A cross-lagged prospective network analysis of depression and anxiety and cognitive functioning components in midlife community adult women

Abstract

Background: Scar theory proposes that heightened depression and anxiety precede and predict worse cognitive functioning outcomes, whereas the vulnerability theory posits the opposite pathway. However, most investigations on this topic have been cross-sectional, precluding causal inferences. Thus, we used cross-lagged prospective network analyses to facilitate causal inferences in understanding the relations between psychopathology and cognitive functioning components.

Methods: Racially-diverse midlife women (n = 1816) participated in the Study of Women's Health Across the Nation at two time-points, spanning one year apart. Five psychopathology (anxiety severity, depressed mood, somatic symptoms, positive affect, interpersonal problems) and four cognitive functioning nodes (working memory (WM), processing speed (PS), facial recognition (FCR), and verbal memory (VRM)) were assessed. All analyses adjusted for age, menopausal status, estradiol, and follicle-stimulating hormones.

Results: Contemporaneous networks yielded notable inverse between-node relations (edges) between interpersonal problems and reduced FCR and PS, and between depressed mood and lower FCR, VRM, or PS. Nodes that had the highest likelihood to bridge other constructs were positive affect, anxiety severity, WM, and VRM. Temporal networks produced edges consistent with the scar (v. vulnerability) hypotheses. Higher somatic symptoms were related to reduced PS and WM, and greater depressed mood was correlated with lower future PS and WM. Also, higher anxiety severity coincided with decreased future PS and WM. Greater positive affect was associated with stronger future PS, FCR, and WM. Also, positive affect had the strongest relations with other nodes.

Conclusions: Findings suggest the importance of targeting symptoms and cognitive functioning simultaneously.

Keywords: Anxiety; cross-lagged network analysis; depression; interpersonal; scar theory.

Fig. 1.

Contemporaneous networks of cognitive functioning and depression components. anx, anxiety severity; dep, depressed mood; frg, face recognition; vrm, verbal memory; int, interpersonal problems; pa, positive affect; ps, processing speed; som, somatic symptoms; fsh, follicle-stimulating hormone (mIU/mL); est, estradiol (pg/mL); age, age of participants at respective wave; mns, menopausal status (pre-menopausal, early perimenopausal, late perimenopausal, and post-menopausal). Light grey nodes indicate mental health symptoms, white nodes reflect cognitive functioning domains, and black nodes denote covariates. Black/grey lines indicate positive relations, whereas grey dotted lines signal negative relations, and line thickness and boldness reflect strength of associations.

Fig. 2.

Temporal network of cognitive functioning and depression components. anx, anxiety severity; dep, depressed mood; frg, face recognition; vrm, verbal memory; int, interpersonal problems; pa, positive affect; ps, processing speed; som, somatic symptoms; fsh, follicle-stimulating hormone (mIU/mL); est, estradiol (pg/mL); age, age of participants at respective wave; mns, menopausal status (pre-menopausal, early perimenopausal, late perimenopausal, and post-menopausal). White nodes indicate mental health symptoms, black nodes reflect cognitive functioning domains, and dark grey nodes denote covariates. Black/grey lines indicate positive relations, whereas grey dotted lines signal negative relations, and line thickness and boldness reflect strength of associations; W1, wave 1; W2, wave 2.

Fig. 3.

In-prediction and out-prediction of temporal network. anx, anxiety severity; dep, depressed mood; frg, face recognition; vrm, verbal memory; int, interpersonal problems; pa, positive affect; ps, processing speed; som, somatic symptoms; fsh, follicle-stimulating hormone (mIU/mL); est, estradiol (pg/mL); age, age of participants at respective wave; mns, menopausal status (pre-menopausal, early perimenopausal, late perimenopausal, and post-menopausal). White bars indicate mental health symptoms, black bars reflect cognitive functioning domains, and grey bars denote covariates.