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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Sex and age differences in depression and anxiety networks among adolescents with idiopathic scoliosis: A network analysis
Shu-Wen Dong, Lei Yang, Yi-Fan Lin, Li-Wen Yang, Dan Li, Li-Wan Zhu, Cai-Yun Zhang, Yan-Zhi Li, Wan-Xin Wang, Ci-Yong Lu, Bin Yan
Shu-Wen Dong, Li-Wen Yang, Li-Wan Zhu, Cai-Yun Zhang, Yan-Zhi Li, Wan-Xin Wang, Ci-Yong Lu, Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
Lei Yang, Yi-Fan Lin, Dan Li, Bin Yan, Department of Spine Surgery, The First Affiliated Hospital of Shenzhen University, Shenzhen 518035, Guangdong Province, China
Lei Yang, Yi-Fan Lin, Dan Li, Bin Yan, Medical Innovation Technology Transformation Center, Shenzhen Second People’s Hospital, Shenzhen 518035, Guangdong Province, China
Lei Yang, Yi-Fan Lin, Dan Li, Bin Yan, Department of Spine Surgery, The First Affiliated Hospital, Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen 518035, Guangdong Province, China
Co-first authors: Shu-Wen Dong and Lei Yang
Co-corresponding authors: Ci-Yong Lu and Bin Yan
Author contributions: Dong SW wrote the paper and analyzed data; Yang L analyzed data and revised the paper; Lin YF analyzed data and contributed new reagents; Yang LW contributed to data cleaning and visualization; Li D contributed to collating data and investigation; Zhu LW contributed to validation and paper revision; Zhang CY contributed to conceptualization and validation; Li YZ contributed to data collation and paper revision; Wang WX contributed to investigation and methodology; Lu CY supervised the project and provided resources; Yan B provided funding and resources, and supervised the project. Dong SW and Yang L contributed equally to this work as co-first authors. The study data were obtained from the Spine Health Center of the Shenzhen Second People's Hospital, which is a well-connected partner with our subject group. The construction of the Shenzhen adolescent idiopathic scoliosis cohort has been carried out for more than 3 years. Yan B is the director of the department and the head of several scoliosis programs, providing us with the platform for data collection and funding support. Yan B also provided valuable comments in the writing and revision of the paper. Therefore, we consider it reasonable to list Yan B as the corresponding author.
Supported by The Sanming Project of Medicine in Shenzhen, No. SZSM202211003; Shenzhen-Hong Kong Jointly Funded Project, Shenzhen Science and Technology Program, No. SGDX20230116093645007; Shenzhen Second People's Hospital Clinical Project, No. 20243357003; and Shenzhen Medical Research Fund, No. B2303005.
Institutional review board statement: This study adhered to the Helsinki Declaration and received approval from the ethics committee of Shenzhen Second People’s Hospital (No. 2023-315-02PJ).
Informed consent statement: Written informed consent was obtained from all participants or their parents before distributing the questionnaire.
Conflict-of-interest statement: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets used and/or analyzed in the present study can be obtained from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ci-Yong Lu, MD, PhD, Professor, Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, No. 74 Zhongshan Road 2, Guangzhou 510080, Guangdong Province, China.
luciyong@mail.sysu.edu.cn
Received: October 30, 2024
Revised: December 11, 2024
Accepted: January 6, 2025
Published online: March 19, 2025
Processing time: 120 Days and 3.1 Hours
BACKGROUND
Depression and anxiety are prevalent psychological challenges among patients with adolescent idiopathic scoliosis (AIS), affecting individuals across both sex and age groups.
AIM
To explore the network structure of depression and anxiety symptoms, with a focus on identifying differences at the symptom level between sex and age subgroups.
METHODS
A total of 1955 participants diagnosed with AIS aged 10-18 years were assessed using the Patient Health Questionnaire Depression Scale (PHO-9) and the Generalized Anxiety Disorder Scale (GAD-7), and 765 patients exhibiting PHQ-9 or GAD-7 scores ≥ 5 were enrolled in our study. Network analysis and network comparison tests were utilized to construct and compare the depression-anxiety symptoms networks among sex and age subgroups.
RESULTS
The results revealed GAD3 “Excessive worry” and PHQ2 “Sad mood” were the most significant central symptoms in all subgroups, while “Sad mood” had higher strength than “Excessive worry” in the lower age group. In the network comparisons, the female network exhibited tighter connectivity, especially on GAD6 “Irritability” and GAD2 “Uncontrollable worry”, while only PHQ3 “Sleep” and PHQ9 “Suicidal ideation” had differences at the local level in the lower age group.
CONCLUSION
Several interventions targeting excessive worry and sad mood could reduce the risk of depression and anxiety symptoms in the AIS population. Furthermore, specific anxiety symptoms in females, along with sleep disturbances and suicidal ideation in the lower age group, should be addressed at an early stage to prevent significant disruptions in mental health trajectories.
Core Tip: Among 1955 adolescents with idiopathic scoliosis, 765 participants showed significant depression and anxiety symptoms. Network analysis identified "Excessive worry" and "Sad mood" as central symptoms across all sex and age subgroups, with "Sad mood" more prominent in younger individuals. Females exhibited tighter connectivity, particularly for "Irritability" and "Uncontrollable worry". Notably, differences in "Sleep disturbances" and "Suicidal ideation" were observed in the lower age group. Targeting these central symptoms through early interventions is crucial to mitigate the risk of depression and anxiety in this population.
