Prevalence, symptom architecture, and clinical correlates of depressive and anxiety symptoms in bipolar disorder: A...

Depressive and anxiety symptoms frequently persist during stable phases of bipolar disorder (BD), yet their interconnected architecture remains unclear. This study examined the prevalence, clinical correlates, and network structure of these symptoms in patients with BD.

We evaluated 9455 clinically stable patients with BD in Hangzhou, China. Symptoms were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Multivariable logistic regression identified correlates, and a regularized Gaussian Graphical Model mapped symptom interactions, centralities, and bridge symptoms.

Screen-positive rates of depressive symptoms, anxiety symptoms, and their co-occurrence were 18.3%, 15.1%, and 12.1%, respectively, with a strong correlation between the two domains (r = 0.71, p < 0.01). Poor social relationships and sleep disturbances were consistently associated with higher symptom burden (ORs: 1.37-2.65). Network analysis revealed a prominent "concentration"-"motor" association (weight = 0.38). Centrality analysis identified "guilty," "uncontrollable worry," and "motor" as the most influential nodes. "Motor," "irritability," and "feeling afraid" served as critical bridge symptoms linking both domains. In the flow network, "suicidal ideation" was directly anchored by "guilty" (weight = 0.21) and "motor" symptoms (weight = 0.20). Three distinct symptom communities were identified, reflecting anxiety, cognitive-behavioral, and somatic-affective clusters.

Even during stable periods of BD, residual depressive and anxiety symptoms form a highly structured network. These findings suggest that clinical management should transcend aggregate scale scores to target key central and bridge features, specifically psychomotor alterations, guilt, and uncontrollable worry, to disrupt symptom reinforcement and mitigate suicide risk.