Exploring which symptom should be targeted first in the comorbidity of anxiety and depression among adolescents with...

To identify central and bridge symptoms linking anxiety and depression and to determine intervention-priority symptoms using simulation in Chinese college students with nomophobia.

A cross-sectional online survey recruited 1, 638 college students in China who met at least mild criteria for nomophobia. Depressive and anxiety symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). Ising networks were estimated for depression, anxiety, and their comorbidity. Expected influence and bridge expected influence were computed, and accuracy and stability were examined via nonparametric and case-dropping bootstraps. Network Intervention simulated analysis, symptom-specific alleviating and aggravating interventions to rank targets.

Motor agitation/retardation (PHQ-8) and restlessness (GAD-5) were the most central symptoms in the depression and anxiety networks and remained central in the comorbidity network. Irritability (GAD-6) and feeling afraid (GAD-7) showed the highest bridge centrality, linking anxiety with depressive symptoms. NIRA indicated that reducing fatigue/low energy (PHQ-4) and excessive worry (GAD-3) would yield the largest decreases in overall network activation, whereas activating suicidal ideation (PHQ-9) and restlessness (GAD-5) would most strongly aggravate the network. Bootstrap results supported acceptable accuracy and stability (e.g., EI CS-C ≈.67 for depression;.60 for anxiety; bridge EI CS-C ≈.44 in the comorbidity network).

Symptom-level analysis highlights actionable leverage points in nomophobia-related comorbidity. Longitudinal and experimental studies are warranted to confirm causal pathways and validate network-informed treatment sequencing.