Exploring Comorbidity Between Anxiety and Depression in Spanish-Speaking School-Aged Children: A Network Analysis Approach

Anxiety and depression are highly prevalent and comorbid problems in childhood, which deserve greater understanding for effective prevention and treatment. The main aim of the present study was to explore the comorbidity between anxiety and depression symptoms using a novel and valuable approach to study comorbidity, such as network analysis. Specifically, the connectivity between symptoms and possible relevant symptoms was examined through comorbidity estimation and shortest pathway networks, as well as bridge symptoms. This study comprised 281 Spanish-speaking children aged 8-12 years (45.2% girls), whose anxiety and depression symptoms were assessed through specific brief parent-report measures. Analyses revealed that in the comorbidity network, the most central symptoms were related to depression ("No good anymore," "Could never be as good," "Hated self," "Did everything wrong," "Nobody loved him/her") or anxiety ("Suddenly feels really scared"). Furthermore, it was found that the most central bridge symptoms, whose activation would play a key role in the activation of other domain symptoms, were anxiety symptoms such as "Trouble going to school" and "Suddenly feels really scared" and depression symptoms, such as "Could never be as good" and "Hated self." Additionally, the shortest path network suggested the existence of different possible pathways of connection between anxiety and depression symptoms. Overall, these findings help to understand the complexity of the anxiety-depression comorbidity. It suggests the existence of central and bridge symptoms that complement previous studies, which may be potential targets for interventions to prevent and treat childhood anxiety and depression.