Symptomatic Pathways of Comorbid Depression, Anxiety, and Stress Among Adolescents Exposed to Childhood Trauma—Insights from the Network Approach

Xinyuan Zou; Qihui Tang; Shujian Wang; Yulin Huang; Jie Gui; Yanqiang Tao; Yulu Jiang

doi:10.2147/PRBM.S492807

Symptomatic Pathways of Comorbid Depression, Anxiety, and Stress Among Adolescents Exposed to Childhood Trauma—Insights from the Network Approach

Xinyuan Zou, Qihui Tang, Shujian Wang, Yulin Huang, Jie Gui, Yanqiang Tao, Yulu Jiang^*

^*Corresponding author for this work

Research output: Journal Publications and Reviews › RGC 21 - Publication in refereed journal › peer-review

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Abstract

Background: Childhood trauma can have a long-lasting influence on individuals and contribute to mental disorders, including depression and anxiety. Depression, anxiety, and stress are highly comorbid among adolescents with the trauma experience. Yet, the evolution of comorbidity remains unclear. To fill this gap, the current study aimed to explore the symptomatic and changing patterns of depression, anxiety, and stress among adolescents exposed to childhood trauma.
Methods: A total of 1548 college students (females = 782 (50.98%), Mean_age = 19.59, SD_age = 1.14) in China completed the Childhood Trauma Questionnaire (CTQ) and the Depression, Anxiety, and Stress Scales (DASS-21), and 942 students (Females = 516 (54.78%), Mean_age = 19.57, SD_age = 1.16) met the selection standard based on the cut-off scores of the CTQ. The symptomatic network and directed acyclic graph (DAG) network approaches were used.
Results: The results revealed that males reported experiencing significantly more physical abuse, physical neglect, emotional neglect, and sexual abuse compared to females. However, females scored significantly higher than males on “Worried” (DASS9), “Agitated” (DASS11), “Panic” (DASS15), and “Scared” (DASS20). No significant difference between genders was observed in the network structure and global strength. Meanwhile, among all participants, “Down-hearted” and “Agitated” appeared to be the most interconnected symptoms, the bridge symptoms in the symptom network, as well as the most vital symptoms in the directed acyclic graph network. Apart from that, “Panic” also served as the most prominent symptom in the directed acyclic graph network.
Conclusion: The results suggested that intervention targeted at assisting adolescents in developing more adaptive coping strategies with stress and regulating emotion could benefit the alleviation of comorbid depression, anxiety, and stress.
© 2025 Zou et al.

Original language	English
Pages (from-to)	673-688
Journal	Psychology Research and Behavior Management
Volume	18
Online published	19 Mar 2025
DOIs	https://doi.org/10.2147/PRBM.S492807
Publication status	Published - 2025
Externally published	Yes

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 5 Gender Equality
SDG 16 Peace, Justice and Strong Institutions

Research Keywords

anxiety
childhood trauma
depression
stress
symptom network

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title = "Symptomatic Pathways of Comorbid Depression, Anxiety, and Stress Among Adolescents Exposed to Childhood Trauma—Insights from the Network Approach",

abstract = "Background: Childhood trauma can have a long-lasting influence on individuals and contribute to mental disorders, including depression and anxiety. Depression, anxiety, and stress are highly comorbid among adolescents with the trauma experience. Yet, the evolution of comorbidity remains unclear. To fill this gap, the current study aimed to explore the symptomatic and changing patterns of depression, anxiety, and stress among adolescents exposed to childhood trauma. Methods: A total of 1548 college students (females = 782 (50.98%), Meanage = 19.59, SDage = 1.14) in China completed the Childhood Trauma Questionnaire (CTQ) and the Depression, Anxiety, and Stress Scales (DASS-21), and 942 students (Females = 516 (54.78%), Meanage = 19.57, SDage = 1.16) met the selection standard based on the cut-off scores of the CTQ. The symptomatic network and directed acyclic graph (DAG) network approaches were used. Results: The results revealed that males reported experiencing significantly more physical abuse, physical neglect, emotional neglect, and sexual abuse compared to females. However, females scored significantly higher than males on “Worried” (DASS9), “Agitated” (DASS11), “Panic” (DASS15), and “Scared” (DASS20). No significant difference between genders was observed in the network structure and global strength. Meanwhile, among all participants, “Down-hearted” and “Agitated” appeared to be the most interconnected symptoms, the bridge symptoms in the symptom network, as well as the most vital symptoms in the directed acyclic graph network. Apart from that, “Panic” also served as the most prominent symptom in the directed acyclic graph network. Conclusion: The results suggested that intervention targeted at assisting adolescents in developing more adaptive coping strategies with stress and regulating emotion could benefit the alleviation of comorbid depression, anxiety, and stress. {\textcopyright} 2025 Zou et al.",

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author = "Xinyuan Zou and Qihui Tang and Shujian Wang and Yulin Huang and Jie Gui and Yanqiang Tao and Yulu Jiang",

year = "2025",

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Symptomatic Pathways of Comorbid Depression, Anxiety, and Stress Among Adolescents Exposed to Childhood Trauma—Insights from the Network Approach. / Zou, Xinyuan; Tang, Qihui; Wang, Shujian et al.
In: Psychology Research and Behavior Management, Vol. 18, 2025, p. 673-688.

Research output: Journal Publications and Reviews › RGC 21 - Publication in refereed journal › peer-review

TY - JOUR

T1 - Symptomatic Pathways of Comorbid Depression, Anxiety, and Stress Among Adolescents Exposed to Childhood Trauma—Insights from the Network Approach

AU - Zou, Xinyuan

AU - Tang, Qihui

AU - Wang, Shujian

AU - Huang, Yulin

AU - Gui, Jie

AU - Tao, Yanqiang

AU - Jiang, Yulu

PY - 2025

Y1 - 2025

N2 - Background: Childhood trauma can have a long-lasting influence on individuals and contribute to mental disorders, including depression and anxiety. Depression, anxiety, and stress are highly comorbid among adolescents with the trauma experience. Yet, the evolution of comorbidity remains unclear. To fill this gap, the current study aimed to explore the symptomatic and changing patterns of depression, anxiety, and stress among adolescents exposed to childhood trauma. Methods: A total of 1548 college students (females = 782 (50.98%), Meanage = 19.59, SDage = 1.14) in China completed the Childhood Trauma Questionnaire (CTQ) and the Depression, Anxiety, and Stress Scales (DASS-21), and 942 students (Females = 516 (54.78%), Meanage = 19.57, SDage = 1.16) met the selection standard based on the cut-off scores of the CTQ. The symptomatic network and directed acyclic graph (DAG) network approaches were used. Results: The results revealed that males reported experiencing significantly more physical abuse, physical neglect, emotional neglect, and sexual abuse compared to females. However, females scored significantly higher than males on “Worried” (DASS9), “Agitated” (DASS11), “Panic” (DASS15), and “Scared” (DASS20). No significant difference between genders was observed in the network structure and global strength. Meanwhile, among all participants, “Down-hearted” and “Agitated” appeared to be the most interconnected symptoms, the bridge symptoms in the symptom network, as well as the most vital symptoms in the directed acyclic graph network. Apart from that, “Panic” also served as the most prominent symptom in the directed acyclic graph network. Conclusion: The results suggested that intervention targeted at assisting adolescents in developing more adaptive coping strategies with stress and regulating emotion could benefit the alleviation of comorbid depression, anxiety, and stress. © 2025 Zou et al.

AB - Background: Childhood trauma can have a long-lasting influence on individuals and contribute to mental disorders, including depression and anxiety. Depression, anxiety, and stress are highly comorbid among adolescents with the trauma experience. Yet, the evolution of comorbidity remains unclear. To fill this gap, the current study aimed to explore the symptomatic and changing patterns of depression, anxiety, and stress among adolescents exposed to childhood trauma. Methods: A total of 1548 college students (females = 782 (50.98%), Meanage = 19.59, SDage = 1.14) in China completed the Childhood Trauma Questionnaire (CTQ) and the Depression, Anxiety, and Stress Scales (DASS-21), and 942 students (Females = 516 (54.78%), Meanage = 19.57, SDage = 1.16) met the selection standard based on the cut-off scores of the CTQ. The symptomatic network and directed acyclic graph (DAG) network approaches were used. Results: The results revealed that males reported experiencing significantly more physical abuse, physical neglect, emotional neglect, and sexual abuse compared to females. However, females scored significantly higher than males on “Worried” (DASS9), “Agitated” (DASS11), “Panic” (DASS15), and “Scared” (DASS20). No significant difference between genders was observed in the network structure and global strength. Meanwhile, among all participants, “Down-hearted” and “Agitated” appeared to be the most interconnected symptoms, the bridge symptoms in the symptom network, as well as the most vital symptoms in the directed acyclic graph network. Apart from that, “Panic” also served as the most prominent symptom in the directed acyclic graph network. Conclusion: The results suggested that intervention targeted at assisting adolescents in developing more adaptive coping strategies with stress and regulating emotion could benefit the alleviation of comorbid depression, anxiety, and stress. © 2025 Zou et al.

KW - anxiety

KW - childhood trauma

KW - depression

KW - stress

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DO - 10.2147/PRBM.S492807

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SN - 1179-1578

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JO - Psychology Research and Behavior Management

JF - Psychology Research and Behavior Management

ER -

Symptomatic Pathways of Comorbid Depression, Anxiety, and Stress Among Adolescents Exposed to Childhood Trauma—Insights from the Network Approach

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