Longitudinal Associations Between Anxiety and Depressive Symptoms in Adolescence, Early Adulthood, and Old Age: Cross-Lagged Panel Network Analyses

Abstract

Background: Depression and anxiety are among the most prevalent psychiatric disorders worldwide, affecting individuals of all ages. The co-occurrence of these disorders often exacerbates their negative health impacts, underscoring the necessity of understanding their comorbid mechanisms. Methods: This study employed cross-lagged panel networks (CLPNs) to explore the longitudinal associations between depression and anxiety symptoms across three age groups and to compare the respective symptom networks. CLPNs were constructed through cross-temporal associations between different symptoms, reflecting both the pattern of interaction and the significance of specific symptoms in comorbidity. The sample consisted of 1258 adolescents (aged 13-19 years, M = 15.98), 1118 college students (aged 17-24 years, M = 19.94), and 548 older adults (aged 60-101 years, M = 85.19) from China. Depression and anxiety symptoms were assessed using the subscales of the Depression, Anxiety, and Stress Scale Short Version (DASS-21) at two time points over a 6-month period during 2020-2021. Results: The findings revealed that the prevalence of depression and anxiety in adolescents, college students, and older adults was 25.9%/46.6%, 53.7%/61.5%, and 7.2%/22.5%, respectively. The network structure varied across age groups: adolescents and college students exhibiting a tight interconnection between depression and anxiety symptoms, while older adults showed stronger small-world network characteristics. A key finding across all age groups was the central role of irrational fear. In addition, somatic anxiety symptoms frequently emerged as outcomes of other psychological symptoms. Conclusion: Depression and anxiety are more pronounced in college students compared to adolescents and older adults. Comparisons of the overall network structure provide insights into the lifelong trajectories of depression and anxiety symptom networks. The centrality of irrational fears and somatization symptoms is emphasized. These results offer guidance for more targeted clinical interventions.

Keywords: anxiety; cross-lagged panel networks; depression.

Figure 1

The T1–T2 cross-lagged panel networks for three age groups. Note: The cross-lagged panel networks for adolescents (a), college students (b), and old adults (c). The arrows represent unique longitudinal relationships. The blue edges indicate positive relationships (i.e., odds ratios greater than 1), and the red edges indicate negative relationships (i.e., odds ratios less than 1). Edge thickness represents the strength of the odds ratio such that thicker edges represent stronger relations. Autoregressive edges and covariates were excluded from the plot to ease visual interpretation.

Figure 2

Symptom centrality estimates in the network of adolescent. Note: Larger values reflect greater centrality.

Figure 3

Symptom centrality estimates in the network of college students. Note: Larger values reflect greater centrality.

Figure 4

Symptom centrality estimates in the network of elderly. Note: Larger values reflect greater centrality.