Objective: This study aimed to construct a symptom network model of depression, anxiety, and NSSI using network analysis and to identify the most central and bridge symptoms within the depression-anxiety-NSSI symptom network.
Methods: A total of 200 adolescent patients with depression were recruited from hospitals and assessed using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Scale-7 (GAD-7), and the Modified version of the Adolescent Self-Harm Scale (MASHS). The structural characteristics of depression, anxiety, and NSSI symptoms were characterized using "strength" and "bridge strength" as centrality indices within the symptom network. Network stability was examined using a case-dropping bootstrap procedure.
Results: The nodes GAD2 (uncontrollable worry), GAD3 (excessive worry), GAD5 (restlessness), and PHQ9 (suicidal ideation) were the most central symptoms in the network model. Furthermore, within this sample, the symptoms PHQ8 (psychomotor agitation/retardation) and GAD6 (irritability) served as bridge symptoms connecting the anxiety and depressive symptom clusters with the NSSI symptom cluster.
Conclusion: The central symptoms (such as uncontrollable worry, excessive worry, restlessness, and suicidal ideation) and key bridge symptoms (such as psychomotor agitation/retardation and irritability) within the depression-anxiety-NSSI symptom network may serve as potential intervention targets for adolescent patients with depression.
Keywords: Adolescent depression; Anxiety; NSSI; Network analysis.
© 2026. The Author(s).