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30-03-2021 | Uitgave 3/2021 Open Access

Journal of Psychopathology and Behavioral Assessment 3/2021

Comorbidity Between Depression and Anxiety in Adolescents: Bridge Symptoms and Relevance of Risk and Protective Factors

Journal of Psychopathology and Behavioral Assessment > Uitgave 3/2021
Deniz Konac, Katherine S. Young, Jennifer Lau, Edward D. Barker
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Supplementary Information

The online version contains supplementary material available at https://​doi.​org/​10.​1007/​s10862-021-09880-5.
Deniz Konac and Edward Barker are both corresponding authors. Deniz Konac is the first author, and Edward Barker is the senior author.
General Scientific Summary: Depression and anxiety very frequently co-occur in adolescents, however, the specific relationships between these disorders that lead to this phenomenon are still unclear. This study examined symptoms that act as a bridge between depression and anxiety symptoms. In a second step, relevant risk factors and protective factors were included in the model and the relationships between these factors and the symptoms were investigated.

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Depression and anxiety are highly prevalent and comorbid in adolescents, and this co-occurrence leads to worse prognosis and additional difficulties. The relationship between depression and anxiety must be delineated to, in turn, reduce and prevent the comorbidity, however our knowledge is still limited. We used network analysis to investigate bridge symptoms; symptoms that connect individual depression and anxiety symptoms and thus can help explain the comorbidity. We also examined the role of relevant risk and protective factors in explaining these symptom-level associations between these disorders. We analyzed data from the Avon Longitudinal Study of Children and Parents (n = 3670). Depression and anxiety symptoms, peer victimization, bullying, peer relational problems, prosocial behavior, and parental monitoring were assessed at a single time point around age 13 years. Stressful life events (SLEs) were assessed at age 11 years. We identified the most prominent bridge symptoms among depression (“feeling unhappy”, “feeling lonely”) and anxiety symptoms (“worrying about past”, “worrying about future”). Peer relational difficulties and SLEs were strongly associated with several depression and anxiety symptoms, such that these two risk factors created a link between individual depression and anxiety symptoms. Prosocial behavior had several negative associations with symptoms of both disorders, suggesting it can be an important protective factor.

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