Understanding Anxiety Symptoms of Mood Disorders Across Bipolar and Major Depressive Disorder Using Network Analysis

Background and Objectives: Anxiety is prevalent in patients with major depressive disorder (MDD) and bipolar disorder (BD). Understanding its interaction with mood disorders may provide deeper insight into symptom clustering, severity, and interventions. We compared the networks of MDD and BD using the Beck Anxiety Inventory (BAI) to identify central symptoms and interconnections. Materials and Methods: This cross-sectional study involved 815 individuals with MDD (n = 332) and BD (n = 483) who had clinically significant anxiety symptoms (BAI score > 8). Network analysis identified anxiety symptom clusters. Network centrality, stability, and comparison tests assessed the structural differences and global strength variations between the groups. Results: Both the MDD and BD networks showed strong interconnections among several BAI items and demonstrated stable centrality measures. Core symptoms with high centrality included "Losing control", "Choking", "Breathing", "Unsteady", and "Shaky" in both MDD and BD. Although no significant differences were found in the overall network structures between MDD and BD, the global strength of the network differed significantly, with MDD exhibiting modestly higher overall anxiety network connectivity than BD. Conclusions: Network clusters revealed aspects of both cognitive and somatic symptoms of anxiety. Although overall structures were similar between the groups, the MDD group showed stronger interconnections for central anxiety symptoms. Targeting central anxiety symptoms can enhance prevention and intervention strategies for mood disorders and improve clinical outcomes.