In search of disorders: internalizing symptom networks in a large clinical sample

Abstract

Background The co‐occurrence of internalizing disorders is a common form of psychiatric comorbidity, raising questions about the boundaries between these diagnostic categories. We employ network psychometrics in order to: (a) determine whether internalizing symptoms cluster in a manner reflecting DSM diagnostic criteria, (b) gauge how distinct these diagnostic clusters are and (c) examine whether this network structure changes from childhood to early and then late adolescence. Method Symptom‐level data were obtained for service users in publicly funded mental health services in England between 2011 and 2015 (N = 37,162). A symptom network (i.e. Gaussian graphical model) was estimated, and a community detection algorithm was used to explore the clustering of symptoms. Results The estimated network was densely connected and characterized by a multitude of weak associations between symptoms. Six communities of symptoms were identified; however, they were weakly demarcated. Two of these communities corresponded to social phobia and panic disorder, and four did not clearly correspond with DSM diagnostic categories. The network structure was largely consistent by sex and across three age groups (8–11, 12–14 and 15–18 years). Symptom connectivity in the two older age groups was significantly greater compared to the youngest group and there were differences in centrality across the age groups, highlighting the age‐specific relevance of certain symptoms. Conclusions These findings clearly demonstrate the interconnected nature of internalizing symptoms, challenging the view that such pathology takes the form of distinct disorders.

The Centrality of Doubting and Checking in the Network Structure of Obsessive-Compulsive Symptom Dimensions in Youth

“…24 In the fourth study, the items of the Revised Children's Anxiety and Depression Scale were analyzed using network techniques in a large sample of treatment-seeking children, and the six OCD items of the scale formed into two clusters: a compulsion-related cluster and a separate obsession-related cluster that was strongly linked to general anxiety. 25 Although informative, these studies did not examine the relationship among the broader symptom dimensions of OCD; the present study aimed to help fill this gap in the literature. Our study had three aims.…”

Network Analyses of Maternal Pre- and Post-Partum Symptoms of Depression and Anxiety

“…This interaction among symptoms is not aligned with the common cause perspective that is assumed in computation of sum scores ( 28 ). Clinically, an understanding of such symptom-symptom interactions via network analyses allows interventions to be tailored for maximum effectiveness ( 29 ).…”

Internalizing Symptoms and Social Support Among Kenyan Adolescents: A Network Analysis

“…Finally, several past studies have examined networks of psychopathology in young people in the USA Mullarkey et al, 2018;McElroy and Patalay, 2019;Boscholoo et al, 2016) and India (Wasil, Venturo-Conerly, Shinde, Patel, & Jones, 2019). However, none of these INTERNALIZING SYMPTOMS AND SOCIAL SUPPORT NETWORK studies on adolescents analyzed networks including both internalizing symptoms and risk or protective factors for psychopathology.…”

“…Across-Cluster (Bridge) Centrality. Several studies have assessed the centrality of items within depression symptom networks (e.g., Beard et al, 2016;Bos et al, 2018) and internalizing symptom networks (e.g., Anker et al, 2017;McElroy & Patalay, 2019). However, we are only aware of one study (Jayawickreme et al, 2017) that examines the cross-cluster relationships between symptoms of internalizing and social problems.…”