This article is more than 5 years old. Information may no longer be current.

Bridge symptoms may play role in later anxiety disorders

Researchers identified bridge symptoms between disruptive and internalizing communities in a cohort of elementary school–aged girls which may help indicate later anxiety disorders, according to the data from a network analysis published in JAMA Psychiatry.

“In recent decades, an increasing number of studies from representative birth cohorts have shown that the onset of adult psychopathologic disorders can be traced back to behavioral or emotional symptoms observed in childhood or adolescence,” Alexandra Rouquette, MD, PhD, of Paris-Saclay University, and colleagues wrote. “These studies have suggested that targeting early childhood symptoms might be effective in preventing future mental disorders. These interventions are challenging to implement because we lack knowledge on which specific childhood symptoms have predictive associations with adult psychopathologic disorders.”

Using a network perspective to conceptualize psychopathologic disorders, researchers examined whether the network structure of emotional and behavioral symptoms among girls in elementary school enrolled in a population-based study in Quebec was tied to anxiety disorders or major depression in early adulthood.

The investigators studied 932 girls whose parents completed the Social Behavior Questionnaire when the girls were aged 6 (baseline), 8 and 10 years, and interviewed 780 participants to evaluate the presence of mental disorders at age 15 and/or 22 years. Graphical models were estimated for 33 internalizing, externalizing and prosocial behavior symptoms assessed via the questionnaire to determine the temporal stability of the symptom network during childhood. At follow-up time points, Rouquette and colleagues assessed mental disorders and re-estimated symptom networks when children were aged 6 to 10 years to include a variable indicative of later diagnosis.

Of the 780 participants examined at follow-up, 270 (34.6%) and 128 (16.4%) had developed anxiety disorders and major depression. The authors identified bridge symptoms clustered in internalizing and externalizing communities. Specifically, irritability, blaming others, being disliked by others, often crying and solitary were the five symptoms that emerged as bridge symptoms between the disruptive and internalizing communities, according to the results.

These symptoms exhibited the strongest relationships with anxiety disorders when participants were aged 15 and 22 years once added to the network, with bootstrapped 95% confidence intervals ranging from –0.063 to 0.068, to 0.561 to 0.701 for positive edges and from –0.156 to 0.027, to –0.081 to 0.078 for negative edges included in the regularized network.

“Bridge symptoms should be investigated further as potential early targets in disease-prevention and health-promotion interventions,” the authors wrote. “Focusing at the symptom level allowed us to reveal information inaccessible to methods traditionally used in classic psychometrics. Clinicians may wish to focus on these bridge symptoms when assessing patients. The network approach provides a natural language for clinicians and patients to use when discussing symptoms and therapeutic options.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.