TY - JOUR
T1 - Inter-relationships of depressive and anxiety symptoms with suicidality among adolescents
T2 - A network perspective
AU - Cai, Hong
AU - Chow, Ines H.I.
AU - Lei, Si Man
AU - Lok, Grace K.I.
AU - Su, Zhaohui
AU - Cheung, Teris
AU - Peshkovskaya, Anastasia
AU - Tang, Yi Lang
AU - Jackson, Todd
AU - Ungvari, Gabor S.
AU - Zhang, Ling
AU - Xiang, Yu Tao
N1 - Funding Information:
The study was supported by the National Science and Technology Major Project for investigational new drug ( 2018ZX09201-014 ), the Beijing Hospitals Authority Clinical Medicine Development of special funding support ( XMLX202128 ), and the University of Macau ( MYRG2019-00066-FHS ; MYRG2022-00187-FHS ).
Publisher Copyright:
© 2023 Elsevier B.V.
PY - 2023/3/1
Y1 - 2023/3/1
N2 - Background: Persons with suicidality including suicidal ideation (SI), suicide plans (SP) and/or suicide attempts (SA) are at higher risk for future suicide than those without suicidality. To reduce the risk of future suicide, it is important to understand symptoms of emotional distress that have the strongest links with SI, SP and SA. This network analysis examined item-level relations of depressive and anxiety symptoms with suicidality among adolescents during the COVID-19 pandemic. Methods: Adolescents between 12 and 20 years of age were assessed with the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and individual binary reponse (no/yes) items assessing SI, SP, and SA during the pandemic. The structure of depressive symptoms, anxiety symptoms and suicidality was characterized using “Expected Influence” and “Bridge Expected Influence” as centrality indices in the symptom network. Network stability was tested using a case-dropping bootstrap procedure. Node-specific predictive betweenness was computed to examine short paths of anhedonia, other depressive symptoms and anxiety symptoms with suicidality. A Network Comparison Test (NCT) was conducted to examine whether network characteristics differed based on gender. Results: Prevalence rates of depressive symptoms, anxiety symptoms, and suicidality were 44.60 % (95% confidence interval (CI) = 41.53–47.67 %), 31.12 % (95%CI = 28.26–33.98 %), and 16.95 % (95%CI = 14.63–19.26 %), respectively, in the study sample. The network analysis identified GAD3 (“Worry too much”) as the most central symptom, followed by GAD6 (“Irritability”) and PHQ6 (“Guilt”) in the sample. Additionally, PHQ6 (“Guilt”), GAD6 (“Irritability”), and PHQ2 (“Sad mood”) were bridge nodes linking depressive and anxiety symptoms with suicidality. A flow network indicated that the connection between S (“Suicidality”) and PHQ6 (“Guilt”) reflected the strongest connection, followed by connections of S (“Suicidality”) with GAD2 (“Uncontrollable worrying”), and S (“Suicidality”) with PHQ2 (“Sad mood”). Finally, PHQ2 (“Sad mood”) was the main bridge node linking anhedonia with other depressive and anxiety symptoms and suicidality in the sample. Conclusions: Findings highlight the potential importance of reducing specific depressive and anxiety symptoms as possible means of reducing suicidality among adolescents during the pandemic. Central symptoms and key bridge symptoms identified in this study should be targeted in suicide prevention for at-risk adolescents.
AB - Background: Persons with suicidality including suicidal ideation (SI), suicide plans (SP) and/or suicide attempts (SA) are at higher risk for future suicide than those without suicidality. To reduce the risk of future suicide, it is important to understand symptoms of emotional distress that have the strongest links with SI, SP and SA. This network analysis examined item-level relations of depressive and anxiety symptoms with suicidality among adolescents during the COVID-19 pandemic. Methods: Adolescents between 12 and 20 years of age were assessed with the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and individual binary reponse (no/yes) items assessing SI, SP, and SA during the pandemic. The structure of depressive symptoms, anxiety symptoms and suicidality was characterized using “Expected Influence” and “Bridge Expected Influence” as centrality indices in the symptom network. Network stability was tested using a case-dropping bootstrap procedure. Node-specific predictive betweenness was computed to examine short paths of anhedonia, other depressive symptoms and anxiety symptoms with suicidality. A Network Comparison Test (NCT) was conducted to examine whether network characteristics differed based on gender. Results: Prevalence rates of depressive symptoms, anxiety symptoms, and suicidality were 44.60 % (95% confidence interval (CI) = 41.53–47.67 %), 31.12 % (95%CI = 28.26–33.98 %), and 16.95 % (95%CI = 14.63–19.26 %), respectively, in the study sample. The network analysis identified GAD3 (“Worry too much”) as the most central symptom, followed by GAD6 (“Irritability”) and PHQ6 (“Guilt”) in the sample. Additionally, PHQ6 (“Guilt”), GAD6 (“Irritability”), and PHQ2 (“Sad mood”) were bridge nodes linking depressive and anxiety symptoms with suicidality. A flow network indicated that the connection between S (“Suicidality”) and PHQ6 (“Guilt”) reflected the strongest connection, followed by connections of S (“Suicidality”) with GAD2 (“Uncontrollable worrying”), and S (“Suicidality”) with PHQ2 (“Sad mood”). Finally, PHQ2 (“Sad mood”) was the main bridge node linking anhedonia with other depressive and anxiety symptoms and suicidality in the sample. Conclusions: Findings highlight the potential importance of reducing specific depressive and anxiety symptoms as possible means of reducing suicidality among adolescents during the pandemic. Central symptoms and key bridge symptoms identified in this study should be targeted in suicide prevention for at-risk adolescents.
KW - Adolescents
KW - Anxiety
KW - Depression
KW - Network analysis
KW - Suicidality
UR - http://www.scopus.com/inward/record.url?scp=85145830905&partnerID=8YFLogxK
U2 - 10.1016/j.jad.2022.12.093
DO - 10.1016/j.jad.2022.12.093
M3 - Journal article
C2 - 36584712
AN - SCOPUS:85145830905
SN - 0165-0327
VL - 324
SP - 480
EP - 488
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
ER -