Distal and proximal perspectives on the comorbidity network structure of anxiety and depression among adolescents: Insights from network analysis.

OBJECTIVE: The transdiagnostic psychopathology theory emphasizes that the distal (i.e., childhood trauma) and proximal (i.e., problematic social networking site use [PSNSU]) factors are associated with comorbid anxiety and depression. However, few studies have explored anxiety and depression comorbidities from both proximal and distal perspectives at the symptom level, leaving a research gap that warrants attention.

METHOD: A total of 5,642 participants from four universities in China participated in this study. Childhood trauma, PSNSU, anxiety, and major depressive disorder were assessed utilizing the Childhood Trauma Questionnaire (CTQ), Social Networking Sites Use Questionnaire, Generalized Anxiety Disorder 7-Item, and Patient Health Questionnaire-9. Participants were divided into CTQ-without (N)-PSNSU (n = 118, Mage = 18.92) and CTQ-PSNSU (n = 574, Mage = 18.86) groups according to the cutoff scores of PSNSU and CTQ. Network analysis was conducted to construct and compare the network models of CTQ-N-PSNSU and CTQ-PSNSU.

RESULTS: The findings revealed that individuals in the CTQ-PSNSU group reported higher levels of childhood trauma, PSNSU, anxiety, and depression than the CTQ-N-PSNSU group. "Energy," "motor," and "irritability" were the strongest bridge symptoms in the CTQ-PSNSU group. Within the CTQ-N-PSNSU group, "nervousness" and "sleep" served as bridge symptoms linking anxiety and depression. Moreover, "energy" was significantly stronger in the CTQ-PSNSU group than in the CTQ-N-PSNSU group through network comparison.

CONCLUSIONS: The present study found a transdiagnostic model for depression and anxiety by including childhood trauma as the distal factor and PSNSU as the proximal factor at the symptom level. (PsycInfo Database Record (c) 2026 APA, all rights reserved).