Objective

Frequent co-occurrence and bidirectional longitudinal associations have led some researchers to question the boundaries between depression and anxiety. A longitudinal investigation of the interconnected symptom structure of these constructs may help determine the extent to which they are distinct, and whether this changes over development. Therefore, the present study used network analysis to examine these symptom−symptom associations developmentally from early childhood to mid-adolescence.

Method

We analyzed data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (N = 1,147). Depression and anxiety symptoms were assessed on 7 occasions between ages 5 and 14 years using maternal reports. Regularized partial correlation networks were constructed at each time point, and diagnostic boundaries were explored using empirical tests of network modularity (ie, clustering of symptom nodes). Nonparametric permutation tests were used to determine whether symptoms became more associated over development, and network centrality was examined to identify developmental changes in the overall importance of specific symptoms.

Results

Symptoms formed highly interconnected networks, as evidenced by strong associations between depression and anxiety symptoms and a lack of distinct clustering. There was some evidence of an increase in overall connectivity as children aged. Feeling “anxious/fearful” and “unhappy/sad” were consistently the most central symptoms over development.

Conclusion

Minimal clustering of nodes indicated no separation of depression and anxiety symptoms from early childhood through mid-adolescence. An increase in connectivity over development suggests that symptoms may reinforce each other, potentially contributing to the high levels of lifetime continuity of these disorders.

中文翻译：

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整个发展过程中抑郁和焦虑症状的网络

客观的

频繁的共现和双向纵向关联使一些研究人员质疑抑郁和焦虑之间的界限。对这些结构相互关联的症状结构的纵向研究可能有助于确定它们的独特程度，以及这种差异是否会随着发展而改变。因此，本研究使用网络分析来检查从儿童早期到青春期中期的这些症状-症状关联。

方法

我们分析了国家儿童健康和人类发展研究所早期儿童保育和青少年发展研究的数据 (N = 1,147)。根据母亲的报告，对 5 岁至 14 岁之间的抑郁和焦虑症状进行了 7 次评估。在每个时间点构建正则化偏相关网络，并使用网络模块性的经验测试（即症状节点的聚类）来探索诊断边界。非参数排列测试用于确定症状是否在发展过程中变得更加相关，并检查网络中心性以确定特定症状的总体重要性的发展变化。

结果

抑郁症和焦虑症症状之间存在很强的关联性，并且缺乏明显的聚类，这证明了症状形成了高度互连的网络。有证据表明，随着儿童年龄的增长，整体连通性有所增加。感觉“焦虑/恐惧”和“不快乐/悲伤”一直是发育过程中最核心的症状。

结论

节点的最小聚集表明从幼儿期到青春期中期抑郁和焦虑症状没有分离。发育过程中连通性的增加表明症状可能会相互强化，可能导致这些疾病在一生中具有高水平的连续性。