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

ABSTRACT: Depression and anxiety are highly prevalent and comorbid in adolescents, and this co-occurrence leads to worse prognosis and additional difficulties. The relationship between depression and anxiety must be delineated to, in turn, reduce and prevent the comorbidity, however our knowledge is still limited. We used network analysis to investigate bridge symptoms; symptoms that connect individual depression and anxiety symptoms and thus can help explain the comorbidity. We also examined the role of relevant risk and protective factors in explaining these symptom-level associations between these disorders. 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 around age 13 years. Stressful life events (SLEs) were assessed at age 11 years. We identified the most prominent bridge symptoms among depression (“feeling unhappy”, “feeling lonely”) and anxiety symptoms (“worrying about past”, “worrying about future”). Peer relational difficulties and SLEs were strongly associated with several depression and anxiety 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.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10862-021-09880-5.

SUBMITTER: Konac D

PROVIDER: S-EPMC8550210 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background Comorbidity between depressive and anxiety disorders is common. A hypothesis of the network perspective on psychopathology is that comorbidity arises due to the interplay of symptoms shared by both disorders, with overlapping symptoms acting as so-called bridges, funneling symptom activation between symptom clusters of each disorder. This study investigated this hypothesis by testing whether (i) two overlapping mental states “worrying” and “feeling irritated” functioned as bridges in dynamic mental state networks of individuals with both depression and anxiety as compared to individuals with either disorder alone, and (ii) overlapping or non-overlapping mental states functioned as stronger bridges. Methods Data come from the Netherlands Study of Depression and Anxiety (NESDA). A total of 143 participants met criteria for comorbid depression and anxiety (65%), 40 participants for depression-only (18.2%), and 37 for anxiety-only (16.8%) during any NESDA wave. Participants completed momentary assessments of symptoms (i.e., mental states) of depression and anxiety, five times a day, for 2?weeks (14,185 assessments). First, dynamics between mental states were modeled with a multilevel vector autoregressive model, using Bayesian estimation. Summed average lagged indirect effects through the hypothesized bridge mental states were compared between groups. Second, we evaluated the role of all mental states as potential bridge mental states. Results While the summed indirect effect for the bridge mental state “worrying” was larger in the comorbid group compared to the single disorder groups, differences between groups were not statistically significant. The difference between groups became more pronounced when only examining individuals with recent diagnoses (<?6?months). However, the credible intervals of the difference scores remained wide. In the second analysis, a non-overlapping item (“feeling down”) acted as the strongest bridge mental state in both the comorbid and anxiety-only groups. Conclusions This study empirically examined a prominent network-approach hypothesis for the first time using longitudinal data. No support was found for overlapping mental states “worrying” and “feeling irritable” functioning as bridge mental states in individuals vulnerable for comorbid depression and anxiety. Potentially, bridge mental state activity can only be observed during acute symptomatology. If so, these may present as interesting targets in treatment, but not prevention. This requires further investigation.

Project description:ObjectivePatients with primary Sjögren's Syndrome (pSS) have diminished health quality and fatigue, arthralgia along with dryness of the mouth and eyes have major impact on their psychological and social aspects of life. The purpose of this study was to determine psychological features of patients with pSS. We analyzed personality, depression and anxiety of patients with primary Sjögren's Syndrome (pSS) in comparison with patients with rheumatoid arthritis (RA) and healthy controls (HC) and assessed their association with sociodemographic factors and comorbidity.MethodsIn 105 pSS patients (mean age 51.34 years, mean disease duration 5.98 years), 52 RA patients (mean age 51.37 years, mean disease duration 8.10 years) and 54 HC (mean age 51.35 years) clinical and sociodemographic characteristics were determined and results analyzed. At enrollment patients and controls completed the Revisited NEO Personality Inventory Five-Factor model (NEO-PI-R), the Zung Self-Rating Depression Scale and the Zung Self-Rating Anxiety Scale. Statistical analyses were performed using SPSS [Version 16.0]. The relative size of the effect was assessed based on standardized estimates of effect size (d).ResultsPatients with pSS, similarly to RA patients had higher scores of Neuroticism (d = 0.46, p = 0.007) and lower scores of Extraversion (d = 0.51, p = 0.001) and Openness for experience (d = 0.65, p = 0.013) compared to HC. There was no significant differences between pSS group and HC in the depression (d = 0.171, p>0.05). However, patients with pSS had higher anxiety in comparison to HC (p<0.0001). In multivariate models, education and satisfaction with family relationships were significant predictors for psychological characteristics of patients, independently of clinical diagnosis.ConclusionsOur study is the first to show that patients with pSS scored high on neuroticism and anxiety and low on sociability. Education and satisfaction with family relationships predisposed to their psychological profile. Psychological assessment of patients with pSS may improve understanding and treatment of this clinical condition.

Project description:Background: Cannabis use is prevalent among adolescents, and many report using in attempts to alleviate negative mood and anxiety. Abstinence from substances such as alcohol and tobacco has been reported to improve symptoms of anxiety and depression. Few studies have examined the effect of cannabis abstinence on symptoms of anxiety and depression. Objective: To test the effect of 4 weeks of continuous cannabis abstinence on depressive and anxious symptoms. Methods: Healthy, non-treatment seeking adolescents who used cannabis at least weekly (n = 179) were randomized to either 4 weeks of cannabis abstinence achieved through a contingency management paradigm (CB-Abst) or cannabis use monitoring without an abstinence requirement (CB-Mon). Abstinence was assessed by self-report verified with quantitative assay of urine for cannabinoids. Anxiety and depressive symptoms were assessed weekly with the Mood and Anxiety Symptom Questionnaire (MASQ). Results: Symptoms of depression and anxiety decreased throughout the study for all participants (MASQ-AA: stnd beta = -0.08, p = 0.01, MASQ-GDA: stnd beta = -0.11, p = 0.003, MASQ-GDD: stnd beta = -0.08, p = 0.02) and did not differ significantly between randomization groups (p's > 0.46). Exploratory analyses revealed a trend that abstinence may be associated with greater improvement in symptoms of anxiety and depression among those using cannabis to cope with negative affect and those with potentially hazardous levels of cannabis use. Conclusions: Among adolescents who use cannabis at least weekly, 4 weeks of cannabis abstinence was not associated with a significant change in anxiety or depressive symptoms compared to continued use. For recreational cannabis users who may be concerned about reducing their use for fear of increased symptoms of anxiety and depression, findings suggest that significant symptom worsening may not occur within the first 4 weeks of abstinence. Further studies are needed in clinical populations where anxiety and depression symptoms are measured more frequently and for a longer period of abstinence. Future studies are also needed to determine whether there are subgroups of adolescents who are uniquely impacted by sustained cannabis abstinence.

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

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