Bridges over Troubled Waters: Mapping the Interplay Between Anxiety, Depression and Stress Through Network Analysis of t
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ORIGINAL PAPER
Bridges over Troubled Waters: Mapping the Interplay Between Anxiety, Depression and Stress Through Network Analysis of the DASS‑21 Nathan Van den Bergh1 · Igor Marchetti2 · Ernst H. W. Koster1 Accepted: 4 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
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. Keywords Depression Anxiety and Stress Scales · Depression · Anxiety · Stress · Networkanalysis · Transdiagnostic · Comorbidity
Introduction
Nathan Van den Bergh and Igor Marchetti contributed equally to the manuscript and share first authorship. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10608-020-10153-w) contains supplementary material, which is available to authorized users. * Nathan Van den Bergh [email protected] 1
Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Gent, Belgium
Department of Life Sciences ‑ Psychology Unit, University of Trieste, Via Edoardo Weiss 21, 34128 Trieste, Italy
2
Depressive and anxiety symptoms are highly prevalent across different countries (Lépine 2001). For instance, about 8% of the individuals from a German community sample (~ 8000 individuals) show subclinical depressive symptoms (Busch et al. 2013), which is associated with lower income (Whooley et al. 2002), less academic success (Eisenberg et al. 2009), and worse health and quality of life (Herrman et al. 2002). Similarly, mild-to-moderate anxiety symptoms are frequently present in the general population as well (Fehm et al. 2008; Haller et al. 2014). Unfortunately, depressive and
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