Temporal Predictions from Anhedonia To Anxiety in Adolescents with Major Depressive Disorder

Anhedonia is a hallmark symptom of major depressive disorder (MDD) characterized by diminished ability to experience pleasure, motivation, or interest in usual activities. Anhedonia also is recognized as a transdiagnostic symptom dimension, but its links to other symptom dimensions are not fully elucidated. Given the high rates of depression and anxiety comorbidity in adolescence, we assessed concurrent and longitudinal associations between anhedonia and anxiety symptoms in adolescents diagnosed with MDD. The sample consisted of 157 adolescents with MDD (M_age = 15.54, 71.34% female) who were followed for several years in a research context involving longitudinal observation and, for a portion of the sample, treatment. Participants regularly completed self-report measures of anhedonia and anxiety symptoms across time. Data were analyzed using multilevel modeling to examine within-person concurrent and temporally lagged effects. Findings indicated that anhedonia was concurrently associated with both social anxiety and generalized anxiety symptoms. Additionally, anhedonia predicted only social anxiety symptoms over time-such that anhedonia at the previous time point predicted subsequent social anxiety but not generalized anxiety. However, neither social anxiety nor generalized anxiety predicted anhedonia temporally. These results suggest that anhedonia may be one driver of comorbid social anxiety symptoms in adolescents with MDD. Putative mechanistic links warrant further investigation, including during transdiagnostic treatments for emotional disorders in adolescents. We highlight avenues for future research and intervention in adolescent MDD.