A Network Analysis of Depression, Anxiety, and Stress Symptoms in Chinese Adolescents

Background: Mental health problems are highly prevalent among adolescents. This study aimed to investigate the interrelations among depressive, anxiety, and stress-related symptoms in Chinese adolescents using a symptom network approach. Methods: A cross-sectional survey was conducted in October 2022 in Tianjin, China. Symptoms of depression, anxiety, and stress were assessed using the 21-item Depression Anxiety Stress Scales (DASS-21). Network analysis was employed to examine centrality, stability, and predictability of symptoms. Network Comparison Tests (NCTs) were used to assess structural differences across gender and residential status. In addition, a flow network analysis was performed to identify symptoms most strongly associated with stress. Results: A total of 660 Chinese adolescents participated in the study. The most central symptom in the network was “Feeling down,” followed by “Palpitations,” “Nervousness,” “Agitation,” and “Difficulty relaxing.” Key bridge symptoms included “Worrying,” “Feeling down,” “Near panic,” and “Nervousness.” NCT results indicated no significant differences in the network structures by gender or residence. In the flow network, “Feeling down” demonstrated the strongest direct association with stress. Conclusion: Specific central and bridge symptoms may play a pivotal role in the onset and maintenance of depression, anxiety, and stress among Chinese adolescents. These findings highlight potential targets for early intervention and prevention efforts in this population.