ArticleBMC medicine2020
Comorbidity between depression and anxiety: assessing the role of bridge mental states in dynamic psychological networks.
Article in BMC medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 90 papers, 1 of them a synthesis that pooled it.
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Who cites it
90 citing papers in PubMed, 1 synthesis or guideline pooled it, 216 citations in OpenAlex.
- A systematic review of studies using network analysis to assess dynamics of psychotic-like experiences in community samples.Psychological medicine · 2025Pooled it
- Nocturnal dexmedetomidine alleviates post-intensive care syndrome following cardiac surgery: a prospective randomized controlled clinical trial.BMC medicine · 2021Trial
- Insomnia in medical students during an examination period: associations with depression, dysfunctional sleep beliefs, and academic performance.BMC medical education · 2026Article
- Comparative Efficacy and Acceptability of Transdiagnostic Psychotherapies for Emotional Disorders: Protocol for a Network Meta-Analysis of Randomized Controlled Trials.JMIR research protocols · 2026Article
- An Analysis of Factors Influencing Comorbid Anxiety and Depression Among Adults in China: A Large-Scale Cross-Sectional Study.Brain and behavior · 2026Review
- The Association Between Structural and Social Determinants of Health and Mood Disorder Symptoms Among Black Adults in the Greater St. Louis Metropolitan Area.Journal of racial and ethnic health disparities · 2026Article
- Predicting six month follow-up of suicidal thoughts and attempts among youth with anxiety presenting to an emergency department.JCPP advances · 2026Article
- Performance of the Patient Health Questionnaire-4 (PHQ-4) in four latin American countries: rethinking the dimensionality of the scale from the perspective of network psychometry.Psicologia, reflexao e critica : revista semestral do Departamento de Psicologia da UFRGS · 2026Article
- Illness Perceptions in Psychiatric Disorders: Assessing Differences and Associations With Symptom Severity.European eating disorders review : the journal of the Eating Disorders Association · 2026Article
- The Impact of Comorbidities on Health-Related Quality of Life Among Patients with Rheumatoid Arthritis.Healthcare (Basel, Switzerland) · 2026Article
- Gender differences in the incidence of psychiatric disorders among breast cancer patients: a nationwide cohort study.Epidemiology and psychiatric sciences · 2026Article
- How does parental psychological control influence adolescent depression? A sequential mediation and network analysis of smartphone addiction and sleep disturbance.BMC public health · 2026Article
- The Effects of Cognitive Behavioral Therapy Interventions on Emotional Disorders in Iranian Studies: A Systematic Review and Meta-Analysis.Iranian journal of psychiatry · 2026Review
- Multilayer network analysis of mental health symptoms in UK University students: association patterns of depression, loneliness, and suicidal ideation.Frontiers in psychiatry · 2026Article
- A latent profile analysis and network analysis of comorbidity of depression and anxiety in left-behind adolescents.Frontiers in psychology · 2026Article
- Network analysis of anxiety, depression and insomnia in the elderly in Jiangsu Province.PeerJ · 2026Article
- Network analysis of anxiety, depression, stress, and sleep disturbances in healthcare workers.Frontiers in psychiatry · 2026Article
- Novel anxiolytic-antidepressant combinations TF-1 and TF-2 and their intervention mechanisms in a mouse model of comorbid anxiety and depression (CAD).Frontiers in pharmacology · 2026Article
- Psychological risk profiles are associated with severity and motivational-volitional mechanisms of non-suicidal self-injury in adolescents and young adults.Frontiers in child and adolescent psychiatry · 2026Article
- Depression, anxiety, and sleep problems among Chinese university students enrolled in basketball elective courses: a network psychometric analysis.Frontiers in psychology · 2026Article
30 more citing papers are in PubMed but not listed here.
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Authors and funding
8 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundComorbidity between depressive and anxiety disorders is common. A hypothesis of the network perspective on psychopathology is that comorbidity arises due to the interplay of symptoms shared by both disorders, with overlapping symptoms acting as so-called bridges, funneling symptom activation between symptom clusters of each disorder. This study investigated this hypothesis by testing whether (i) two overlapping mental states "worrying" and "feeling irritated" functioned as bridges in dynamic mental state networks of individuals with both depression and anxiety as compared to individuals with either disorder alone, and (ii) overlapping or non-overlapping mental states functioned as stronger bridges.
methodsData come from the Netherlands Study of Depression and Anxiety (NESDA). A total of 143 participants met criteria for comorbid depression and anxiety (65%), 40 participants for depression-only (18.2%), and 37 for anxiety-only (16.8%) during any NESDA wave. Participants completed momentary assessments of symptoms (i.e., mental states) of depression and anxiety, five times a day, for 2 weeks (14,185 assessments). First, dynamics between mental states were modeled with a multilevel vector autoregressive model, using Bayesian estimation. Summed average lagged indirect effects through the hypothesized bridge mental states were compared between groups. Second, we evaluated the role of all mental states as potential bridge mental states.
resultsWhile the summed indirect effect for the bridge mental state "worrying" was larger in the comorbid group compared to the single disorder groups, differences between groups were not statistically significant. The difference between groups became more pronounced when only examining individuals with recent diagnoses (< 6 months). However, the credible intervals of the difference scores remained wide. In the second analysis, a non-overlapping item ("feeling down") acted as the strongest bridge mental state in both the comorbid and anxiety-only groups.
conclusionsThis study empirically examined a prominent network-approach hypothesis for the first time using longitudinal data. No support was found for overlapping mental states "worrying" and "feeling irritable" functioning as bridge mental states in individuals vulnerable for comorbid depression and anxiety. Potentially, bridge mental state activity can only be observed during acute symptomatology. If so, these may present as interesting targets in treatment, but not prevention. This requires further investigation.
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