Network Architecture of Anxiety-Related Distress in 346,677 Chinese Youth: Divergence by Educational Track and...

Physical symptoms in children and adolescents are frequently misattributed to standalone medical conditions, obscuring how they relate to broader anxiety-related distress. Clarifying how physical symptoms are interconnected with other facets of anxiety-related distress-and how developmental and social contexts shape these interconnections-can inform more integrated assessment and intervention. In this cross-sectional study, we analyzed a provincially representative sample of 346,677 Chinese students from primary, junior high, senior high, and vocational high schools. Participants completed the Mental Health Test (MHT), which assesses eight dimensions of anxiety-related distress. We used Bayesian Gaussian Graphical Modeling (BGGM) to estimate undirected symptom networks and to compare network structure across groups. Overall symptom severity increased across academic-track stages and was consistently higher in female than male students, whereas vocational-track students reported lower severity than their academic-track peers. Across all subgroups, physical symptoms showed the highest strength centrality, indicating that they were the most strongly interconnected dimension of the network. Network structure differed by educational track, developmental stage, and sex: academic-track networks were most strongly organized around learning anxiety, whereas vocational-track networks showed a more prominent interpersonal-emotional cluster; primary-school networks centered on physical symptoms, whereas secondary-school networks showed tighter integration of social-evaluative concerns. Because the design is cross-sectional, these results describe associative structure rather than causal or directional processes. Contextually precise, developmentally staged assessment and intervention strategies are therefore warranted.