Using Network Analysis to Identify Central Symptoms of Adolescent Depression

Objective: Experiencing depression symptoms, even at mild to moderate levels, is associated with maladaptive outcomes for adolescents. We used network analysis to evaluate which symptoms (and associations between symptoms) are most central to adolescent depression. Method: Participants were part of a large, diverse community sample (N = 1,409) of adolescents between the ages of 13-19 years old. Network analysis was used to identify the most central symptoms (nodes) and associations between symptoms (edges) assessed by the Children’s Depression Inventory (CDI). We also evaluated these centrality indicators for network robustness using stability and accuracy tests, associated symptom centrality with mean levels of symptoms, and examined potential differences between the structure and connectivity of depression networks in boys and girls. Results: The most central symptoms in the network were self-hatred, loneliness, sadness, and pessimism. The strongest associations between symptoms were sadness-crying, anhedonia-school dislike, sadness-loneliness, school work difficulty-school performance decrement, self-hatred-negative body image, sleep disturbance-fatigue, and self-deprecation-self-blame. The network was robust to stability and accuracy tests. Notably, symptom centrality and mean levels of symptoms were not associated. Boys and girls’ networks did not differ in levels of connectivity, though the link between body image and self-hatred was stronger in girls than boys. Conclusions: Self-hatred, loneliness, sadness, and pessimism were the most central symptoms in adolescent depression networks, suggesting these symptoms (and associations between symptoms) should be prioritized in theoretical models of adolescent depression and could also serve as important treatment targets for adolescent depression interventions.