Symptom patterns in the co-occurrence of depressive and generalized anxiety symptoms: A network analysis of a Canadian nationally representative sample

J Affect Disord. 2024 Apr 15:351:888-894. doi: 10.1016/j.jad.2024.01.266. Epub 2024 Feb 4.


Background: This study aimed to investigate the symptom patterns of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in a matched nationally representative sample of the Canadian population. We also tested whether childhood maltreatment (CM) exposures and sex would be linked with different symptom patterns.

Methods: A total of 3296 participants from the Canadian Community Health Survey-Mental Health with complete information on MDD and GAD symptoms and being matched on the studied sociodemographic characteristics were included in the current study. Network analysis was performed to examine the MDD-GAD symptom network, network stability and centrality indices were also estimated. Finally, network comparison in connectivity patterns was conducted to explore the impact of maltreatment experience and sex differences in the MDD-GAD symptom networks.

Results: The CM group had stronger network connections and showed differences in the network structures from the non-CM group. In the CM group, depressed mood and diminished interest were central symptoms and strongly connected with other symptoms. Additionally, females had stronger connections in the MDD-GAD symptom network than males, and sleep disturbance was a central symptom for females, alongside depressed mood and diminished interest.

Limitations: The cross-sectional design restricts our capacity to establish longitudinal or causal connections between symptoms.

Conclusions: Depressed mood was the most central node that was strongly connected with other symptoms in the network. Distinct MDD-GAD symptom networks were discovered in the CM and the female group when compared to their counterparts. Noteworthy, individuals with CM had a stronger correlation between worry and suicidal ideation. Clinical management and intervention efforts should pay close attention to these core symptoms to yield optimal treatment effects, particularly for females and individuals with CM.

Keywords: Generalized anxiety disorder; Major depressive disorder; Network analysis.

MeSH terms

  • Anxiety
  • Canada / epidemiology
  • Comorbidity
  • Cross-Sectional Studies
  • Depressive Disorder, Major* / psychology
  • Female
  • Humans
  • Male