Comorbid Depression and Anxiety Symptoms in Chinese Adolescents: Testing the Explanatory Power of a Diathesis-Anxiety Model

Investigating the network structure and causal relationships among bridge symptoms of comorbid depression and anxiety: A Bayesian network analysis

BACKGROUND

The network analysis method emphasizes the interaction between individual symptoms to identify shared or bridging symptoms between depression and anxiety to understand comorbidity. However, the network analysis and community detection approach have limitations in identifying causal relationships among symptoms. This study aims to address this gap by applying Bayesian network (BN) analysis to investigate potential causal relationships.

METHOD

Data were collected from a sample of newly enrolled college students. The network structure of depression and anxiety was estimated using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) Scale measures, respectively. Shared symptoms between depression and anxiety were identified through network analysis and clique percolation (CP) method. The causal relationships among symptoms were estimated using BN.

RESULTS

The strongest bridge symptoms, as indicated by bridge strength, include sad mood (PHQ2), motor (PHQ8), suicide (PHQ9), restlessness (GAD5), and irritability (GAD6). These bridge symptoms formed a distinct community using the CP algorithm. Sad mood (PHQ2) played an activating role, influencing other symptoms. Meanwhile, restlessness (GAD5) played a mediating role with reciprocal influences on both anxiety and depression symptoms. Motor (PHQ8), suicide (PHQ9), and irritability (GAD6) assumed recipient positions.

CONCLUSION

BN analysis presents a valuable approach for investigating the complex interplay between symptoms in the context of comorbid depression and anxiety. It identifies two activating symptoms (i.e., sadness and worry), which serve to underscore the fundamental differences between these two disorders. Additionally, psychomotor symptoms and suicidal ideations are recognized as recipient roles, being influenced by other symptoms within the network.

Comorbid anxiety and depressive symptoms and the related factors among international medical students in China during COVID-19 pandemic: a cross-sectional study

BACKGROUND

The two most prevalent mental health conditions are anxiety and depression and they often coexist (comorbidity) in an individual aggravating the person's psychological or medical conditions. College students suffered from anxiety and depressive symptoms during the COVID-19 pandemic, according to numerous studies. The lack of information on the comorbidity of anxiety and depression (CAD) among international medical students, however, makes it difficult to develop effective policies or strategies to support these students.

OBJECTIVE

The present research seeks to investigate the incidence of CAD among international medical students in China and to identify the variables that may be useful in predicting CAD.

METHOD

A cross-sectional study was conducted at China Medical University in Shenyang, China, for international medical students during November 2020. A total of 519 international students provided information on their demographics, stress related to the COVID-19 pandemic, generalized anxiety disorder assessment (GAD-7), patient health questionnaire-9 (PHQ-9), simplified coping style questionnaire (SCSQ), perceived stress scale (PSS-10), the multidimensional scale of perceived social support (MSPSS), revised life orientation test (LOT-R), and resilience scale-14 (RS-14). To investigate the potential predictors of CAD, a chi-square test, a nonparametric test, and multinomial logistic regression analyses were carried out as appropriate.

RESULTS

The incidence of anxiety, depression, and CAD in the current study was 5.8%, 8.9%, and 22.7%, respectively. The predictors for students having symptoms of anxiety were observed to be the negative coping style (β = 0.662, OR = 1.938, CI:1.07-3.694) and perceived stress (β = 0.167, OR = 1.181, CI:1.076-1.297); the predictors for students having symptoms of depression were observed to be the COVID-19 pandemic-related stress (β = 0.323,OR = 1.382,CI:1.211-1.577), negative coping style (β = 0.693,OR = 2.000, CI:1.21-3.568), and perceived stress (β = 0.135,OR = 1.145,CI:1.050-1.248); whereas the predictors for students with CAD were observed to be staying up late (Yes VS No) (β = 1.028,OR = 2.794,CI:1.227-6.364), current place of residence (Other continents VS China) (β = -1.413, OR = 0.243,CI:0.065-0.910), COVID-19 pandemic-related stress (β = 0.371,OR = 1.450,CI:1.284-1.636), negative coping style (β = 1.092,OR = 2.979,CI:1.706-5.203), and perceived stress (β = 0.339,OR = 1.403,CI:1.289-1.527).

CONCLUSION

Single anxiety and depressive symptoms were moderately prevalent among international medical students in China. However, CAD turned out to be the most prevalent mental health issue due to its relatively higher incidence. Negative coping style and perceived stress were the communal predictors of the three categories, whereas stress related to the COVID-19 pandemic was linked to both depression and CAD, and staying up late and in residential places were specific predictors for CAD. Study results suggest that COVID-19 pandemic-related stress was related to students' CAD and depressive symptoms, and specific intervention measures with stress reduction, proper coping strategy, and a good lifestyle might be useful in improving the international students' mental health status.

Aggression and Depression in Chinese Early Adolescents: Same-Domain and Cross-Domain Effects in Friendships

From late childhood, friendships as a distinct peer experience become increasingly salient in affecting individual development. This one-year longitudinal study examined same-domain and cross-domain effects of aggression and depression in friendships among early adolescents in China. Participants included 226 students (95 boys) within 113 friendship dyads initially in sixth grade (initial mean age = 12 years) in two public junior high schools. Data on aggression, depression, and friendship were collected from self-reports and peer nominations in 2017 and 2018. The results using the actor-partner interdependence model showed that friends' aggression positively predicted adolescents' later aggression and that friends' depression positively predicted adolescents' later depression, indicating same-domain contagion effects. In addition, friends' aggression positively predicted adolescents' later depression, indicating cross-domain cascading effects. The results suggest that adolescents with more aggressive friends are at risk for developing higher levels of social-behavioral and psychological problems with time. The results help understand the role of friendships in individual maladaptive development and are discussed in terms of the Chinese context.

Feasibility and Acceptability of a Novel Online Program for Mental Health Carers

Objective

To evaluate the feasibility and acceptability of a new online program (Minds Together ) for carers of a person with depressive or anxiety symptoms.

Methods

Using a two-arm randomised controlled trial design, 108 carers of a person with depressive or anxiety symptomology aged 16 years or over (89% female; mean age 50 years) received immediate or delayed access to the Minds Together program. Feasibility was measured using program activation and survey completion rates. Acceptability was measured using a project-specific satisfaction scale, semi-structured interviews, and program completion metadata. The study used intention-to-treat (ITT) analysis for participant-reported outcomes (carer burden, coping self-efficacy) across groups.

Results

Feasibility and acceptability thresholds were consistent with similar studies: 59% activated their program account, 47% met the program completion threshold, and almost all reported satisfaction with the program. The ITT indicated trends in increased coping self-efficacy and reduced carer burden for the Intervention group, compared to the Waitlist control.

Conclusions

The Minds Together program is a feasible and acceptable program for carers supporting a person with depressive or anxiety symptomology. Results support exploration of the program's efficacy in a full-scale RCT.

Assessing Clinical Features of Adolescents Suffering from Depression Who Engage in Non-Suicidal Self-Injury

Depressive disorders (DDs) and non-suicidal self-injury (NSSI) are important juvenile mental health issues, showing alarming increasing rates. They frequently co-occur, mainly among adolescents, increasing the suicide risk. We aimed to compare the clinical features of two groups of adolescents with DDs, differed by their engagement or not in NSSI (“DD + NSSI” and “DD”). We hypothesized that NSSI would characterize particularly severe forms of DDs suitable for becoming specific phenotypes of adolescent depression. We enrolled 56 adolescents (11–17 years) diagnosed with a DD according to the DSM-5 criteria. They were assessed for NSSI endorsement (Ottawa Self-Injury Inventory), depressive symptoms (Children’s Depression Inventory 2), emotional dysregulation (Difficulties in Emotional Regulation Scale), and anxiety symptoms (Screen for Child Anxiety-Related Emotional Disorders). The two groups accounted for 31 (“DD + NSSI”) and 25 (“DD”) individuals. The “DD + NSSI” group had significantly higher suicidal ideation (p 0.0039), emotional dysregulation (p 0.0092), depressive symptoms (p 0.0138), and anxiety symptoms (p 0.0153) than the “DD” group. NSSI seemed to characterize more severe phenotypes of adolescent depression, applying for a potential role as a “specifier” of DDs, describing relevant information for their management. Further studies are needed to support this hypothesis and its potential opportunities for prevention and treatment.

Prevalence of and risk factors for depressive and anxiety symptoms in a large sample of Chinese adolescents in the post-COVID-19 era

BACKGROUND

Depressive and anxiety symptoms are widespread among adolescents today, creating a large social problem. However, few previous studies have addressed depression and anxiety among adolescents in Chinese cohorts. The aim of this study was to evaluate the prevalence of and risk factors for depressive and anxiety symptoms among Chinese middle school adolescent students in the post-COVID-19 era.

METHODS

A total of 22,380 middle school students from Jiangsu Province were surveyed online, and their general demographic data were collected. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms, and the seven-item Generalized Anxiety Disorder (GAD-7) scale was used to measure anxiety symptoms.

RESULTS

Of these participants (aged 12-17 years), 25.6% had depressive symptoms, 26.9% had anxiety symptoms, and 20.6% had a combination of depression and anxiety symptoms. The prevalence of depressive symptoms was higher in female adolescents (27.6%) than in male adolescents (23.7%; χ² = 45.479, P = 0.000), and the proportion with anxiety symptoms was higher among female adolescents (28.6%) than among male adolescents (25.4%; χ² = 29.390, P = 0.000). Furthermore, binary logistic regression analysis showed that gender, region, and parental relationship were significantly associated with depressive symptoms among adolescents, while age, gender, region, and parental relationship were significantly associated with anxiety symptoms.

CONCLUSIONS

Our findings demonstrated that the prevalence of reported depressive and anxiety symptoms in Chinese adolescents are high. Female gender, urban region, and poor parental relationship may be risk factors for depressive and anxiety symptoms. Furthermore, policy makers, schools, and families need to pay more attention to the psychological health of adolescents, develop response plans and take early intervention measures to reduce the prevalence of adolescent depression and anxiety.