Mapping bridges between anxiety, depression, and somatic symptoms in primary care patients

In primary care centers, emotional disorders (EDs; depression, anxiety, and somatoform disorders) frequently appear to be associated. However, there is no previous information on the key (bridge) symptoms that maintain comorbidity. The current study aimed to identify symptoms that may play a linking role in bridging comorbidity among EDs from a network analysis perspective. A sample of adult primary care patients ( N = 1704) with symptoms of EDs was assessed using the Patient Health Questionnaire (PHQ). Network analysis was applied to examine the network structure, communities, expected influence, and bridge symptoms between depressive, anxiety, and somatic symptoms. Sad mood and low energy were the most central symptoms. Furthermore, low energy , fainting spells, sad mood, and restlessness were detected as prominent bridge symptoms between anxiety, depression, and somatic symptoms. These bridge symptoms could be therapeutic targets for early intervention and prevent the development of comorbidity among EDs. The results of this research highlight the importance of symptom-specific functional properties for the activation of communities within EDs, providing new insights on a complex phenomenon such as comorbidity

Anxiety · Comorbidity · Mood · Psychiatry · Clinical Psychology · Mental Health Research Topics · Psychology · Schizophrenia research and treatment · Tryptophan and brain disorders

• Psychometric validation of selected scales assessing mental health conditions among Ghanaian youth

  Open Access•Daniel Kwasi Ahorsu, Derek Oppong et al.•Cambridge Prisms Global Mental…•2026

  Incluir item

• Construction and verification of a predictive model for depression risk of patients with somatization symptoms

  Open Access•Liming Tang, Jiuchang Zhong et al.•Frontiers in Psychiatry•2025

  Incluir item

• Genetic overlap between major depressive disorder and obstructive sleep apnea

  Open Access•Fangbo Lin, Yuanyuan Deng et al.•Frontiers in Psychiatry•2024

  Incluir item

• Brief screening tools to facilitate referral of people with emotional disorders in primary care

  Open Access•Óscar Peris‐baquero, Ó Peris-Baquero et al.•Current Psychology•2025

  Incluir item

• Network analysis to examine sex differences linked to emotional well-being in cardiovascular disease

  Open Access•Antonio R Hidalgo-Muñoz, Carmen Tabernero et al.•Journal of Health Psychology•2024

  Incluir item

• The Global Burden of Mental, Neurological and Substance Use Disorders

  Open Access•Harvey A Whiteford, Harvey Whiteford et al.•PLoS ONE•2015

  Incluir item

• Identifying highly influential nodes in the complicated grief network.

  Donald J Robinaugh, Alexander J Millner et al.•Journal of Abnormal Psychology•2016

  Incluir item

• What are 'good' depression symptoms? Comparing the centrality of DSM and non-DSM symptoms of depression in a network analysis

  Open Access•Eiko I Fried, Sacha Epskamp et al.•Journal of Affective Disorders•2016

  Incluir item

• Comorbidity

  Open Access•Angélique O J Cramer, Lourens Waldorp et al.•Behavioral and Brain Sciences•2010

  Incluir item

• Unraveling the comorbidity of depression and anxiety in a large inpatient sample

  Open Access•Tim Kaiser, Philipp Herzog et al.•Depression and Anxiety•2021

  Incluir item

• Clinical diagnosis of depression in primary care

  Open Access•Alex J Mitchell, Amol Vaze et al.•The Lancet•2009

  Incluir item

• Mental disorders as networks of problems

  Open Access•Eiko I Fried, Claudia D van Borkulo et al.•Social Psychiatry and Psychiatric…•2017

  Incluir item

• Community detection in networks

  Open Access•Santo Fortunato, Darko Hric•Physics Reports•2016

  Incluir item

• Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013

  Open Access•Theo Vos, Ryan M Barber et al.•The Lancet•2015

  Incluir item

• A new method for constructing networks from binary data

  Open Access•Claudia D van Borkulo, Denny Borsboom et al.•Scientific Reports•2014

  Incluir item

• Network Analysis of Psychopathology

  Richard J Mcnally•Annual Review of Clinical…•2021

  Incluir item

• Network analysis of depression and anxiety symptom relationships in a psychiatric sample

  Open Access•Courtney Beard, Alexander J Millner et al.•Psychological Medicine•2016

  Incluir item

• Development and validation of the penn state worry questionnaire

  Open Access•Thomas Meyer, T J Meyer et al.•Behaviour Research and Therapy•1990

  Incluir item

• A short form of the metacognitions questionnaire

  Open Access•Adrian Wells, Sam Cartwright‐Hatton et al.•Behaviour Research and Therapy•2004

  Incluir item

• Estimating psychological networks and their accuracy

  Open Access•Sacha Epskamp, Denny Borsboom et al.•Behavior Research Methods•2018

  Incluir item

• Qgraph

  Open Access•Sacha Epskamp, Angélique O J Cramer et al.•Journal of Statistical Software•2012

  Incluir item

• A tutorial on regularized partial correlation networks.

  Sacha Epskamp, Eiko I Fried•Psychological Methods•2018

  Incluir item

• A Brief Measure for Assessing Generalized Anxiety Disorder

  Robert L Spitzer, Carmen Pérez de los Ríos et al.•A.M.A. Archives of Internal…•2006

  Incluir item

• The PHQ-9

  Kurt Kroenke, Robert L Spitzer et al.•Journal of General Internal…•2001

  Incluir item

• The PHQ-15

  Kurt Kroenke, Robert L Spitzer et al.•Psychosomatic Medicine•2002

  Incluir item

• Bridge Centrality

  Payton J Jones, Ruofan Ma et al.•Multivariate Behavioral Research•2021

  Incluir item

• The stability of centrality measures when networks are sampled

  Open Access•Elizabeth Costenbader, T W Valente•Social Networks•2003

  Incluir item

• The WHO quality of life (WHOQOL) questionnaire

  Open Access•Ramona Lucas‐Carrasco, Ramona Lucas-Carrasco•Quality of Life Research•2011

  Incluir item