Comorbidity among depression, anxiety and stress symptoms in naturalistic clinical samples: A cross‐cultural network analysis

Abstract

Comorbidity between depression and anxiety is well‐established across various settings and cultures. We approached comorbidity from the network psychopathology perspective and examined the depression, anxiety/autonomic arousal and stress/tension symptoms in naturalistic clinical samples from Serbia, Italy and Croatia. This was a multisite study in which regularized partial correlation networks of the symptoms, obtained via self‐reports on the Depression Anxiety and Stress Scales‐21 (DASS‐21) in three cross‐cultural, clinical samples (total N = 874), were compared with respect to centrality, edge weights, community structure and bridge centrality. A moderate degree of similarity in a number of network indices across the three networks was observed. While negative mood emerged to be the most central node, stress/tension nodes were the most likely bridge symptoms between depressive and anxiety/autonomic arousal symptoms. We demonstrated that the network structure and features in mixed clinical samples were similar across three different languages and cultures. The symptoms such as agitation, restlessness and inability to relax functioned as bridges across the three symptom communities explored in this study. Important theoretical and clinical implications were derived.

Are anxiety, depression, and stress distinguishable in Italian adolescents? an examination through the Depression Anxiety Stress Scales-21

“…This result also resonates with what was observed in the Italian validation study [32]; consequently, linguistic and cultural aspects can add to age-related factors in explaining the performance of this item. Further research involving different cultural and age groups may be helpful in unravelling this issue [53]. Some Anxiety, Depression, and Stress items were also found to load significantly on nontarget factors, pinpointing the presence of partly overlapping components of anxiety, depression, and stress and thus the theoretical relevance of adopting an ESEM framework when studying these constructs.…”

“…This result also resonates with what was observed in the Italian validation study [ 32 ]; consequently, linguistic and cultural aspects can add to age-related factors in explaining the performance of this item. Further research involving different cultural and age groups may be helpful in unravelling this issue [ 53 ].…”