Multidimensional stressors and depressive and anxiety symptoms in adolescents: A network analysis through simulations

Background: Existing research has established associations between various stressors and adolescent mental health, primarily from a variable-level perspective. However, a symptom-level understanding about which stressors and symptoms might play a important role is scarce.Methods: The sample consisted of 15,570 adolescents aged 10 to 19. Participants completed questionnaires which assessed multidimensional stressors, depressive symptoms, anxiety symptoms, and demographic information. Network analysis was conducted to explore the relationships between stressors and depressive and anxiety symptoms. Additionally, to identify effective targets for the treatment and prevention of adolescent mental health issues, symptom-specific intervention simulations were performed on the network to investigate changes in symptom values in response to the alleviation and aggravation of specific stressors and symptoms.Results: Findings revealed that academic stressors exhibited stronger associations with anxiety symptoms than other stressors, particularly nervousness. Family relationships were more closely linked to depressive symptoms than other stressors, particularly suicidal ideation. Academic stressors emerged as an effective intervention target, and uncontrollable worry as an important prevention target. With the exception of academic stressors, simulating aggravation interventions on symptoms resulted in more changes in overall symptom activation than alleviation interventions.Limitations: A cross-sectional design did not uncover network changes over time and the sample was non-clinical.Conclusions: This study highlights the importance of addressing academic stressors to alleviate adolescents' depressive and anxiety symptoms and reveals that uncontrollable worry is a key prevention target. The findings are helpful for clinicians and educators to develop effective strategies to protect adolescents' mental health.