Investigating the Central and Bridge Symptoms of Depression and Anxiety in China Rural Children With and Without Non-Suicidal Self-Injury: A Network Analysis Approach

Background: This study investigated the central and bridge symptoms of the comorbidity between depression and anxiety in rural Chinese children with and without non-suicidal self-injury (NSSI). The aim was to utilize psychological network analysis to identify distinct symptom patterns across these two groups. Methods: Data were collected from 1,731 rural Chinese children. Symptoms of depression and anxiety were analyzed using psychological network analysis to determine central and bridge symptoms, and to identify differences between children with and without NSSI. Results: The findings revealed that children with NSSI exhibited higher levels of depression and anxiety compared to those without NSSI. In the comorbidity network, “anhedonia” and “negative mood” emerged as central symptoms in both groups. Additionally, these two symptoms of depression were identified as bridge symptoms linking anxiety in both groups. Unique to children with NSSI, “negative self-esteem” was also a central symptom, while the central symptom for anxiety was “nervous”. For children without NSSI, the central symptom of anxiety was “afraid”. The bridge symptoms also differed: in children with NSSI, “nervous” and “irritable” linked depression and anxiety, whereas “afraid” served as the bridge symptom in children without NSSI. Conclusion: This network analysis highlights critical differences in the comorbidity of depression and anxiety between children with and without NSSI. The findings provide valuable insights for developing targeted interventions to prevent mental health issues and NSSI in rural Chinese children.