A computational network perspective on pediatric anxiety symptoms

Abstract

Background: While taxonomy segregates anxiety symptoms into diagnoses, patients typically present with multiple diagnoses; this poses major challenges, particularly for youth, where mixed presentation is particularly common. Anxiety comorbidity could reflect multivariate, cross-domain interactions insufficiently emphasized in current taxonomy. We utilize network analytic approaches that model these interactions by characterizing pediatric anxiety as involving distinct, inter-connected, symptom domains. Quantifying this network structure could inform views of pediatric anxiety that shape clinical practice and research.

Methods: Participants were 4964 youths (ages 5-17 years) from seven international sites. Participants completed standard symptom inventory assessing severity along distinct domains that follow pediatric anxiety diagnostic categories. We first applied network analytic tools to quantify the anxiety domain network structure. We then examined whether variation in the network structure related to age (3-year longitudinal assessments) and sex, key moderators of pediatric anxiety expression.

Results: The anxiety network featured a highly inter-connected structure; all domains correlated positively but to varying degrees. Anxiety patients and healthy youth differed in severity but demonstrated a comparable network structure. We noted specific sex differences in the network structure; longitudinal data indicated additional structural changes during childhood. Generalized-anxiety and panic symptoms consistently emerged as central domains.

Conclusions: Pediatric anxiety manifests along multiple, inter-connected symptom domains. By quantifying cross-domain associations and related moderation effects, the current study might shape views on the diagnosis, treatment, and study of pediatric anxiety.

Keywords: Adolescent; anxiety; child; comorbidity; development; network; pediatric; symptoms.

Fig. 1.

Anxiety symptom domains in the full sample (n = 4964). Top: mean domain severity score for the five anxiety symptom domains. Center: anxiety symptom network topology. All edges are positive; thicker edges represent stronger associations. Bottom: strength of each domain node in the anxiety network (Z-scored). GAD, generalized anxiety disorder symptoms; SEP, separation anxiety disorder symptoms; SOC, social anxiety disorder symptoms; PAN, panic disorder/somatic symptoms; SCH, school phobia symptoms. Note: Symptom domain severity score was calculated as a subscale score divided by the number of subscale items. Error bars indicate one standard error of the mean.

Fig. 2.

Anxiety symptoms in (a) HVs (n = 634) and (b) anxiety patients (n = 1089). Top: mean domain score for the five anxiety symptom domains. Center: anxiety symptom network topology. All edges are positive; thicker edges represent stronger associations. Bottom: strength of each domain node in the anxiety network (Z-scored). GAD, generalized anxiety disorder symptoms; SEP, separation anxiety disorder symptoms; SOC, social anxiety disorder symptoms; PAN, panic disorder/somatic symptoms; SCH, school phobia symptoms. Note: Symptom domain severity score was calculated as a subscale score divided by the number of subscale items. Error bars indicate one standard error of the mean.

Fig. 3.

Anxiety symptoms in the male and female samples. Data presented are for the full sample divided into: (a) males (n = 2522) and (b) females (n = 2470). Top: mean domain severity score for the five anxiety symptom domains. Center: anxiety symptom network topology. All edges are positive; thicker edges represent stronger regularized partial correlations. Bottom: strength of each node in the anxiety network (Z-scored). GAD, generalized anxiety disorder symptoms; SEP, separation anxiety disorder symptoms; SOC, social anxiety disorder symptoms; PAN, panic disorder/somatic symptoms; SCH, school phobia symptoms. Note: Symptom domain severity score was calculated as a subscale score divided by the number of subscale items. Error bars indicate one standard error of the mean.

Fig. 4.

Longitudinal changes in anxiety symptoms (n = 1664). Data presented reflect longitudinal changes (from Time 1 to Time 2) in anxiety symptoms across two 3-year periods: (a) childhood (age 5.8–9.9 years at Time 1; n = 793), and (b) adolescence (age 10.0–14.3 years at Time 1; n = 871). Top: mean domain severity score for the five anxiety symptom domains. Center: anxiety symptom network topology. All edges are positive; thicker edges represent stronger associations. Bottom: strength of each domain node in the anxiety network (Z-scored). GAD, generalized anxiety disorder symptoms; SEP, separation anxiety disorder symptoms; SOC, social anxiety disorder symptoms; PAN, panic disorder/somatic symptoms; SCH, school phobia symptoms. Note: Symptom domain severity score was calculated as a subscale score divided by the number of subscale items. Error bars indicate one standard error of the mean.