A computational network perspective on pediatric anxiety symptoms

Psychological Medicine, vol. 51, pp. 1752–1762

Abstract

BACKGROUND: While taxonomy segregates anxiety symptoms into diagnoses, patients typically present with multiple diagnoses; this poses major challenges, particularly for youth, where mixed presentation is particularly common. Anxiety comorbidity could reflect multivariate, cross-domain interactions insufficiently emphasized in current taxonomy. We utilize network analytic approaches that model these interactions by characterizing pediatric anxiety as involving distinct, inter-connected, symptom domains. Quantifying this network structure could inform views of pediatric anxiety that shape clinical practice and research. METHODS: Participants were 4964 youths (ages 5-17 years) from seven international sites. Participants completed standard symptom inventory assessing severity along distinct domains that follow pediatric anxiety diagnostic categories. We first applied network analytic tools to quantify the anxiety domain network structure. We then examined whether variation in the network structure related to age (3-year longitudinal assessments) and sex, key moderators of pediatric anxiety expression. RESULTS: The anxiety network featured a highly inter-connected structure; all domains correlated positively but to varying degrees. Anxiety patients and healthy youth differed in severity but demonstrated a comparable network structure. We noted specific sex differences in the network structure; longitudinal data indicated additional structural changes during childhood. Generalized-anxiety and panic symptoms consistently emerged as central domains. CONCLUSIONS: Pediatric anxiety manifests along multiple, inter-connected symptom domains. By quantifying cross-domain associations and related moderation effects, the current study might shape views on the diagnosis, treatment, and study of pediatric anxiety.

Authors 18

1. Rany Abend

   National Institutes of Health · National Institute of Mental Health

   Affiliation as printed

   Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA

2. Mira A. Bajaj

   National Institutes of Health · National Institute of Mental Health

   Affiliation as printed

   Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA

3. Daniel D.L. Coppersmith

   Harvard University

   Affiliation as printed

   Department of Psychology, Harvard University, Cambridge, MA, USA

4. Katharina Kircanski

   National Institutes of Health · National Institute of Mental Health

   Affiliation as printed

   Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA

5. Simone P. Haller

   National Institutes of Health · National Institute of Mental Health

   Affiliation as printed

   Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA

6. Elise M. Cardinale

   National Institutes of Health · National Institute of Mental Health

   Affiliation as printed

   Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA

7. Giovanni Abrahão Salum

   Conselho Nacional de Desenvolvimento Científico e Tecnológico · Universidade Federal do Rio Grande do Sul

   Affiliation as printed

   Department of Psychiatry, Universidad Federal do Rio Grande do Sul, Porto Alegre, Brazil

   National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil

8. Reinout W. H. J. Wiers

   University of Amsterdam

   Affiliation as printed

   Addiction Development and Psychopathology (ADAPT)-lab, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands

9. Elske Salemink

   Utrecht University

   Affiliation as printed

   Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands

10. Jeremy W. Pettit

    Florida International University

    Affiliation as printed

    Florida International University, Miami, FL, USA

11. Koraly E. Pérez‐Edgar

    Pennsylvania State University

    Affiliation as printed

    The Pennsylvania State University, University Park, PA, USA

12. Eli R. Lebowitz

    Yale University

    Affiliation as printed

    Yale University, New Haven, CT, USA

13. Wendy K. Silverman

    Yale University

    Affiliation as printed

    Yale University, New Haven, CT, USA

14. Yair Bar‐Haim

    Tel Aviv University

    Affiliation as printed

    Tel Aviv University, Tel Aviv, Israel

15. Melissa A. Brotman

    National Institutes of Health · National Institute of Mental Health

    Affiliation as printed

    Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA

16. Ellen Leibenluft

    National Institutes of Health · National Institute of Mental Health

    Affiliation as printed

    Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA

17. Eiko I. Fried Aachen Department of Clinical Psychology

    Leiden University

    Affiliation as printed

    Department of Clinical Psychology, Leiden University, Leiden, the Netherlands

18. Daniel S. Pine

    National Institutes of Health · National Institute of Mental Health

    Affiliation as printed

    Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA