Symptom network structure of anxiety, depression, and stress among Chinese adolescents: a large-scale cross-sectional study in Fujian Province
6 affiliations
- 1Department of Public Health, Fuzhou Neuropsychiatric Hospital Affiliated to Fujian Medical University
- 2Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University
- 3University International College, Macau University of Science and Technology
- 4Department of Medical Service, Fuzhou University Affiliated Provincial Hospital
- 5Fuzhou University Affiliated Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fujian Emergency Medical Center
- 6School of Health Management, Fujian Medical University
Abstract
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.
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BibTeX
@article{rao2026symptom,
title = {{Symptom network structure of anxiety, depression, and stress among Chinese adolescents: a large-scale cross-sectional study in Fujian Province}},
author = {Wenqing Rao and Zhifeng Lin and Hua Jiang and Yixin Wu and Jian Jiang},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1959039},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1959039/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Symptom network structure of anxiety, depression, and stress among Chinese adolescents: a large-scale cross-sectional study in Fujian Province
AU - Wenqing Rao
AU - Zhifeng Lin
AU - Hua Jiang
AU - Yixin Wu
AU - Jian Jiang
PY - 2026
DA - 2026/10/26
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1959039
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1959039/full
AB - 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.
SN - 2296-2565
ER -