Understanding Comorbidity in Adolescence: A Bridge Centrality Network Analysis of Depression, Anxiety, and Stress

Depression and anxiety are increasingly prevalent and often co-occur in adolescence. Symptoms of stress are a commonality of these disorders. However, the role of this commonality in the co-occurrence remains unknown. This cross-sectional study investigated the co-occurrence of depression, anxiety, and stress in adolescence using the network psychometrics approach. We obtained our data from the Open-Source Psychometrics Project. The data consisted of the Depression Anxiety Stress Scale (DASS)-42 (N = 25,086, ages 13-24 years old). We estimated Gaussian Graphical Models (i.e., partial correlations between nodes) and analyzed the bridge nodes. Bridge nodes are nodes of the network that are most influential in connecting the different disorders. We expected the bridge nodes to be the overlapping symptoms found among depression, anxiety, and stress as indicated in the DSM-V. Moreover, to examine whether bridge nodes were consistent across adolescence, we divided our sample into three...Show moreDepression and anxiety are increasingly prevalent and often co-occur in adolescence. Symptoms of stress are a commonality of these disorders. However, the role of this commonality in the co-occurrence remains unknown. This cross-sectional study investigated the co-occurrence of depression, anxiety, and stress in adolescence using the network psychometrics approach. We obtained our data from the Open-Source Psychometrics Project. The data consisted of the Depression Anxiety Stress Scale (DASS)-42 (N = 25,086, ages 13-24 years old). We estimated Gaussian Graphical Models (i.e., partial correlations between nodes) and analyzed the bridge nodes. Bridge nodes are nodes of the network that are most influential in connecting the different disorders. We expected the bridge nodes to be the overlapping symptoms found among depression, anxiety, and stress as indicated in the DSM-V. Moreover, to examine whether bridge nodes were consistent across adolescence, we divided our sample into three age groups: early adolescence (ages 13-15, N = 2,354), middle adolescence (ages 16-19, N = 9,476) and late adolescence (ages 20-24, N = 13,256). Our findings of the full sample adolescent network indicated that symptoms of restlessness (stress) and negative mood (depression) served as bridge nodes, which was in line with our hypothesis. Other bridge nodes, not in line with our hypothesis, were symptoms of subjective experience of anxiety (anxiety) and situational anxiety (anxiety). Bridge nodes exclusive to the late adolescent network were: Finding it hard to wind down (stress) and feeling terrified (anxiety). Moreover, relief after anxious situations (anxiety) was uniquely present in the early and late adolescent networks. This study expands the current theoretical knowledge by, for the first time to our knowledge, including stress symptoms in the network models and by comparing the different adolescent age groups using a broad age range (13 to 24 years). Future research should examine whether clinicians can successfully incorporate this knowledge into transdiagnostic treatment interventions, which could contribute to better overall mental health.Show less

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Understanding Comorbidity in Adolescence: A Bridge Centrality Network Analysis of Depression, Anxiety, and Stress