Abstract
Background
Symptoms of depression and anxiety often co-occur in the same individuals. In order to increase our understanding of concurrent depression and anxiety, it may be necessary to define and model psychopathology as a network of symptoms, that actively reinforce (or inhibit) one another. The current study set out to investigate how depression, anxiety and stress symptoms cluster together, and which symptoms act as bridges between these clusters.
Methods
Network analysis was used to investigate the symptom structure of the DASS-21 in a large international sample (N = 11,647). After checking whether the original symptom structure was replicated, the network was further investigated at multiple levels: individual symptoms that are central in the network (1) or function as bridges between clusters (2); symptom pairs that show especially strong associations (3), and the overall structure that may or may not differ between gender groups (4).
Results
Items referring to panic, worry, worthlessness, hopelessness and meaninglessness of life emerged as potentially crucial symptoms in the interplay between depression and anxiety. When comparing female and male networks, the results suggest that the network structures are similar, but not identical.
Conclusions
Specific symptoms can function as bridges between depression, anxiety and stress, which is clinically relevant on top of being theoretically important.
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Notes
The study was conducted on the data set made available on February 21st 2019, which was accessed on May 25th 2019.
Similar results were obtained when the full data set was analyzed (see the section “Comparison between the selected and the original samples”).
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Acknowledgements
Nathan Van den Bergh is supported by the Concerted Research Action Grant of Ghent University (Grant BOF16/GOA/017), awarded to Ernst H. W. Koster. Ernst H. W. Koster is also supported by an Applied Biomedical (TBM) grant of the Agency for Innovation through Science and Technology (IWT), part of the Research Foundation–Flanders (FWO), PrevenD project (B/14730/01). The authors are grateful for the Open Source Psychometrics Project, as this study would not have not been possible without the data derived from https://openpsychometrics.org.
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Van den Bergh, N., Marchetti, I. & Koster, E.H.W. Bridges over Troubled Waters: Mapping the Interplay Between Anxiety, Depression and Stress Through Network Analysis of the DASS-21. Cogn Ther Res 45, 46–60 (2021). https://doi.org/10.1007/s10608-020-10153-w
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DOI: https://doi.org/10.1007/s10608-020-10153-w