Gender differences in the co-occurrence of anxiety and depressive symptoms among early adolescents: A network approach

Gender differences have been identified in the co-occurrence of anxiety and depressive symptoms. However, the underlying mechanisms that give rise to this gender difference remain unclear, and few studies have examined the issue at the symptom level. The current study employed the 7-item Generalized Anxiety Disorder scale (GAD-7) and the 9-item Patient Health Questionnaire (PHQ-9) to assess anxiety and depressive symptoms in a national sample of early adolescents (N = 15 391). A network approach was applied to investigate the gender differences in symptom interconnectivity. Gender differences were found in the co-occurrence of anxiety and depressive symptoms. The results indicated that girls with higher global strength (p < 0.01) exhibited stronger interconnectivity between symptoms. Central symptom PHQ2 (Sad mood) was significantly stronger in girls (p < 0.01), whereas PHQ6 (Guilt) was stronger in boys (p < 0.05). GAD7 (Feeling afraid) was identified as a prominent bridge symptom in girls, while PHQ6 (Guilt) was observed to play a similar role in boys. The directed acyclic graphs (DAGs) demonstrated that one symptom of anxiety triggered a series of emotional symptoms of anxiety and depression, ultimately resulting in a depressive somatic symptom in girls, whereas leading to both depressive somatic and anxiety symptoms in boys. These findings enhance our understanding and provide insights into potential intervention targets to prevent the co-occurrence of anxiety and depressive symptoms at an early stage.