Unraveling the comorbidity of depression and anxiety in a large inpatient sample: Network analysis to examine bridge symptoms
Open accessAbstract
BACKGROUND: Comorbidities in mental disorders are often understood by assuming a common cause. The network theory of mental disorders offers an alternative to this assumption by understanding comorbidities as mutually reinforced problems. In this study, we used network analysis to examine bridge symptoms between anxiety and depression in a large sample. METHOD: Using data from a sample of patients diagnosed with both depression and an anxiety disorder before and after inpatient treatment (N = 5,614, mean age: 42.24, 63.59% female, average treatment duration: 48.12 days), network models of depression and anxiety symptoms are estimated. Topology, the centrality of nodes, stability, and changes in network structure are analyzed. Symptoms that drive comorbidity are determined by bridge node analysis. As an alternative to network communities based on categorical diagnosis, we performed a community analysis and propose empirically derived symptom subsets. RESULTS: The obtained network models are highly stable. Sad mood and the inability to control worry are the most central. Psychomotor agitation or retardation is the strongest bridge node between anxiety and depression, followed by concentration problems and restlessness. Changes in appetite and suicidality were unique to depression. Community analysis revealed four symptom groups. CONCLUSION: The estimated network structure of depression and anxiety symptoms proves to be highly accurate. Results indicate that some symptoms are considerably more influential than others and that only a small number of predominantly physical symptoms are strong candidates for explaining comorbidity. Future studies should include physiological measures in network models to provide a more accurate understanding.
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Depression and anxiety are often comorbid, they show important differences.
“Relatedly, although depression and anxiety are often comorbid, they show important differences.51”
From Differential associations of Acceptance and Commitment Therapy processes with psychological distress across racial groups. (2026) · cites this paper as [51]
In two network analyses based on clinical psychiatric samples, sad mood was the most central symptom in the anxiety and depression network structure, followed by uncontrollable worry.
“In two network analyses based on clinical psychiatric samples, sad mood was the most central symptom in the anxiety and depression network structure, followed by uncontrollable worry [ 37 , 57 ].”
From Anxiety and Depression Symptoms among Youth Survivors of Childhood Sexual Abuse: A Network Analysis (2023) · cites this paper as [57]
In line with previous network structures of anxiety and depression, restlessness is highly correlated to female CSA survivors' inability to relax.
“In line with previous network structures of anxiety and depression [ 37 , 57 ], restlessness is highly correlated to female CSA survivors’ inability to relax.”
From Anxiety and Depression Symptoms among Youth Survivors of Childhood Sexual Abuse: A Network Analysis (2023) · cites this paper as [57]
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- Authors
- Kaiser, T., Herzog, P., Voderholzer, U., & Brakemeier, E.
- Affiliations
- Universität Greifswald (DE)
- Schön Klinik Roseneck (DE)
- Corresponding author
- Kaiser, Tim
- Venue
- Depression and Anxiety
- Publisher
- Wiley
- Published
- 2021-01-19
- Volume
- 38
- Issue
- 3
- Pages
- 307-317
- ISSN
- 1091-4269 (ISSN-L)
- 1520-6394
- OpenAlex
- W3124170626
- Cited by
- 296
- References
- 60
- Citations by year
- 2026: 65 · 2025: 77 · 2024: 65 · 2023: 47 · 2022: 35 · 2021: 6 · 2020: 1
- FWCI
- 36.93
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Depression and Anxiety (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- depression, anxiety disorders, comorbidities, bridge symptoms, symptom networks, network centrality, community structure, psychiatric inpatient care, sad mood, psychomotor agitation, concentration difficulties, appetite changes, suicidality, symptom clusters
- MeSH terms
- Adult, Anxiety, Anxiety Disorders, Depression, Female, Humans, Male, Psychomotor Agitation, Comorbidity
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