychopathology between males and females. Problems relaxing, feelings of depression, being isolated from others, and poor life satisfaction contribute to poor mental health and may be potential intervention targets.

The symptom network of oral health conditions in older populations with oral frailty: a cross-sectional study

BACKGROUND

Population aging is increasing globally, with oral frailty affecting 24% of the older population. Previous studies have demonstrated the relationship between oral frailty and poor oral health symptoms but the interactions and core symptoms among these oral symptoms remain vague.

OBJECTIVE

To clarify the relationship between oral frailty and oral symptoms, explore the intrinsic connections between these symptoms, and identify core symptoms to provide more effective management and treatment strategies for oral frailty and related health issues.

METHODS

The study conducted a cross-sectional study from January 2024 to April 2024, included 547 participants using a convenient sampling method. The study adopted the Geriatric Self-Efficacy Scale for Oral Health (GSEOH), Oral Frailty Index-8, FRAIL scale, and oral symptoms, including the simplified oral hygiene index score (OHI-S), plaque index, periodontal pocket depth and gingival index, teeth numbers and tooth mobility index. T-test, Chi-Square test, Mann-Whitney test and binary logistic regression were used to explore the relationship between oral symptoms and oral frailty, and symptom network analysis and subgroup network analysis were used to explore the intrinsic connections between oral symptoms and identify core symptoms.

RESULTS

The study found that while teeth number and GSEOH were significantly associated with oral frailty (teeth number: β = -0.262, P = 0.013) (GSEOH: β = -0.056, P = 0.000), the centrality of teeth number and GSEOH was the lowest compared to other oral symptoms. oral hygiene status (CI-S and plaque index), and gingival index were the core symptoms in older adults, and gingival index was the strongest bridge node.

CONCLUSION

The study explored the relationship between oral symptoms and oral frailty using network analysis. The study recommended that communities implement routine oral functional assessments to increase the denture restoration rate and identify oral frailty at an early stage, as well as educational and promotional programs aimed at maintaining oral hygiene and function. Future research should further analyze the causal relationships between oral symptoms, particularly periodontal pocket depth, oral frailty, and overall frailty.

Sex and age differences in depression and anxiety networks among adolescents with idiopathic scoliosis: A network analysis

BACKGROUND

Depression and anxiety are prevalent psychological challenges among patients with adolescent idiopathic scoliosis (AIS), affecting individuals across both sex and age groups.

AIM

To explore the network structure of depression and anxiety symptoms, with a focus on identifying differences at the symptom level between sex and age subgroups.

METHODS

A total of 1955 participants diagnosed with AIS aged 10-18 years were assessed using the Patient Health Questionnaire Depression Scale (PHO-9) and the Generalized Anxiety Disorder Scale (GAD-7), and 765 patients exhibiting PHQ-9 or GAD-7 scores ≥ 5 were enrolled in our study. Network analysis and network comparison tests were utilized to construct and compare the depression-anxiety symptoms networks among sex and age subgroups.

RESULTS

The results revealed GAD3 "Excessive worry" and PHQ2 "Sad mood" were the most significant central symptoms in all subgroups, while "Sad mood" had higher strength than "Excessive worry" in the lower age group. In the network comparisons, the female network exhibited tighter connectivity, especially on GAD6 "Irritability" and GAD2 "Uncontrollable worry", while only PHQ3 "Sleep" and PHQ9 "Suicidal ideation" had differences at the local level in the lower age group.

CONCLUSION

Several interventions targeting excessive worry and sad mood could reduce the risk of depression and anxiety symptoms in the AIS population. Furthermore, specific anxiety symptoms in females, along with sleep disturbances and suicidal ideation in the lower age group, should be addressed at an early stage to prevent significant disruptions in mental health trajectories.

Longitudinal network analysis of depression, anxiety, and post-traumatic stress disorder comorbidities among adolescents in regional China

Purpose

The network theory of mental disorders offers a new perspective for the understanding of comorbidities, but the research on the comorbidities among depression, anxiety, and post-traumatic stress disorder (PTSD) is still insufficient. The aim of this study was to explore the internal relationship by establishing and analyzing the comorbidity networks, and to provide suggestions for the intervention after traumatic events.

Methods

We utilized data from the second and third wave of the Chengdu Positive Child Development cohort (N = 3,189, 47.79% female), we estimated to network models of depression, anxiety and PTSD. To assess difference in global connectivity between the two networks, we conducted invariance test.

Results

K27 (Somatic 10), K37 (Generalized Anxiety 9), K15 (Somatic 5), K33 (Generalized Anxiety 7), K24 (Somatic 9) were the most central nodes in both networks, P13 (Sleep problem) had the highest Bridge Expected Influence value. The structural difference between the two networks was statistically significant (M = 0.229, p = 0.010), and the global strength of the network at wave 2 was higher than the network at wave 3 (35.1 vs. 33.9, S = 1.20, p = 0.010).

Conclusion

The correlation in symptoms of the three disorders underscores the need for more comprehensive treatment options for intervention after traumatic events. Central and bridge nodes could inform targeted interventions or policy decisions. Anxiety disorders, especially Som and Gen dimensions, should be the focus of intervention. The Arousal dimension in PTSD, especially sleep disorders, may contribute to the comorbidities. In addition, this study highlights the importance of staged post-traumatic interventions.

Inter-relationships of depression and anxiety symptoms among widowed and non-widowed older adults: findings from the Chinese Longitudinal Healthy Longevity Survey based on network analysis and propensity score matching

Background

Depression and anxiety are prevalent mental health issues among older adult widowed adults. However, the symptom-level relationships between these conditions remain unclear. Due to the high correlations and complex relationships among various symptoms, this study employs network analysis to explore differences in the network structures of depression and anxiety symptoms between widowed and non-widowed older adults.

Methods

Propensity score matching was used to identify widowed older adults with similar demographic characteristics. Data from 1,736 widowed and 1,736 matched controls were analyzed using the Chinese Longitudinal Healthy Longevity Survey (2017-2018). Depression and anxiety were measured by the Center for Epidemiologic Studies Depression Scale-10 (CESD-10) and the seven-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Central and bridge symptoms were evaluated using expected influence (EI) and bridge expected influence (BEI), respectively.

Results

Network analysis revealed similarities in central symptoms between widowed and non-widowed older adults, with both groups exhibiting "Feeling depressed or down" (CESD3), "Feeling tense and having difficulty relaxing" (GAD4), and "Being unable to stop or control worrying" (GAD2) as core symptoms. However, differences emerged in bridge symptoms. In the widowed group, "Feeling anxious, worried, or distressed" (GAD1) was most strongly connected to "Felt lonely" (CESD8); "Worrying too much about various things" (GAD3) was strongly linked to "Feeling increasingly exhausted and useless with age" (CESD4); and "Feeling depressed or down" (CESD3) had a strong association with "Becoming easily annoyed or irritable" (GAD6). In the non-widowed group, "Feeling anxious, worried, or distressed" (GAD1) exhibited the strongest association with "Having good sleep quality" (CESD10); "Getting upset over small matters" (CESD1) was closely connected to "Feeling anxious, worried, or distressed" (GAD1); and "Worrying too much about various things" (GAD3) was most strongly connected to "Feeling depressed or down" (CESD3).

Conclusion

Common central and bridge symptoms highlight universal intervention targets. Addressing "Feeling depressed or down" in widowed and "Getting upset over small matters" in non-widowed older adults may help prevent depression-anxiety comorbidity. These findings support targeted interventions to improve mental health outcomes. Future research should evaluate tailored intervention effectiveness.

Understanding the Impact of Intimate Partner Violence on Mental Health in Migrant Spanish Women: A Network Analysis Approach

The main aim of this paper was to perform a secondary analysis of a dataset of migrant women in Spain to determine relationships between different types of intimate partner violence (IPV) and psychiatric symptoms, as well as core symptoms within IPV dimensions. The Cyber Aggression item "Sent messages that were threatening or harassing" (Cyber.10) was centrally situated across many measures, having a betweenness of 2.607, a closeness of 2.464, and a strength of 1.513. The research demonstrated how the relationship between multiple IPV and mental health disorders among Spanish migrant women is very multifactorial.

A multicenter cross-sectional study of gambling disorder among patients with methamphetamine use disorder in drug rehabilitation centers: prevalence, correlates, and network analysis

BACKGROUND

This study sought to investigate the prevalence, correlates, and network structure of the manifested symptoms in gambling disorder (GD) among methamphetamine (MA) use disorder (MUD) patients in China.

METHODS

We interviewed 1069 patients using the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA), Chinese version. Besides MA and other substance use disorders, GD was also ascertained by SSADDA. Other psychiatric diagnoses were ascertained, including major depressive episodes (MDEs), antisocial personality disorder, suicide and self-harm, and environmental factors, including childhood experiences.

RESULTS

Of 1069 participants, 711 met the DSM-5 diagnostic criteria for MUD. Among the 711 participants with MUD, 52.3% met DSM-5 diagnostic criteria for GD. We found that alcohol use together with MA, childhood violent experiences, MDEs, severe MUD, and gambling duration significantly differed between MUD participants with and without GD. In the GD-MUD network, the central symptoms were gambling preoccupation (GD1), giving up important activities (MUD6), financial trouble (GD9), and MA tolerance (MUD5). MA tolerance (MUD5) also served as a bridge symptom across the network, exhibiting substantial associations with gambling preoccupation (GD1).

CONCLUSION

GD is prevalent among individuals in treatment for MUD in China. Network analysis suggests that gambling preoccupation and MA tolerance represent central features, and that MA tolerance serves as a bridge across GD and MUD.

Network analysis of correlations between suicide exposure, depression, and anxiety symptoms in adolescents

BACKGROUND

Adolescents with a history of suicide exposure, defined as experiencing the suicide death of a family member, friend, or other acquaintances, are more likely to experience mental health issues such as depression or anxiety.

AIMS

This study aimed to explore prevalence rates and the network of adolescents' suicide exposure, depression, and anxiety symptoms, and to clarify the correlations between suicide exposure and symptoms of depression and anxiety.

METHOD

A total of 8,957 adolescents were included in this cross-sectional study. Data regarding general information, symptoms of depression and anxiety, and suicide exposure were collected from mid-September to early October 2021. Network analysis was employed to assess relationships between suicide exposure and individual symptoms of both depression and anxiety. Central symptoms were identified by strength; the flow network was visualized to identify symptoms directly related to suicide exposure.

RESULTS

The prevalence rates of suicide exposure, depression, and anxiety were 5.28%, 12.87%, and 10.48%. Results indicated that suicide exposure was associated with both depression and anxiety, and had the strongest positive association with suicidal ideation. Central symptoms of the network were sad mood, nervousness, fatigue, irritability, and uncontrollable worry. Bridge symptoms were suicidal ideation and irritability. Appetite changes, suicidal ideation, uncontrollable worry, sleep difficulties, and irritability were symptoms directly related to suicide exposure.

CONCLUSIONS

There were significant inter-symptom associations between suicide exposure, depression, and anxiety in adolescents. It is recommended that future studies explore whether targeted interventions and long-term monitoring concerning these inter-symptom associations can protect adolescents with suicide exposure.

A Network Analysis of Depression and Cognitive Impairments in Fibromyalgia: A Secondary Analysis Study

INTRODUCTION

Fibromyalgia is a chronic condition often accompanied by cognitive impairments, such as difficulties with sustained attention, and emotional disturbances, particularly depression and anxiety. Understanding how these emotional and cognitive factors interact is crucial to improving treatment for fibromyalgia patients. This study aimed to investigate the network structure of these interactions, focusing on the relationship between depression, anxiety, and cognitive performance.

METHOD

A total of one hundred ten participants diagnosed with fibromyalgia completed self-reported assessments of depression and anxiety, alongside cognitive performance tests. Key measures included Continuous Performance Tasks (CPT) for impulsivity and sustained attention, the Stroop Interference Index (StI), Stroop Color Naming (StC), and Stroop Word Reading (StW). Network analysis was conducted to estimate the relationships between emotional and cognitive variables and assess their centrality within the network.

RESULTS

Errors in CPT emerged as the most significant indicators of the relationship between depression and cognitive performance, with high centrality values observed for the Stroop tasks (StI, StC, and StW). Additionally, Trait Anxiety (A_T) and Beck Depression Inventory (BDI) measures showed high centrality, underscoring the critical role of emotional states in the network of cognitive and emotional variables. The centrality values for cognitive flexibility, processing speed, and inhibitory control were found to be 0.85, 0.78, and 0.72, respectively.

CONCLUSION

This study highlights the strong association between depression symptoms and deficits in cognitive domains, emphasizing the need for integrated care approaches that address both cognitive and emotional health. Multidisciplinary treatment programs, including cognitive rehabilitation and psychological support, could improve patient outcomes by targeting the most influential variables in the cognitive-emotional network.

Network Analysis of Core Symptoms of Internalizing and Externalizing Symptoms Among Children with Dyslexia in Saudi Arabia

Researches indicate that children with dyslexia are more likely to experience psychiatric symptoms throughout life compared to peers in the general population. Improving the classification of psychiatric symptoms in this population can be a valuable goal for strengthing therapeutic models. The current study aimed to evaluate the dynamic associations between internalizing and externalizing symptoms in children with dyslexia using network analysis. This cross-sectional study was conducted in Saudi Arabia from April to July 2024, involving 183 children aged 8-11 diagnosed with dyslexia, recruited through convenience sampling from local schools and clinics. The Child Behavior Checklist (CBCL) was utilized to assess a range of psychopathological symptoms, focusing on six clusters: affective problems, anxiety problems, somatic symptoms, ADHD symptoms, oppositional defiant problems, and conduct problems. Notably, "cries a lot" emerged as a central symptom in the affective network, while "dependent" was identified as the most pivotal symptom in the anxiety network. Centrality measures-betweenness, closeness, and strength-were employed to quantify the significance of each symptom. The findings suggest that these central symptoms may contribute to the development and persistence of psychiatric comorbidities in children with dyslexia. Interventions targeting these core symptoms could enhance psychological outcomes for this population. Overall, this study lays the groundwork for future research into tailored intervention strategies to address unique psychiatric comorbidities associated with dyslexia.

Network Analysis of Internalizing and Externalizing Symptoms in Arab Gifted Children: A Cross-Sectional Study

The current paper aimed to estimate the network structure of general psychopathology (internalizing and externalizing symptoms/disorders) among 239 gifted children in Jordan. This cross-sectional study with a convenience sampling method was conducted between September 2023 and October 2024 among gifted children aged 7-12. The Child Behavior Checklist (CBCL) was employed to assess six symptom clusters: conduct problems, attention-deficit/hyperactivity disorder (ADHD), and oppositional defiant problems as externalizing symptoms, and affective problems, anxiety issues, and somatic complaints as internalizing symptoms. We used the network analysis perspective by graphical least absolute shrinkage and selection operator (gLASSO) and the Extended Bayesian Information Criterion (EBIC). These methods were used to determine network structure and important nodes in the estimated network. "Sleeps less" (centrality strength = 2.04, edge weight = 0.33) was the central symptom in the affective cluster. In contrast, "worries" (centrality strength = 1.89, edge weight = 0.28) and "headaches" (centrality strength = 2.35, edge weight = 0.41) were pivotal in the anxiety and somatic clusters, respectively. The findings suggested that these symptoms had critical roles in the context of the general psychopathology among gifted children. Accordingly, the mentioned symptoms should be assessed and targeted among gifted children. Future studies could evaluate the results of targeting these symptoms on gifted children's well-being and daily functions.

Exploring the Relationship Between Adverse Childhood Experiences and Internalizing and Externalizing Symptoms among Jordanian Adolescents: A Network Analysis Approach

The extensive presence of adverse childhood experiences (ACEs) in children has been established through documentation. Still, the detailed connections between specific types of ACEs and psychiatric symptoms have not yet been comprehensively understood. A network analysis approach has not been undertaken to study how ACEs affect internalizing and externalizing symptoms among high school students in Jordan. The research investigates how ACEs lead to internalizing and externalizing symptoms through network analysis, which helps reveal the complex interconnections between these factors. A total of 517 high school student participants (mean age: 14.47 ± 2.25) and their parents completed the modified list of ACEs and Child Behavior Checklist (CBCL) self-report measures. The Extended Bayesian Information Criterion (EBIC) and Directed Acyclic Graph (DAG) were used for unidirectional and directional methods. The network analysis identified key nodes and connections within internalizing, externalizing, and ACE symptoms. YSR.35 (Worthless) had the highest strength centrality among internalizing symptoms (0.89), while YSR.41 (Impulsive) (0.77) and ACE.3 (Physical abuse) (0.68) ranked highest for externalizing and ACE items, respectively. Centrality measures highlighted ACE.1 (Loss of a parent) as the most influential node (betweenness = 3.738, closeness = 2.664, strength = 2.866), followed by YSR.29 (Fears) (strength = 1.938) and YSR.104 (Talks too much) (betweenness = 1.921). The DAG results, generated using the iamb algorithm with bootstrapping (1,000 iterations), showed higher levels of ACE's predicated Affective Problems and symptoms. In conclusion, these findings underscore the need for more targeted and timely interventions to prevent the emergence of more complex disorders in the future. Ultimately, the implications of this research can contribute to the development of more effective preventive and therapeutic interventions to reduce the impact of ACEs on mental health.

A network analysis of the heterogeneity and associated risk and protective factors of depression and anxiety among college students

BACKGROUND

Comorbidity of depression and anxiety is common among adolescents and can lead to adverse outcomes. However, there is limited understanding of the latent characteristics and mechanisms governing these disorders and their interactions. Moreover, few studies have examined the impacts of relevant risk and protective factors.

METHODS

This cross-sectional study involved 1,719 students. Mplus 8.0 software was used to conduct latent profile analysis to explore the potential categories of depression and anxiety comorbidities. R4.3.2 software was used to explore the network of core depression and anxiety symptoms, bridge these disorders, and evaluate the effects of risk and protective factors.

RESULTS

Three categories were established: "healthy" (57.8%), "mild depression-mild anxiety" (36.6%), and "moderately severe depression-moderate anxiety" (5.6%). "Depressed mood", "nervousness", and "difficulty relaxing" were core symptoms in both the depression-anxiety comorbidity network and the network of risk and protective factors. Stress perception and neuroticism serve as bridging nodes connecting some symptoms of depression and anxiety and are thus considered the most prominent risk factors.

CONCLUSIONS

According to the core and bridging symptoms identified in this study, targeted intervention and treatment can be provided to groups with comorbid depression and anxiety, thereby reducing the risk of these comorbidities in adolescents.

The association between adaptability and the symptoms of depression and anxiety in early adolescents: a network analysis in a longitudinal design

BACKGROUND

The co-occurrence of depression and anxiety is relatively more common among adolescents. Emerging evidence suggests that adaptability might affect this phenomenon. Network analysis can provide insight into the dynamics between symptoms of mental disorders. Therefore, we used network analysis 1) to explore symptom networks and 2) to investigate the association between adaptability and symptoms based on a longitudinal design.

METHODS

833 Chinese adolescents (449 males and 384 female) were recruited, with adaptability, depressive and anxiety symptoms measured at T1, 426 of them were followed up one year later at T2. Symptom networks were constructed for all participants and for the two groups based on their adaptability scores at T1. Furthermore, mediation analysis was performed to examine the relationship between adaptability and bridge symptoms at both timepoints.

RESULTS

Irritable and Guilty showed the highest expected value at T1 (p < 0.05). The high adaptability group's symptom network (HGN) was less connected than the low adaptability group's symptom network (LGN) (p < 0.001). Furthermore, Irritable (T1) and adaptability (T2) were sequential mediators (p < 0.001) between adaptability (T1) and Irritable (T2).

CONCLUSIONS

These findings suggest that adaptability might affect the network dynamics, underscoring its importance to the occurrence of depression and anxiety among adolescents. Irritable and Guilty being the bridge symptoms may indicate the interventions to target in adolescents with comorbid depression and anxiety.

The co-occurrence between symptoms of internet gaming disorder, depression, and anxiety in middle and late adolescence: A cross-lagged panel network analysis

Although there is a growing awareness of the co-occurrence of internet gaming disorder (IGD) with other mental health problems, the specific patterns of how these symptoms interact over time, especially across different age groups, remain unclear. The current study utilizes cross-lagged panel network modeling (CLPN) to investigate the dynamic, longitudinal relationships among symptoms of IGD, depression and anxiety among adolescents across time, and how these connections change with different developmental stages. A total of 3296 middle and late adolescents who have finished 3-time points research were included in the present study. Significant differences were found between middle and late adolescents in the structures and strengths of the contemporaneous and longitudinal networks. For middle adolescents, symptoms tended to predict subsequent symptoms within the same disorder. However, late adolescents showed a stronger trend of symptoms being interconnected across comorbid conditions. Feelings of worthlessness & hopelessness were the most impactful symptoms for middle adolescents in the short term and they continued to significantly affect late adolescents in the long term. In addition, restless and suicide or self-harm were the most important bridge symptoms for middle and late adolescents, respectively. This study emphasizes the importance of developing targeted intervention strategies focusing on both central and bridging symptoms of the comorbid conditions of IGD, depression, and anxiety in adolescence. Recognizing distinct adolescents' needs, interventions should be tailored to effectively address the unique challenges at different developmental stages.

A network analysis of postpartum depression and mother-to-infant bonding shows common and unique symptom-level connections across three postpartum periods

Postpartum depression and mother-to-infant bonding difficulties (MIBD), two issues crucial to maternal and infant mental health, often coexist and affect each other. Our study aims to dissect their complex relationship through a graphical LASSO network analysis of individual symptoms in 5594 Japanese postpartum women, whose geographical distribution was nationally representative. We identified 'fear', 'enjoyment', 'overwhelm', and 'insomnia' as common bridge symptoms linking postpartum depression and MIBD across three distinct postpartum periods. Moreover, 'self-harm' emerged as a bridge symptom in the first 6 months and the 7-12 month period, while 'laugh' was a bridge symptom in the first 6 months and the 13-24 month period. Notably, 'self-blame' was identified as a unique bridge symptom specific to the 13-24 month period. Our analysis highlights the complexities of symptom connectivity across postpartum stages and underscores the critical need for interventions that address both common and stage-specific bridge symptoms to effectively support maternal mental health and strengthen mother-to-infant bonding.

Examining the effects of school-vacation transitions on depression and anxiety in adolescents: network analysis

BACKGROUND

The school-vacation cycle may have impacts on the psychological states of adolescents. However, little evidence illustrates how transition from school to vacation impacts students' psychological states (e.g. depression and anxiety).

AIMS

To explore the changing patterns of depression and anxiety symptoms among adolescent students within a school-vacation transition and to provide insights for prevention or intervention targets.

METHOD

Social demographic data and depression and anxiety symptoms were measured from 1380 adolescent students during the school year (age: 13.8 ± 0.88) and 1100 students during the summer vacation (age: 14.2 ± 0.93) in China. Multilevel mixed-effect models were used to examine the changes in depression and anxiety levels and the associated influencing factors. Network analysis was used to explore the symptom network structures of depression and anxiety during school and vacation.

RESULTS

Depression and anxiety symptoms significantly decreased during the vacation compared to the school period. Being female, higher age and with lower mother's educational level were identified as longitudinal risk factors. Interaction effects were found between group (school versus vacation) and the father's educational level as well as grade. Network analyses demonstrated that the anxiety symptoms, including 'Nervous', 'Control worry' and 'Relax' were the most central symptoms at both times. Psychomotor disturbance, including 'Restless', 'Nervous' and 'Motor', bridged depression and anxiety symptoms. The central and bridge symptoms showed variation across the school vacation.

CONCLUSIONS

The school-vacation transition had an impact on students' depression and anxiety symptoms. Prevention and intervention strategies for adolescents' depression and anxiety during school and vacation periods should be differentially developed.

A Cross-Sectional Network Analysis of Intimate Partner Violence and Suicidal Ideation Among Arab Women

INTRODUCTION

The current study aimed to evaluate the relationship between intimate partner violence (IPV) and suicidal ideation among women using a network analysis approach.

METHOD

Secondary data including 440 women (mean age ± SD = 32.78 ± 8.09) who experienced IPV in the last 6 months were used. The Revised Composite Abuse Scale-Short Form, Columbia-Suicide Severity Rating Scale and Revised Scale of Economic Abuse were used to assess IPV and suicidal ideation. Network analysis, centrality measures and bridge centrality were applied to understand the interplay between IPV and suicide risk factors.

RESULTS

The strongest association in the network analysis was found between 'Wish to be Dead' (S.1) and 'Non-Specific Active Suicidal Thoughts' (S.2) with a weight of 0.523, indicating a substantial correlation between general suicidal thoughts and particular desires to die. IPV symptoms, particularly economic exploitation and psychological abuse, showed strong links to suicidal ideation. 'Active Suicidal Ideation with Specific Plan and Intent' (S.5) was significantly related to 'Make you take out a loan or buy something on credit when you didn't want to' (EA.11) with a weight of 0.276. Additionally, centrality analysis showed that 'Wish to be Dead' (S.1) was the most central node in the network of suicidal ideation, with the highest centrality score (betweenness = 2.625).

CONCLUSION

These findings suggest that IPV, mainly psychological abuse, plays a pivotal role in suicidal ideation among women. Mental health interventions should focus on addressing IPV-related psychological abuse. Suicide prevention efforts must integrate IPV screening into clinical practice.

The Mediating Role of Basic Psychological Needs and Meaning in Life in Adolescent Suicidal Ideation

Suicidal ideation and behavior are critical psychological crises among children and adolescents, posing significant concerns for their mental health and safety. This cross-sectional study investigated the factors and underlying psychological mechanisms of suicidal ideation in adolescents. A total of 6474 middle school students from Sichuan and Hebei provinces, China, participated in the study. Data were collected using the Self-Assessment of Suicidal Ideation Scale, the Parental Psychological Control Scale, the Meaning in Life Scale, and the Basic Psychological Needs Scale. Statistical analyses, including mediation and chain mediation analyses, were conducted to examine the relationships between parental psychological control, basic psychological needs, meaning in life, and suicidal ideation. The results revealed the following: (1) Parental psychological control positively predicted suicidal ideation in middle school students; (2) basic psychological needs mediated the relationship between parental psychological control and suicidal ideation; (3) meaning in life mediated the relationship between parental psychological control and suicidal ideation; (4) basic psychological needs and meaning in life together played a chain-mediating role in this relationship. These findings highlight the importance of addressing parental psychological control and fostering a supportive family environment to meet adolescents' psychological needs, enhance their sense of life meaning, and reduce suicidal ideation. Insights from this study provide valuable guidance for prevention and intervention strategies aimed at safeguarding adolescents' mental health and well-being.

Family Functioning, Anxiety and Depression in Chinese Higher Vocational School Students: A Network Analysis

Purpose

Network analysis is a statistical method that explores the complex interrelationships among variables by representing them as nodes and edges in a network structure. This study aimed to examine the interconnections between family functioning, anxiety, and depression among vocational school students through network analysis approach.

Participants and Methods

A sample of 2728 higher vocational school students participated in a survey utilizing the Family APGAR Index Questionnaire (APGAR), Generalized Anxiety Disorder Scale (GAD-7), and Patient Health Questionnaire (PHQ-9). Meanwhile, a network analysis was conducted to investigate the interrelationships between family functioning, anxiety, and depression symptoms among the higher vocational school students.

Results

The network analysis revealed that node APGAR2 ("Partnership") exhibited the highest strength, followed by node GAD5 ("Restlessness"); node GAD7 ("Negative future anticipation"), PHQ9 ("Suicidal ideation"), and PHQ6 ("Guilty") were bridge nodes linking family functioning, anxiety and depressive symptoms in the sample. The results of the Network comparisons test between male and female indicated that the edge weights and global strength did not exhibit a statistically significant difference.

Conclusion

These results emphasized that certain anxiety symptoms and family functioning nodes are more central than others, and thus play a more critical role in the family functioning-anxiety-depression network, which highlight potential targeting symptoms to be considered in future interventions.

The Relationship Between Cognitive Emotion Regulation Strategy and Mental Health Among University Students During Public Health Emergency: A Network Analysis

Background

Public health emergencies pose threats to mental health, and cognitive emotional regulation can be a crucial coping strategy. This study explored the relationship between cognitive emotion regulation strategies and mental health among university students during the COVID-19 pandemic using network analysis.

Methods

1100 university students completed questionnaires assessing depression, anxiety, somatization, and cognitive emotion regulation strategies. Network analysis was conducted to identify network structures and bridge symptoms.

Results

(1) In the depression network, the strongest edge is D1 (Little interest)-D2 (Feeling down), while D2 emerged as the node with the highest centrality. C1 (Self-blame), C8 (Catastrophizing), D6 (Feeling bad), and D9 (Suicide) are bridge symptoms. (2) In the anxiety network, A2 (Uncontrollable worrying)-A3 (Worrying too much) were identified as the strongest edge, and A2 exhibiting the highest centrality. C1 (Self-blame), C8 (Catastrophizing), and A6 (Easy annoyance) are bridge symptoms. (3) In the somatization network, the strongest edge is S14 (Fatigue)-S15 (Sleep disturbances) and S9 (Palpitations) exhibited the highest centrality. C1 (Self-blame), C3 (Rumination), C8 (Catastrophizing), S9 (Palpitations), and S14 (Fatigue) are bridge symptoms.

Conclusion

Self-blame and catastrophizing are important bridge symptoms for cognitive emotion regulation strategies and mental health networks, so cognitive behavioral therapy, focusing on self-blame and catastrophizing as intervention targets, could most effectively improve mental health during public health emergencies.

Graph Machine Learning With Systematic Hyper-Parameter Selection on Hidden Networks and Mental Health Conditions in the Middle-Aged and Old

OBJECTIVE

It takes significant time and energy to collect data on explicit networks. This study used graph machine learning to identify hidden networks and predict mental health conditions in the middle-aged and old.

METHODS

Data came from the Korean Longitudinal Study of Ageing (2016-2018), with 2,000 participants aged 56 or more. The dependent variable was mental disease (no vs. yes) in 2018. Twenty-eight predictors in 2016 were included. Graph machine learning with systematic hyper-parameter selection was conducted.

RESULTS

The area under the curve was similar across different models in different scenarios. However, sensitivity (93%) was highest for the graph random forest in the scenario of 2,000 participants and the centrality requirement of life satisfaction 90. Based on the graph random forest, top-10 determinants of mental disease were mental disease in previous period (2016), age, income, life satisfaction-health, life satisfaction-overall, subjective health, body mass index, life satisfaction-economic, children alive and health insurance. Especially, life satisfaction-overall was a top-5 determinant in the graph random forest, which considers life satisfaction as an emotional connection and a group interaction.

CONCLUSION

Improving an individual's life satisfaction as a personal condition is expected to strengthen the individual's emotional connection as a group interaction, which would reduce the risk of the individual's mental disease in the end. This would bring an important clinical implication for highlighting the importance of a patient's life satisfaction and emotional connection regarding the diagnosis and management of the patient's mental disease.

Interrelationships of stress, burnout, anxiety, depression, quality of life and suicidality among Chinese residents under Standardized Residency Training: a network analysis

BACKGROUND

Chinese resident physicians confront challenges such as staff shortages and heavy workloads, leading to a heightened prevalence of mental distress. This study aims to investigate the symptom network of stress, burnout, anxiety, depression (SBAD) and adverse personal outcomes in this cohort.

METHODS

From October 2020 to April 2022, 994 physicians were recruited across China through snowball sampling. Stress, burnout, anxiety and depression were assessed using the 10-item Perceived Stress Scale, a two-item burnout questionnaire, Generalized Anxiety Disorder Scale-7 and the Patient Health Questionnaire-9, respectively. Data on adverse personal outcomes (low quality of life [QOL] and suicidal ideation) were collected. We constructed and visualized two networks, calculating expected influence (EI) and bridge EI indices to identify central and bridge symptoms.

RESULTS

In the SBAD network, perceived helplessness was the most central and critical bridge symptom connecting stress and mental distress, with emotional exhaustion identified as the secondary bridge symptom. Perceived helplessness, perceived self-efficacy and emotional exhaustion exhibited the highest negative correlations with QOL. Worthless (PHQ6) and motor (PHQ8) symptoms were strongly correlated with suicidal ideation. The estimated SBAD network showed excellent stability and accuracy.

CONCLUSIONS

Our study emphasizes that perceived helplessness may be a high-priority target for preventing and intervening in mental distress and improving QOL among residents. Burnout transcends workplace problems and is widely connected to depression, anxiety and QOL. Implementing early detection and intervention measures at three levels-the individual physician, health system and professional colleges, and external regulators-is crucial for preventing and alleviating stress and mental distress among residents.

Network analysis of depressive and anxiety symptoms with well-being in students during the COVID-19 pandemic: a repeated cross-sectional study

The university student population is particularly vulnerable to depression, which was identified during the COVID-19 pandemic. Understanding how depressive symptoms are interrelated with mental and physical health in students is essential. The aim of this study was to reveal the network of depressive and anxiety symptoms with respect to well-being (life satisfaction, physical health, physical activity, and perceived stress) during a difficult situation-the COVID-19 pandemic-at two measurement points of different pandemic severities. A repeated cross-sectional study was conducted in June 2020 (T1) (lower pandemic severity) and March 2021 (T2) (higher pandemic severity) among 592 and 1230 Czech university students, respectively. The measurements used were the PHQ-9, GAD-7, PSS-10, SWLS, self-rated physical health (SRH), and sociodemographic survey. The network analysis approach was utilized. For the significance of differences, the χ2 test, Student's t test, and ANOVA were performed. The results revealed that scale-level depression, stress, and worse SRH increased over time, whereas life satisfaction decreased. Scale-level anxiety and physical activity were stable over time. PHQ2 Sad mood was the most central and influential node at T1 and T2. PHQ9 Suicidal Ideation was closely related to other variables at T1, whereas PHQ1 Anhedonia was closely related to other variables at T2. The most influential risk factors were the PHQ-2 score and the GAD-2 score, which are associated with uncontrollable worrying, whereas life satisfaction, physical health, and physical activity were the most protective factors. It is crucial to recognize and decrease the PHQ2 score and increase life satisfaction to improve the mental health of university students.

Exploring Comorbidity Between Anxiety and Depression in Spanish-Speaking School-Aged Children: A Network Analysis Approach

Anxiety and depression are highly prevalent and comorbid problems in childhood, which deserve greater understanding for effective prevention and treatment. The main aim of the present study was to explore the comorbidity between anxiety and depression symptoms using a novel and valuable approach to study comorbidity, such as network analysis. Specifically, the connectivity between symptoms and possible relevant symptoms was examined through comorbidity estimation and shortest pathway networks, as well as bridge symptoms. This study comprised 281 Spanish-speaking children aged 8-12 years (45.2% girls), whose anxiety and depression symptoms were assessed through specific brief parent-report measures. Analyses revealed that in the comorbidity network, the most central symptoms were related to depression ("No good anymore," "Could never be as good," "Hated self," "Did everything wrong," "Nobody loved him/her") or anxiety ("Suddenly feels really scared"). Furthermore, it was found that the most central bridge symptoms, whose activation would play a key role in the activation of other domain symptoms, were anxiety symptoms such as "Trouble going to school" and "Suddenly feels really scared" and depression symptoms, such as "Could never be as good" and "Hated self." Additionally, the shortest path network suggested the existence of different possible pathways of connection between anxiety and depression symptoms. Overall, these findings help to understand the complexity of the anxiety-depression comorbidity. It suggests the existence of central and bridge symptoms that complement previous studies, which may be potential targets for interventions to prevent and treat childhood anxiety and depression.

Gender differences in the co-occurrence of anxiety and depressive symptoms among early adolescents: A network approach

Gender differences have been identified in the co-occurrence of anxiety and depressive symptoms. However, the underlying mechanisms that give rise to this gender difference remain unclear, and few studies have examined the issue at the symptom level. The current study employed the 7-item Generalized Anxiety Disorder scale (GAD-7) and the 9-item Patient Health Questionnaire (PHQ-9) to assess anxiety and depressive symptoms in a national sample of early adolescents (N = 15 391). A network approach was applied to investigate the gender differences in symptom interconnectivity. Gender differences were found in the co-occurrence of anxiety and depressive symptoms. The results indicated that girls with higher global strength (p < 0.01) exhibited stronger interconnectivity between symptoms. Central symptom PHQ2 (Sad mood) was significantly stronger in girls (p < 0.01), whereas PHQ6 (Guilt) was stronger in boys (p < 0.05). GAD7 (Feeling afraid) was identified as a prominent bridge symptom in girls, while PHQ6 (Guilt) was observed to play a similar role in boys. The directed acyclic graphs (DAGs) demonstrated that one symptom of anxiety triggered a series of emotional symptoms of anxiety and depression, ultimately resulting in a depressive somatic symptom in girls, whereas leading to both depressive somatic and anxiety symptoms in boys. These findings enhance our understanding and provide insights into potential intervention targets to prevent the co-occurrence of anxiety and depressive symptoms at an early stage.

A network analysis of body image concern, interoceptive sensibility, self-consciousness, and self-objectification

OBJECTIVE

Disrupted interoception has been found in individuals with body image concerns and related psychiatric conditions (i.e., eating disorders, body dysmorphic disorder). However, few studies have explored the role of interoception in the relationship between body image concern and self-objectification (SO). As components of the bodily self, interoception and body image may also contribute to the fostering of self-consciousness.

METHODS

The current study estimated the network model of body image concern, adaptive and maladaptive interoceptive sensibility (IS), self-consciousness, and SO, with data from 743 neurotypical adults. The centrality of nodes and the robustness of the network were verified.

RESULTS

Our network showed that interoception correlated with certain characteristics of body image concern (BIC) with varying strength and different directions. The most central node described beliefs of BIC, namely, negative evaluation toward appearance. Self-objectification and maladaptive IS presented the highest bridge centrality. Interoception also linked BICs with SO and self-consciousness.

CONCLUSION

Findings suggested that SO, adaptive and maladaptive interoception might be the targets of intervention for individuals with BIC, specifically for those with high levels of appearance-related negative self-evaluations.

Maternal Depressive Symptoms and Offspring Internalizing Problems: A Cross-Lagged Panel Network Analysis in Late Childhood and Early Adolescence

The present study investigated the relations between maternal depressive symptoms and internalizing problems in offspring during late childhood and early adolescence, examining sex differences using symptom network analysis. A total of 885 Chinese youths in late childhood (n = 497, 38.6% girls; age = 9.58 years, SD = 0.24) and early adolescence (n = 388, 48.5% girls; age = 11.30 years, SD = 0.24) and their mothers (Mage = 37.34 years, SD = 5.42) were recruited. Cross-lagged panel network (CLPN) analysis was used to explore bridge symptoms (i.e., symptoms connecting two or more mental disorders) and identify transmission pathways between maternal depressive symptoms and offspring's internalizing problems at these two developmental stages. The CLPN results revealed that in late childhood, the bridge connections in the network model were boys feeling worried to mothers feeling distractible, and girls feeling worried to mothers feeling powerless. In early adolescence, the bridge connections were boys experiencing depressed mood to mothers feeling powerless, and mothers feeling bad to girls experiencing depressed mood. These findings highlight the network-level relations between maternal depressive symptoms and offspring internalizing problems. They provide insights into the developmental differences and similarities in symptoms during these periods and suggest ways to break the vicious cycle of psychopathology between mothers and their children.

Bridging the relationship between physical exercise and mental health in adolescents based on network analysis

Although physical exercise has been recommended as a useful means of enhancing the mental health of adolescents, the exact mechanisms through which physical exercise plays a role are unclear. Both physical exercise and mental health are complex concepts with multiple facets, and traditional methods may constrain the manifestations of their mapping relationships. This research aimed to find the bridging connections between physical exercise and mental health. Mental health and physical exercise behaviors were assessed using the Symptom Checklist 90 (SCL-90) and the Adolescent Physical Activity Questionnaire (PAQ-A) in 9072 Chinese adolescents, respectively. Network analysis was utilized to construct the mental health-physical exercise network and to analyze the relationships between individual physical exercise behaviors and mental health symptoms. Core and bridging nodes were identified based on expected influence (EI) and bridge expected influence (BEI). Gender differences were also examined. The results revealed specific and distinct pathways between physical exercise and mental health (e.g., winter sports-obsessive-compulsive symptoms, winter sports-phobia). For both males and females, anxiety, depression, interpersonal sensitivity, ball sports, and evening activity were the most central symptoms/behaviors, reflecting their relative significance in their respective associations. The nodes with the highest BEI were obsessive-compulsive symptoms and physical education, showing negative associations with nodes in the other community. Furthermore, in the male group, somatization and winter sports stood out as the most positive bridge nodes. Conversely, in the female group, interpersonal sensitivity and sports games were the most positive bridge nodes. These findings illuminate the pathways linking physical exercise and mental health, supporting the implementation of physical exercise in a more elaborate way.

Psychosomatic health status and corresponding comorbid network analysis of college students in traditional Chinese medicine schools

Introduction

Depression, anxiety, and somatic symptoms are highly comorbid and represent the most prevalent psychosomatic health issues. Few studies have investigated the network structure of psychosomatic symptoms among traditional Chinese medicine (TCM) students. This study aims to investigate the psychosomatic health status of college students in TCM universities, while simultaneously constructing a network structure of common somatic symptoms and psychological symptoms.

Methods

Online investigation was conducted among 665 students from a university of Chinese medicine. Health Status Questionnaire, Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-2 (PHQ-2) were used to assess the mental symptoms and physical status of participants. With the R software processing, a network model of psychosomatic symptoms was constructed. Specifically, we computed the predictability (PRE), expected influence (EI), and bridging expected influence (BEI) of each symptom. Meanwhile, the stability and accuracy of the network were evaluated using the case-deletion bootstrap method.

Results

Among the participants, 277 (41.65%) subjects exhibited depressive symptoms, and 244 (36.69%) subjects showed symptoms of anxiety. Common somatic symptoms included fatigue, forgetfulness, sighing, thirst, and sweating. Within the psychosomatic symptoms network, " worrying too much about things ", "uncontrollable worries" and "weakness" exhibited the high EI and PRE, suggesting they are central symptoms. " Little interest or pleasure in doing things," " feeling down, depressed, or hopeless," " dyssomnia," and "sighing" with high BEI values demonstrated that they are bridging symptoms in the comorbid network.

Conclusion

The psychosomatic health status of college students in traditional Chinese medicine schools is concerning, showing high tendencies for depression, anxiety, and somatic symptoms. There exists a complex relationship between somatic symptoms and psychological symptoms among students. " Worrying too much about things ", "uncontrollable worries" and "weakness" enable to serve as comorbid intervention targets for anxiety, depression, and somatic symptoms. Addressing " little interest or pleasure in doing things," " feeling down, depressed, or hopeless," " dyssomnia," and "sighing" may effectively prevent the mutual transmission between psychological and physical symptoms. The network model highlighting the potential targeting symptoms to intervene in the treatment of psychosomatic health.

A simulation-based network analysis of intervention targets for adolescent depressive and anxiety symptoms

Although previous research has well explored central and bridge symptoms of mental health problems, little examined whether these symptoms can serve as effective targets for intervention practices. Based on the Ising model, this study constructed a network structure of depressive and anxiety symptoms. The NodeIdentifyR algorithm (NIRA) was used to simulate interventions within this network, examining the effects of alleviating or aggravating specific symptoms on the network's sum scores. In this study, a total of 15,569 participants were recruited from China (50.87 % females, Mage = 13.44; SD = 0.97). The Ising model demonstrated that "sad mood" had the highest expected influence, and "irritability" had the highest bridge expected influence. Alleviating interventions suggested that decreasing the symptom value of "nervousness" resulted in the greatest projected reduction in network symptom activation, which may be a potential target symptom for treatment. Aggravating interventions indicated that elevating the symptom value of "sad mood" had the most projected increase in network activation, which may be a potential target for prevention. Additionally, network structure indices (e.g., central or bridge symptoms) need to be interpreted with more caution as intervention targets, since they may not be exactly the same. These findings enriched the comprehension of the depressive and anxiety network in Chinese adolescents, offering valuable insights for designing effective interventions.

Comorbidity among symptoms of internet gaming disorder, social withdrawal, and depression in 3430 young people in Hong Kong: A network analysis

BACKGROUND

The present study aimed to examine the comorbidity among symptoms of internet gaming disorder (IGD), social withdrawal, and depression using the network perspective.

METHODS

An online survey recruited 3430 young people in Hong Kong (mean age = 19.4 years, 80.5 % male) via gaming channels in 2019. The participants completed the 9-item IGD Scale, Hikikomori Questionnaire, and Patient Health Questionnaire-9. Network analysis was conducted using R to estimate the central symptoms of IGD and depression in individual networks and identified the bridge symptoms in combined network of IGD, social withdrawal, and depressive symptoms.

RESULTS

All network models showed high stability. 'Withdrawal', 'Loss of control', and 'Tolerance' were the central IGD symptoms, while 'Depressed mood' and 'Self-blame/guilt' were the central depressive symptoms. The bridge symptoms were 'Gaming as escape or mood relief' from IGD cluster, 'Depressed mood' and 'Self-blame/guilt' from depression cluster, and 'Marked social isolation at home' and 'Significant distress due to social isolation' from social withdrawal cluster. The combined network showed no significant differences in network structure and global strength across gender and age groups.

LIMITATIONS

The cross-sectional sample only indicated undirected associations between the symptoms in the three clusters and could not model the intra-individual variation.

CONCLUSIONS

The present study provided the first results on the comorbidity among IGD, social withdrawal, and depression at a symptom level among Chinese young people via network analysis. The bridge symptoms highlight potential targets for interventions of comorbidity among the disorders.

Longitudinal Relationships Between Depressive Symptoms and Generalized Anxiety Symptoms in Adolescents: A Cross-Lagged Network Analysis

The comorbidity of depression and generalized anxiety have raised questions about the existing classification system. Based on the perspective of network analysis, the developmental relationship between psychological symptoms can be explored more clearly. The current study aimed to explore the longitudinal network association of depressive symptoms and generalized anxiety symptoms in non-clinical adolescents. The sample contained 1,947 Chinese adolescents (Mage = 13.93, SD = 1.71; 48.5% girls). Their depression (PHQ-9) and generalized anxiety (GAD-7) symptoms were assessed at baseline (T1) and 6-month follow-up (T2). Data was analyzed using a cross-lagged network analysis. Depressive symptoms and generalized anxiety symptoms were closely related and did not appear to be distinct categories in adolescence. More generalized anxiety symptoms predicted depressive symptoms rather than vice versa. After controlling for gender, and age, "Difficulty relaxing" presented the highest out-expected influence (out-EI) in the network, while "trouble concentrating", and "suicidal ideation" showed the lowest in expected influence (in-EI). Findings suggested that interventions for generalized anxiety symptoms may help reduce depressive symptoms among Chinese adolescents. Specifically, alleviating "difficulty relaxing" may improve overall mental health.

Identification of the Core Characteristics of Vulnerable/Hypersensitive Narcissism and its Association with the Dark Triad in a Large International Sample: A Network Analysis Study

The current paper aimed to investigate the network structure and centrality indexes of hypersensitive narcissism using the hypersensitive Narcissism Scale (HSN). Additionally, we aimed to explore its relationships with dark triad personality aspects. A globally diverse sample of "53,981" participants (47.9% non-United States responders) completed the HSN and Dark Triad Dirty Dozen scale (DTD). We estimated the network structure across genders to determine the core characteristics of hypersensitive narcissism. Additionally, bridge and central nodes (characteristics) were identified. All analyses were performed using R-Studio programming software. The network comparison test indicated significant differences in the network structures between males and females (Network-Invariance: 0.0489, P < 0.01; Global Strength Invariance: 0.101, P < 0.01). In the network of HSN for male participants, characteristics with the highest strength centrality were "Highly affected by criticism" (HSN.2, strength = 1.08) and "Self-absorbed in personal pursuits" (HSN.8, strength = 1.28). For female participants, "Self-absorbed in personal pursuits" (HSN.8, strength = 1.32) and "privately annoyed by others' needs" (HSN.10, strength = 1.21) were the highest central characteristics. The assessment of bridge strength indicated that nodes HSN.2 (Highly sensitive to criticism), scoring 0.42, and DTD.1 (Tendency to manipulate for gain, a component of Machiavellianism), scoring 0.428, showed the highest bridge strength values. The current study identified core characteristics of hypersensitive narcissism and its correlation with dark triad personality, revealing gender-specific patterns and bridging symptoms between the two constructs. These findings showed that focusing on these core characteristics may be advantageous in treating individuals exhibiting elevated levels of narcissism.

Depression, anxiety, and insomnia symptoms among Chinese college students: A network analysis across pandemic stages

BACKGROUND

As the stages of the COVID-19 pandemic evolved, the symptoms of depression, anxiety, and insomnia have increasingly manifested among Chinese college students. The aim of this study is to investigate the relationships between these symptoms through network analysis among Chinese college students during COVID-19.

METHOD

A three-wave cross-sectional survey was conducted at 22 colleges in Guangdong Province, involving 381,152 students during three specific time intervals: T1 (baseline, February 3 to 10, 2020), T2 (19 months after baseline, June 10 to 18, 2021), and T3 (37 months after baseline, March 15 to April 22, 2023). Depression (PHQ-9), anxiety (GAD-7), and insomnia (YSIS) were used separately. We analyzed two key network indices: "Expected influence" and "Bridge expected influence". Network stability was assessed through a case-dropping bootstrap program.

RESULT

The effective sample sizes for the three periods were as follows: T1 - 164,101 (103,645 females, 63.2 %), T2 - 86,767 (52,146 females, 60.1 %), and T3 - 130,284 (76,720 females, 58.9 %). Across these three periods, the key central symptoms were "Fatigue" (PHQ4), "Restlessness" (GAD5), "Uncontrollable worrying" (GAD2), "Worry too much" (GAD3) and "Sleep insufficiency" (YSIS6). Notably, "Fatigue" (PHQ4), "Restlessness" (GAD5) and "Irritability" (GAD6) consistently served as bridge symptoms. In the T1 and T2 period, "Motor" (PHQ8) acted as a bridge symptom but weakened in T3.

CONCLUSION

Throughout the three periods, the mental health issues among Chinese college students displayed characteristics of somatization within the depression-anxiety-insomnia comorbidity network. Over time, anxiety symptoms appeared to become more prominent. Consequently, this study highlights the importance of accurately identifying and promptly intervening in these core symptoms of mental health among college students, as these symptoms may evolve across different stages of a pandemic.

Anxious and depressive symptoms and health-related quality of life in a cohort of people who recently attempted suicide: A network analysis

BACKGROUND

Suicide is an international health concern with immeasurable impact from the perspective of human and social suffering. Prior suicide attempts, anxious and depressive symptoms, and relatively lower health-related quality of life (HRQoL) are among the most replicated risk factors for suicide. Our goal was to visualize the distribution of these features and their interconnections with use of a network analysis approach in individuals who recently attempted suicide.

METHODS

Individuals with a recent suicide attempt were recruited from nine University Hospitals across Spain as part of the SURVIVE cohort study. Anxious and depressive symptoms, and perceived HRQoL were included in the network analysis. Network structures were estimated with the EBICglasso model. Centrality measures and bridge symptoms connecting communities were explored. Subnetworks comparing younger and older individuals, and women and men were analyzed.

RESULTS

A total of 1106 individuals with a recent suicide attempt were included. Depressed mood was the symptom with the greatest influence in the overall network, followed by anxiety symptoms such as feeling nervous, worrying, restless, and having difficulties to relax. Perceived general health was associated with increased suicidal ideation in the whole sample. Older people showed a specific connection between perceived general health and depressed mood.

LIMITATIONS

The cross-sectional design does not allow determination of established causality.

CONCLUSIONS

Depressed mood was the core network's symptom and, therefore, an important target in the management and prevention of suicide. HRQoL had more influence on the network of older populations, in which it should be a primary focus.

Network analysis of pandemic fatigue symptoms in samples from five South American countries

BACKGROUND

Pandemic fatigue generates low motivation or the ability to comply with protective behaviors to mitigate the spread of COVID-19.

AIMS

This study aimed to analyze the symptoms of pandemic fatigue through network analysis in individuals from five South American countries.

METHOD

A total of 1,444 individuals from Argentina, Bolivia, Paraguay, Peru, and Uruguay participated and were evaluated using the Pandemic Fatigue Scale. The networks were estimated using the ggmModSelect estimation method and a polychoric correlation matrix was used. Stability assessment of the five networks was performed using the nonparametric resampling method based on the case bootstrap type. For the estimation of network centrality, a metric based on node strength was used, whereas network comparison was performed using a permutation-based approach.

RESULTS

The results showed that the relationships between pandemic fatigue symptoms were strongest in the demotivation dimension. Variability in the centrality of pandemic fatigue symptoms was observed among participating countries. Finally, symptom networks were invariant and almost identical across participating countries.

CONCLUSIONS

This study is the first to provide information on how pandemic fatigue symptoms were related during the COVID-19 pandemic.

The comorbid network characteristics of anxiety and depressive symptoms among Chinese college freshmen

BACKGROUND

This study aimed to investigate the interplay between anxiety and depressive symptoms in Chinese college freshmen using the causal system perspective (CSP), which differs from the traditional common cause perspective (CCP) by providing an alternative explanation by attributing comorbidity to direct interactions among symptoms.

METHODS

A convenience sample of 2,082 Chinese college freshmen (39.51% male, Mage = 18.61) from a normal university completed the Generalized Anxiety Disorder 7-Item Scale (GAD-7) and the Patient Health Questionnaire (PHQ-9). Network analysis was conducted and evaluated as to centrality, stability, node predictability, and bridging features. Moreover, the moderated network model (MNM) was utilized to detect the moderation effects of gender in the comorbidity network.

RESULTS

The network of anxiety and depressive symptoms exhibited stability, characterized by the core symptoms of "restlessness", "lack of energy", and "excessive worry about control", as well as the bridging symptoms of "fearfulness", "sad mood", and "irritability". Notably, the nodes representing "uncontrollable worry" and "difficulty in relaxation" demonstrated the highest predictive power. Gender did not exert any moderating effects on the anxiety and depressive symptom network.

CONCLUSION

These results reinforce that certain anxiety or depressive symptoms are more central than others, and thus play a more vital role in the comorbid network. These findings highlight underlying potential targeting symptoms to consider in future interventions.

Symptom patterns in the co-occurrence of depressive and generalized anxiety symptoms: A network analysis of a Canadian nationally representative sample

BACKGROUND

This study aimed to investigate the symptom patterns of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in a matched nationally representative sample of the Canadian population. We also tested whether childhood maltreatment (CM) exposures and sex would be linked with different symptom patterns.

METHODS

A total of 3296 participants from the Canadian Community Health Survey-Mental Health with complete information on MDD and GAD symptoms and being matched on the studied sociodemographic characteristics were included in the current study. Network analysis was performed to examine the MDD-GAD symptom network, network stability and centrality indices were also estimated. Finally, network comparison in connectivity patterns was conducted to explore the impact of maltreatment experience and sex differences in the MDD-GAD symptom networks.

RESULTS

The CM group had stronger network connections and showed differences in the network structures from the non-CM group. In the CM group, depressed mood and diminished interest were central symptoms and strongly connected with other symptoms. Additionally, females had stronger connections in the MDD-GAD symptom network than males, and sleep disturbance was a central symptom for females, alongside depressed mood and diminished interest.

LIMITATIONS

The cross-sectional design restricts our capacity to establish longitudinal or causal connections between symptoms.

CONCLUSIONS

Depressed mood was the most central node that was strongly connected with other symptoms in the network. Distinct MDD-GAD symptom networks were discovered in the CM and the female group when compared to their counterparts. Noteworthy, individuals with CM had a stronger correlation between worry and suicidal ideation. Clinical management and intervention efforts should pay close attention to these core symptoms to yield optimal treatment effects, particularly for females and individuals with CM.

Temporal network of experience sampling methodology identifies sleep disturbance as a central symptom in generalized anxiety disorder

BACKGROUND

A temporal network of generalized anxiety disorder (GAD) symptoms could provide valuable understanding of the occurrence and maintenance of GAD. We aim to obtain an exploratory conceptualization of temporal GAD network and identify the central symptom.

METHODS

A sample of participants (n = 115) with elevated GAD-7 scores (Generalized Anxiety Disorder 7-Item Questionnaire [GAD-7] ≥ 10) participated in an online daily diary study in which they reported their GAD symptoms based on DSM-5 diagnostic criteria (eight symptoms in total) for 50 consecutive days. We used a multilevel VAR model to obtain the temporal network.

RESULTS

In temporal network, a lot of lagged relationships exist among GAD symptoms and these lagged relationships are all positive. All symptoms have autocorrelations and there are also some interesting feedback loops in temporal network. Sleep disturbance has the highest Out-strength centrality.

CONCLUSIONS

This study indicates how GAD symptoms interact with each other and strengthen themselves over time, and particularly highlights the relationships between sleep disturbance and other GAD symptoms. Sleep disturbance may play an important role in the dynamic development and maintenance process of GAD. The present study may develop the knowledge of the theoretical model, diagnosis, prevention and intervention of GAD from a temporal symptoms network perspective.

Network analysis of suicide ideation and depression-anxiety symptoms among Chinese adolescents

Background

The co-occurrence of depression and anxiety among adolescents is typically associated with suicide ideation.

Aims

The study aimed to investigate the symptom-level relationship between suicide ideation and the comorbidity of depression and anxiety.

Methods

1501 adolescents aged 12-19 years were assessed using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale, and 716 adolescents who scored ≥5 on both scales were selected as participants. Network analysis was used to identify the network structure of depressive symptoms and anxiety symptoms. Participants were categorised into either the suicide ideation or non-suicide ideation groups based on their scoring on the suicide-related item in PHQ-9. A comparison was made between the depression-anxiety symptom networks of the two groups.

Results

'Restlessness', 'sad mood' and 'trouble relaxing' were the most prominent central symptoms in the depression-anxiety symptom network, and 'restlessness', 'nervousness' and 'reduced movement' were the bridge symptoms in this network. 'Sad mood' was found to be directly related to 'suicide ideation' with the highest variance. The network structure was significantly different in properties between the suicide ideation group and the non-suicide ideation group, with 'restlessness' and 'sad mood' exhibiting significantly higher influence in the network of the suicide ideation group than that in the non-suicide ideation group.

Conclusion

Restlessness and sad mood could be targeted for the intervention of depression-anxiety symptoms among adolescents with suicide ideation.

Associations between anxiety, depression, and personal mastery in community-dwelling older adults: a network-based analysis

BACKGROUND

In China, about 18.70% of the population aged 60 years and older are at risk of low personal mastery as well as anxiety and depression for a variety of reasons. The purpose of this study was to construct a symptom network model of the relationship between anxiety, depression, and personal mastery in community-dwelling older adults and to identify central and bridge symptoms in this network.

METHODS

Depression, anxiety, and personal mastery were measured using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and Personal Mastery Scale (PMS), respectively. A total of 501 older adults in 16 communities in Changzhou and Zhenjiang, Jiangsu Province, China, were surveyed by using a combination of stratified sampling and convenience sampling methods. The R language was used to construct the network.

RESULTS

(1) The network structure of anxiety-depression-personal mastery was stable, with "Nervousness" (node GAD1, strength = 1.38), "Sad mood" (node PHQ2, strength = 1.22), " Inability to change" (node PMS2, strength = 1.01) and "Involuntarily" (node PMS3, strength = 0.95) as the central symptoms. (2) "Irritability" (node GAD6, bridge strength = 0.743), "Sad mood" (node PHQ2, bridge strength = 0.655), and "Trouble relaxing" (node GAD4, bridge strength = 0.550) were the bridge symptoms connecting anxiety, depressive symptoms, and personal mastery. (3) In the network comparison test (NCT), residence, somatic chronic comorbidity and gender had no significant effect on network structure.

CONCLUSIONS

The construction of the anxiety-depression-personal mastery network structure opens up new possibilities for mechanisms of action and intervention formulation for psychological disorders in community-dwelling older adults. The identification of central symptoms (e.g., nervousness, sad mood, inability to change, involuntarily) and bridge symptoms (e.g., irritability, sad mood, trouble relaxing) in community-dwelling older adults with anxiety, depression, and low sense of mastery can provide a scientific basis for the development of precise interventions.

A network model of depressive and anxiety symptoms: a statistical evaluation

BACKGROUND

Although network analysis studies of psychiatric syndromes have increased in recent years, most have emphasized centrality symptoms and robust edges. Broadening the focus to include bridge symptoms within a systematic review could help to elucidate symptoms having the strongest links in network models of psychiatric syndromes. We conducted this systematic review and statistical evaluation of network analyses on depressive and anxiety symptoms to identify the most central symptoms and bridge symptoms, as well as the most robust edge indices of networks.

METHODS

A systematic literature search was performed in PubMed, PsycINFO, Web of Science, and EMBASE databases from their inception to May 25, 2022. To determine the most influential symptoms and connections, we analyzed centrality and bridge centrality rankings and aggregated the most robust symptom connections into a summary network. After determining the most central symptoms and bridge symptoms across network models, heterogeneity across studies was examined using linear logistic regression.

RESULTS

Thirty-three studies with 78,721 participants were included in this systematic review. Seventeen studies with 23 cross-sectional networks based on the Patient Health Questionnaire (PHQ) and Generalized Anxiety Disorder (GAD-7) assessments of clinical and community samples were examined using centrality scores. Twelve cross-sectional networks based on the PHQ and GAD-7 assessments were examined using bridge centrality scores. We found substantial variability between study samples and network features. 'Sad mood', 'Uncontrollable worry', and 'Worrying too much' were the most central symptoms, while 'Sad mood', 'Restlessness', and 'Motor disturbance' were the most frequent bridge centrality symptoms. In addition, the connection between 'Sleep' and 'Fatigue' was the most frequent edge for the depressive and anxiety symptoms network model.

CONCLUSION

Central symptoms, bridge symptoms and robust edges identified in this systematic review can be viewed as potential intervention targets. We also identified gaps in the literature and future directions for network analysis of comorbid depression and anxiety.