A network analysis of anxiety, depressive, and psychotic symptoms and functioning in children and adolescents at clinical high risk for psychosis

Abstract

Objective: Youths at clinical high risk for psychosis (CHR-P) are characterized by a high prevalence of anxiety and depressive disorders. The present study aimed at developing and analyzing a network structure of CHR-P symptom domains (i.e., positive, negative, disorganization, and general subclinical psychotic symptoms), depressive and anxiety symptoms, and general functioning.

Methods: Network analysis was applied to data on 111 CHR-P children and adolescents (M _age = 14.1), who were assessed using the Structured Interview for Prodromal Syndromes, the Children's Depression Inventory, the Children's Global Assessment Scale, and the Multidimensional Anxiety Scale for Children.

Results: In the network, negative and disorganization symptoms showed the strongest association (r = 0.71), and depressive and anxiety symptoms showed dense within-domain connections, with a main bridging role played by physical symptoms of anxiety. The positive symptom cluster was not associated with any other node. The network stability coefficient (CS) was slightly below 0.25, and observed correlations observed ranged from 0.35 to 0.71.

Conclusion: The lack of association between subclinical positive symptoms and other network variables confirmed the independent nature of subclinical positive symptoms from comorbid symptoms, which were found to play a central role in the analyzed network. Complex interventions should be developed to target positive and comorbid symptoms, prioritizing those with the most significant impact on functioning and the most relevance for the young individual, through a shared decision-making process. Importantly, the results suggest that negative and disorganization symptoms, as well as depressive and anxiety symptoms, may be targeted simultaneously.

Keywords: anxiety symptoms; attenuated psychotic symptoms; clinical high risk for psychosis (CHR-P); comorbidity; depressive symptoms; general functioning; network analysis.

FIGURE 1

Network structure of 13 symptoms (based on symptomatology, as assessed with the SIPS, CDI, MASC, and CGAS). Node colors refer to a priori symptom domains (see legend) and numbers refer to specific individual items (i.e., symptoms) (see section “Measures”). The associations are either positive (colored black) or negative (colored red), with thicker lines representing stronger associations.

FIGURE 2

Correlation matrix. Phys, physical symptoms; Avoid, harm avoidance; Social, social anxiety; Sep, separation anxiety; Mood, negative mood; Self-Est, negative self-esteem; Interp, interpersonal problems; Func, general functioning; P, psychotic symptoms; N, negative symptoms; D, disorganization symptoms; G, general symptoms.

FIGURE 3

Centrality indices of the study variables within the network. Centrality indices (i.e., node strength, closeness, betweenness) are shown as standardized z-scores.