Psychotic-like experiences as precursors to emotional symptoms in adolescents: a longitudinal network analysis

Psychotic-like experiences (PLEs), anxiety, and depressive symptoms frequently co-occur in adolescents. While traditional research has relied on cross-sectional data and overall symptom levels, this approach fails to clarify their dynamic interactions over time. Network analysis offers a novel methodological framework to address this critical limitation.

In this longitudinal study, 2,101 adolescent participants from Hunan Province, China, completed a battery of questionnaires at two assessment time points (T1: March 2024; T2: March 2025). The questionnaires measured psychotic-like experiences (PLEs) via the 15-item Community Assessment of Psychic Experiences (CAPE-P15), anxiety symptoms via the 7-item Generalized Anxiety Disorder Scale (GAD-7), and depressive symptoms via the 9-item Patient Health Questionnaire (PHQ-9), with sociodemographic and clinical characteristics also collected via this survey. Cross-lagged panel network (CLPN) analysis and contemporaneous network analysis were conducted.

The contemporaneous network revealed extensive anxiety-depression comorbidity. The strongest connections were between "Worrying too much" (GAD3) and "Feeling bad about yourself" (PHQ6), and between "Trouble relaxing" (GAD4) and "Sleep problems" (PHQ3). "Perceptual abnormalities" (PA) and "Suicidal ideation" (PHQ9) showed the strongest cross‑domain connections between PLEs and depression. In the CLPN analysis, T1 "Persecutory ideation" (PI) predicted T2 "Irritability" (GAD6) and "Feeling bad about yourself" (PHQ6), while T1 "Bizarre experiences" (BE) predicted T2 "Fear of something terrible happening" (GAD7). Centrality analysis indicated that PI and BE had the highest out‑degree influence, whereas T2 anxiety symptoms "Feeling nervous" (GAD1), "Inability to stop or control worries" (GAD2), and "Worrying too much" (GAD3) had the highest in‑degree centrality, reflecting their susceptibility to influence from other symptoms.

This study pinpoints specific symptomatic pathways, particularly certain PLEs' predictive role for emotional symptoms. This provides a solid foundation for precise early intervention and prevention strategies for at-risk adolescents.