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Mihić L, Janičić B, Marchetti I, Novović Z, Sica C, Bottesi G, Belopavlović R, Jakšić N. Comorbidity among depression, anxiety and stress symptoms in naturalistic clinical samples: A cross-cultural network analysis. Clin Psychol Psychother 2023. [PMID: 37940606 DOI: 10.1002/cpp.2927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023]
Abstract
Comorbidity between depression and anxiety is well-established across various settings and cultures. We approached comorbidity from the network psychopathology perspective and examined the depression, anxiety/autonomic arousal and stress/tension symptoms in naturalistic clinical samples from Serbia, Italy and Croatia. This was a multisite study in which regularized partial correlation networks of the symptoms, obtained via self-reports on the Depression Anxiety and Stress Scales-21 (DASS-21) in three cross-cultural, clinical samples (total N = 874), were compared with respect to centrality, edge weights, community structure and bridge centrality. A moderate degree of similarity in a number of network indices across the three networks was observed. While negative mood emerged to be the most central node, stress/tension nodes were the most likely bridge symptoms between depressive and anxiety/autonomic arousal symptoms. We demonstrated that the network structure and features in mixed clinical samples were similar across three different languages and cultures. The symptoms such as agitation, restlessness and inability to relax functioned as bridges across the three symptom communities explored in this study. Important theoretical and clinical implications were derived.
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Affiliation(s)
- Ljiljana Mihić
- Department of Psychology, Faculty of Philosophy, University of Novi Sad, Novi Sad, Serbia
| | - Bojan Janičić
- Department of Psychology, Faculty of Philosophy, University of Novi Sad, Novi Sad, Serbia
| | - Igor Marchetti
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Zdenka Novović
- Department of Psychology, Faculty of Philosophy, University of Novi Sad, Novi Sad, Serbia
| | - Claudio Sica
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Gioia Bottesi
- Department of General Psychology, University of Padova, Padova, Italy
| | - Radomir Belopavlović
- Department of Psychology, Faculty of Philosophy, University of Novi Sad, Novi Sad, Serbia
| | - Nenad Jakšić
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
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2
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Kokou-Kpolou CK, Park S, Bet Q, Iorfa SK, Chinweuba DC, Chukwuorji JC. Towards a more comprehensive understanding of depressive symptoms among young adults using Gaussian graphical and directed acyclic graph models. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-04192-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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3
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Lara E, Miret M, Olaya B, Caballero FF, Morillo D, Moneta MV, Haro JM, Ayuso-Mateos JL. Cohort Profile: The Spanish Longitudinal Study on Ageing and Health (Edad Con Salud). Int J Epidemiol 2022; 51:e189-e199. [PMID: 35712861 DOI: 10.1093/ije/dyac118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 05/20/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Elvira Lara
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain.,Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain.,CIBERSAM (CIBER of Mental Health), Institute of Health Carlos III, Madrid, Spain
| | - Marta Miret
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain.,CIBERSAM (CIBER of Mental Health), Institute of Health Carlos III, Madrid, Spain
| | - Beatriz Olaya
- CIBERSAM (CIBER of Mental Health), Institute of Health Carlos III, Madrid, Spain.,Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Francisco Félix Caballero
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Spain.,IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Institute of Health Carlos III, Madrid, Spain
| | - Daniel Morillo
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain.,CIBERSAM (CIBER of Mental Health), Institute of Health Carlos III, Madrid, Spain
| | - María Victoria Moneta
- CIBERSAM (CIBER of Mental Health), Institute of Health Carlos III, Madrid, Spain.,Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Josep Maria Haro
- CIBERSAM (CIBER of Mental Health), Institute of Health Carlos III, Madrid, Spain.,Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain.,Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain.,CIBERSAM (CIBER of Mental Health), Institute of Health Carlos III, Madrid, Spain
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4
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Steen OD, van Borkulo CD, van Loo HM. Symptom networks in major depression do not diverge across sex, familial risk, and environmental risk. J Affect Disord 2021; 294:227-234. [PMID: 34303301 DOI: 10.1016/j.jad.2021.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Major depression (MD) is a heterogeneous disorder in terms of its symptoms. Symptoms vary by presence of risk factors such as female sex, familial risk, and environmental adversity. However, it is unclear if these factors also influence interactions between symptoms. This study investigates if symptom networks diverge across sex, familial risk, and adversity. METHODS We included 9713 subjects from the general population who reported a lifetime episode of MD based on DSM-IV criteria. The survey assessed a wide set of symptoms, both from within the DSM criteria as well as other symptoms commonly experienced in MD. We compared symptom endorsement rates across sex, age at onset, family history and environmental adversity. We used the Network Comparison Test to test for symptom network differences across risk factors. RESULTS We found differences in symptom endorsement between groups. For instance, participants with an early onset of MD reported suicidal ideation nearly twice as often compared to participants with a later onset. We did not find any robust differences in symptom networks, which suggests that symptom networks do not diverge across sex, familial risk, and adversity. LIMITATIONS We estimated symptom networks of individuals during their worst lifetime episode of MD. Network differences might exist in a prodromal stage, while disappearing in full-blown MD (equifinality). Furthermore, as we used retrospective reports, results could be prone to recall bias. CONCLUSIONS Despite MD's heterogeneous symptomatology, interactions between symptoms are stable across risk factors and sex.
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Affiliation(s)
- Olivier D Steen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands.
| | - Claudia D van Borkulo
- Department of Psychological Methods, University of Amsterdam, Amsterdam, the Netherlands; Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
| | - Hanna M van Loo
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
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5
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Malgaroli M, Calderon A, Bonanno GA. Networks of major depressive disorder: A systematic review. Clin Psychol Rev 2021; 85:102000. [DOI: 10.1016/j.cpr.2021.102000] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/06/2021] [Accepted: 02/23/2021] [Indexed: 12/14/2022]
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6
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Wichers M, Riese H, Hodges TM, Snippe E, Bos FM. A Narrative Review of Network Studies in Depression: What Different Methodological Approaches Tell Us About Depression. Front Psychiatry 2021; 12:719490. [PMID: 34777038 PMCID: PMC8581034 DOI: 10.3389/fpsyt.2021.719490] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
The network theory of psychopathology proposes that mental disorders arise from direct interactions between symptoms. This theory provides a promising framework to understand the development and maintenance of mental disorders such as depression. In this narrative review, we summarize the literature on network studies in the field of depression. Four methodological network approaches are distinguished: (i) studies focusing on symptoms at the macro-level vs. (ii) on momentary states at the micro-level, and (iii) studies based on cross-sectional vs. (iv) time-series (dynamic) data. Fifty-six studies were identified. We found that different methodological approaches to network theory yielded largely inconsistent findings on depression. Centrality is a notable exception: the majority of studies identified either positive affect or anhedonia as central nodes. To aid future research in this field, we outline a novel complementary network theory, the momentary affect dynamics (MAD) network theory, to understand the development of depression. Furthermore, we provide directions for future research and discuss if and how networks might be used in clinical practice. We conclude that more empirical network studies are needed to determine whether the network theory of psychopathology can indeed enhance our understanding of the underlying structure of depression and advance clinical treatment.
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Affiliation(s)
- Marieke Wichers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, Netherlands
| | - Harriëtte Riese
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, Netherlands
| | - Taylor M Hodges
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, Netherlands
| | - Evelien Snippe
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, Netherlands
| | - Fionneke M Bos
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, Netherlands.,University of Groningen, University Medical Center Groningen, Department of Psychiatry, Rob Giel Research Center, Groningen, Netherlands
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