Network analysis of suicide ideation and depression-anxiety symptoms among Chinese adolescents

Abstract

Background: The co-occurrence of depression and anxiety among adolescents is typically associated with suicide ideation.

Aims: The study aimed to investigate the symptom-level relationship between suicide ideation and the comorbidity of depression and anxiety.

Methods: 1501 adolescents aged 12-19 years were assessed using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale, and 716 adolescents who scored ≥5 on both scales were selected as participants. Network analysis was used to identify the network structure of depressive symptoms and anxiety symptoms. Participants were categorised into either the suicide ideation or non-suicide ideation groups based on their scoring on the suicide-related item in PHQ-9. A comparison was made between the depression-anxiety symptom networks of the two groups.

Results: 'Restlessness', 'sad mood' and 'trouble relaxing' were the most prominent central symptoms in the depression-anxiety symptom network, and 'restlessness', 'nervousness' and 'reduced movement' were the bridge symptoms in this network. 'Sad mood' was found to be directly related to 'suicide ideation' with the highest variance. The network structure was significantly different in properties between the suicide ideation group and the non-suicide ideation group, with 'restlessness' and 'sad mood' exhibiting significantly higher influence in the network of the suicide ideation group than that in the non-suicide ideation group.

Conclusion: Restlessness and sad mood could be targeted for the intervention of depression-anxiety symptoms among adolescents with suicide ideation.

Keywords: Adolescent Behavior; Anxiety; Depression; Suicidal Ideation.

Figure 1

The flowchart of the participant enrolment procedure. GAD-7, Generalized Anxiety Disorder Scale; PHQ-9, Patient Health Questionnaire.

Figure 2

(A) Network structure of depression and anxiety symptoms among adolescents (n=716). Nodes are coloured according to their clusters, with blue nodes indicating depressive symptoms and red nodes indicating anxiety symptoms. Blue edges represent positive associations. Red edges represent negative associations. Thicker edges represent a greater association between two nodes, while thinner edges represent a weaker association. (B) Strength; (C) expected influence; (D) bridge strength; (E) bridge-expected influence. G1, nervousness; G2, uncontrollable worrying; G3, excessive worry; G4, trouble relaxing; G5, restlessness; G6, irritability; G7, feeling afraid; P1, anhedonia; P2, sad mood; P3, sleep disturbance; P4, lack of energy; P5, loss of appetite; P6, guilt; P7, trouble concentrating; P8, reduced movement; P9, suicide ideation.

Figure 3

Flow network of suicide ideation. Blue edges represent positive associations. Red edges represent negative associations. G1, nervousness; G2, uncontrollable worrying; G3, excessive worry; G4, trouble relaxing; G5, restlessness; G6, irritability; G7, feeling afraid; P1, anhedonia; P2, sad mood; P3, sleep disturbance; P4, lack of energy; P5, loss of appetite; P6, guilt; P7, trouble concentrating; P8, reduced movement; P9, suicide ideation.

Figure 4

(A) Network structure of depressive–anxiety symptoms among the non-suicide ideation group. (B) Expected influence of the non-suicide ideation group. (C) Bridge-expected influence of the non-suicide ideation group. (D) Network structure of depressive–anxiety symptoms among the suicide ideation group. (E) Expected influence of the suicide ideation group. (F) Bridge-expected influence of the suicide ideation group. G1, nervousness; G2, uncontrollable worrying; G3, excessive worry; G4, trouble relaxing; G5, restlessness; G6, irritability; G7, feeling afraid; P1, anhedonia; P2, sad mood; P3, sleep disturbance; P4, lack of energy; P5, loss of appetite; P6, guilt; P7, trouble concentrating; P8, reduced movement; P9, suicide ideation.