Time-Variant Patterns of Comorbid Depression and Anxiety Across Early to Late Adolescence: The Sex-Specific Role of Emotion Regulation.
- 1School of Education Guangzhou University Guangzhou China gzhu.edu.cn.
- 2School of Public Health LKS Faculty of Medicine The University of Hong Kong Hong Kong Special Administrative Region China hku.hk.
- 3Department of Social Work and Social Administration The University of Hong Kong Hong Kong Special Administrative Region China hku.hk.
Abstract
Aims
Depression-anxiety comorbidity is common in adolescence, yet prevention efforts often overlook the nonlinear course of psychosocial development. This study mapped the dynamic risk of depression-anxiety comorbidity across adolescence and examined whether emotion regulation moderated these associations by grade and sex.Methods
We utilised time-varying effect modelling (TVEM) on data of youth from all primary and secondary schools in Chenzhou, China (n = 58,622; grades 4-12), to map the dynamic change of comorbid risk and potential moderating role of emotion regulation, with consideration of sex difference. Participants reported depressive and anxiety symptoms through the patient health questionnaire and generalised anxiety disorder questionnaire, respectively. The emotion regulation questionnaire (ERQ) measured two dimensions of emotion regulation, cognitive reappraisal and expression suppression.Results
Overall comorbid risk increased throughout adolescence. Anxiety (OR = 1.67, 95% CI [1.61, 1.74]) and depressive (OR = 1.68, 95% CI [1.50, 1.89]) symptoms had similar overall comorbid risk, while depression-related risk became stronger than anxiety-related risk in late adolescence. Sex-specific patterns revealed higher comorbid risks in females. A gradual risk progression across grades emerged in males, whereas females showed a steeper increase in depression-associated comorbidity and an anxiety-associated peak around grade 8 (OR = 1.74, 95% CI [1.69, 1.80]). The role of emotion regulation is more pronounced in females than males. Cognitive reappraisal had a protective role against anxiety-related comorbid risk (OR = 0.99, 95% CI [0.99, 0.99]) and a maladaptive role for depression-related comorbid risk (OR = 1.01, 95% CI [1.01, 1.01]). The maladaptive role of expressive suppression for anxiety-associated comorbidity peaked during middle school for females and only emerged during early adolescence for males.Interpretation
Depression-anxiety comorbidity showed distinct grade- and sex-specific risk patterns across adolescence. These findings advocate for precise interventions prioritising anxiety management during primary-to-middle school transition and depression prevention during late adolescence. Emotion regulation interventions should be tailored by sex, adolescence stage and existing symptoms.
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BibTeX
@article{liu2026timevariant,
title = {{Time-Variant Patterns of Comorbid Depression and Anxiety Across Early to Late Adolescence: The Sex-Specific Role of Emotion Regulation.}},
author = {Dongyu Liu and Xiyu Wei and Luxia Jia and Bao Zhang},
journal = {Depression and anxiety},
year = {2026},
month = oct,
doi = {10.1155/da/7875846},
url = {https://europepmc.org/article/MED/42959527},
note = {CC BY},
}
RIS
TY - JOUR
TI - Time-Variant Patterns of Comorbid Depression and Anxiety Across Early to Late Adolescence: The Sex-Specific Role of Emotion Regulation.
AU - Dongyu Liu
AU - Xiyu Wei
AU - Luxia Jia
AU - Bao Zhang
PY - 2026
DA - 2026/10/29
JO - Depression and anxiety
DO - 10.1155/da/7875846
UR - https://europepmc.org/article/MED/42959527
AB - Aims Depression-anxiety comorbidity is common in adolescence, yet prevention efforts often overlook the nonlinear course of psychosocial development. This study mapped the dynamic risk of depression-anxiety comorbidity across adolescence and examined whether emotion regulation moderated these associations by grade and sex.Methods We utilised time-varying effect modelling (TVEM) on data of youth from all primary and secondary schools in Chenzhou, China (n = 58,622; grades 4-12), to map the dynamic change of comorbid risk and potential moderating role of emotion regulation, with consideration of sex difference. Participants reported depressive and anxiety symptoms through the patient health questionnaire and generalised anxiety disorder questionnaire, respectively. The emotion regulation questionnaire (ERQ) measured two dimensions of emotion regulation, cognitive reappraisal and expression suppression.Results Overall comorbid risk increased throughout adolescence. Anxiety (OR = 1.67, 95% CI [1.61, 1.74]) and depressive (OR = 1.68, 95% CI [1.50, 1.89]) symptoms had similar overall comorbid risk, while depression-related risk became stronger than anxiety-related risk in late adolescence. Sex-specific patterns revealed higher comorbid risks in females. A gradual risk progression across grades emerged in males, whereas females showed a steeper increase in depression-associated comorbidity and an anxiety-associated peak around grade 8 (OR = 1.74, 95% CI [1.69, 1.80]). The role of emotion regulation is more pronounced in females than males. Cognitive reappraisal had a protective role against anxiety-related comorbid risk (OR = 0.99, 95% CI [0.99, 0.99]) and a maladaptive role for depression-related comorbid risk (OR = 1.01, 95% CI [1.01, 1.01]). The maladaptive role of expressive suppression for anxiety-associated comorbidity peaked during middle school for females and only emerged during early adolescence for males.Interpretation Depression-anxiety comorbidity showed distinct grade- and sex-specific risk patterns across adolescence. These findings advocate for precise interventions prioritising anxiety management during primary-to-middle school transition and depression prevention during late adolescence. Emotion regulation interventions should be tailored by sex, adolescence stage and existing symptoms.
SN - 1091-4269
SN - 1520-6394
ER -