Comorbidity Between Depression and Anxiety in Adolescents: Bridge Symptoms and Relevance of Risk and Protective Factors

• In Event: Poster Session 12
  In Poster Session: PS 12 Topic - Developmental Psychopathology

Abstract

Background: Depression and anxiety are highly common in adolescents with 10% and 24.9% 12-month prevalence in the US, respectively (Kessler et al., 2012). These disorders are often comorbid with rates reaching up to 50% in community samples (Garber & Weersing, 2010). The comorbidity causes much worse prognosis than depression or anxiety alone, and leads to further difficulties in several aspects of individuals’ lives (Cummings et al., 2014; Schoevers et al., 2005). As such, prevention and reduction of comorbidity is important. However, this necessitates a deep understanding of the inter-relationship between depression and anxiety (Jones et al., 2019), and the mechanisms that underlie this co-occurrence, to date, are poorly understood (Karlsson et al., 2006).

Aims: First, to use network analysis to investigate individual depression symptoms that are highly associated with non-overlapping individual anxiety symptoms (i.e. anxiety symptoms that are not also symptoms of depression) and vice versa (i.e. the bridge symptoms). Second, to assess the role of relevant risk and protective factors (e.g. peer relational problems, prosocial behavior etc.) in explaining associations between these disorders. Third, to investigate the overall network structure of non-overlapping depression and anxiety symptoms alone, and with the risk and protective factors.

Method: We analyzed data from the Avon Longitudinal Study of Children and Parents (N = 3670). Depression and anxiety symptoms, peer victimization, bullying, peer relational problems, prosocial behavior, and parental monitoring were assessed at a single time point between ages 12 years 6 months and 13 years 10 months. Stressful life events (SLEs) that took place between ages 9 years and 11 years were assessed at age 11 years. Two networks that depict the conditional independence relationships among the variables (i.e. unregularized partial correlation networks) were estimated. The first network was consisted of depression and anxiety symptoms only, and the second network was consisted of the symptoms and risk/protective factors. Centrality indices and bridge centrality indices were examined to identify bridge symptoms and associations with risk and protective factors. The stability and accuracy of the networks were assessed using bootstrapping techniques.

Results: The symptoms that most strongly linked clusters of depression symptoms from the Short Moods and Feelings Questionnaire with a non-overlapping cluster of anxiety symptoms (GAD worries) were, depression symptoms of “feeling unhappy” and “feeling lonely”, and GAD worry symptoms of “worrying about past” and “worrying about future.” Higher levels of peer relational difficulties and SLEs were strongly associated with several depression and GAD worry symptoms, such that these two risk factors created a link between individual depression and anxiety symptoms. Prosocial behavior had several negative associations with symptoms of both disorders, suggesting it can be an important protective factor.

Conclusion: Depression and GAD worries were interconnected through several symptom-symptom interactions. Depression symptoms of “feeling lonely” was an important bridge symptom even though it is not considered a core depression symptom in the DSM. SLEs and peer relational problems were the most prominent risk factors and prosocial behavior is likely to be an important protective factor.

Authors

• Deniz Konac, King’s College London
  Presenting Author

• Edward D Barker, King’s College London
  Non-Presenting Author

• Katherine Young, King's College London
  Non-Presenting Author

• Jennifer Lau, King's College London
  Non-Presenting Author