Symptom network structure of anxiety, depression, and stress among Chinese adolescents: a large-scale cross-sectional study in Fujian Province

Background Anxiety, depression, and stress are highly prevalent mental health problems among adolescents. This study aims to employ network analysis methods to investigate the relationships of anxiety, depression, and stress symptoms among middle and high school students in Fujian, China. Methods A total of 57,739 students were included in this study. The Depression Anxiety Stress Scales for Youth (DASS-Y) were used among adolescents. Symptom networks were estimated using regularized Gaussian graphical models with EBICglasso. The stability and precision of the network were assessed by the bootstrap method. Network comparison were performed to exam potential differences by gender, educational stage, and hobby status. Results “I hated myself” (Depression5) emerged as the highest mean score symptom. “I felt like I was about to panic” (Anxiety5) and “I found it difficult to relax” (Stress5) were bridge symptoms, showing strong cross-domain connectivity. “I was stressing about lots of things” (Stress3) not only displayed the high centrality in the context of intensity, but also was a bridge symptom. Bootstrap analyses indicated the acceptable precision of edge-weight estimates with and good stability of both strength and bridge strength estimates. Comparison of the networks between adolescents with and without hobby revealed the significant differences in network global strength (absolute difference = 0.38, p = 0.048). Conclusion Anxiety, depression, and stress symptoms are highly interactive with each other in adolescents. The central and bridge symptoms identified in the network, together with the observed subgroup patterns, provide descriptive evidence and may contribute to future longitudinal and intervention studies.