Comorbidity between depression and anxiety: assessing the role of bridge mental states in dynamic psychological networks
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RESEARCH ARTICLE
Open Access
Comorbidity between depression and anxiety: assessing the role of bridge mental states in dynamic psychological networks Robin N. Groen1* , Oisín Ryan2, Johanna T. W. Wigman1, Harriëtte Riese1, Brenda W. J. H. Penninx3, Erik J. Giltay4, Marieke Wichers1 and Catharina A. Hartman1
Abstract Background: Comorbidity between depressive and anxiety disorders is common. A hypothesis of the network perspective on psychopathology is that comorbidity arises due to the interplay of symptoms shared by both disorders, with overlapping symptoms acting as so-called bridges, funneling symptom activation between symptom clusters of each disorder. This study investigated this hypothesis by testing whether (i) two overlapping mental states “worrying” and “feeling irritated” functioned as bridges in dynamic mental state networks of individuals with both depression and anxiety as compared to individuals with either disorder alone, and (ii) overlapping or nonoverlapping mental states functioned as stronger bridges. Methods: Data come from the Netherlands Study of Depression and Anxiety (NESDA). A total of 143 participants met criteria for comorbid depression and anxiety (65%), 40 participants for depression-only (18.2%), and 37 for anxiety-only (16.8%) during any NESDA wave. Participants completed momentary assessments of symptoms (i.e., mental states) of depression and anxiety, five times a day, for 2 weeks (14,185 assessments). First, dynamics between mental states were modeled with a multilevel vector autoregressive model, using Bayesian estimation. Summed average lagged indirect effects through the hypothesized bridge mental states were compared between groups. Second, we evaluated the role of all mental states as potential bridge mental states. Results: While the summed indirect effect for the bridge mental state “worrying” was larger in the comorbid group compared to the single disorder groups, differences between groups were not statistically significant. The difference between groups became more pronounced when only examining individuals with recent diagnoses (< 6 months). However, the credible intervals of the difference scores remained wide. In the second analysis, a nonoverlapping item (“feeling down”) acted as the strongest bridge mental state in both the comorbid and anxietyonly groups. (Continued on next page)
* Correspondence: [email protected] 1 Department of Psychiatry, Interdisciplinary Center for Psychopathology and Emotion regulation (ICPE), University Medical Center Groningen (UMCG), University of Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if c
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