Dr Alexandra Rouquette MD PhD Center for Research in Epidemiology and Population... French Institute of Health and Medical Research Paris

Bridge Symptoms in Adolescence Linked To Adult Anxiety Disorders

MedicalResearch.com Interview with:

Dr Alexandra Rouquette MD PhD Center for Research in Epidemiology and Population... French Institute of Health and Medical Research Paris

Dr. Rouquette

Dr Alexandra Rouquette MD PhD
Center for Research in Epidemiology and Population…
French Institute of Health and Medical Research

MedicalResearch.com: What is the background for this study? What are the main findings?

 Response: There is a growing number of clues in the literature that suggest that the onset of adult psychopathologic disorders can be traced back to behavioral or emotional symptoms observed in childhood or adolescence. Targeting early childhood symptoms might thus be effective in preventing future mental disorders. However, these interventions are challenging to implement because we lack knowledge on which specific childhood symptoms have predictive associations with adult psychopathologic disorders. In our study, we used a novel methodologic approach, the network perspective, in which symptoms are conceptualized as distinct entities that can causally influence each other, be self-reinforcing and are thus part of causal chains which can culminate in disorders.

We investigated longitudinally the network structure among a broad range of emotional and behavioral symptoms (symptoms of attention deficit, symptoms of hyperactivity, disruptive symptoms, internalizing symptoms, prosocial symptoms) collected in elementary school girls (6-10 years) included in the Quebec Longitudinal Study of Kindergarten Children. We showed that symptoms “irritable”, “blames others”, “not liked by other children”, “often cries”, and “solitary” retained a distinctive position in the network because most of the direct relationships between the disruptive and internalizing symptom clusters transited through them. These symptoms have been termed bridge symptoms in the network perspective, as they constitute pathways that can connect different disorders.

We then investigated the relationships between this emotional and behavioral symptoms network in childhood and the occurrence of anxiety disorders at age 15 and 22 years. Importantly, the bridge symptoms (particularly “not liked by other children” and “irritable”) exhibited the strongest relationships with future anxiety disorders.

MedicalResearch.com: What should readers take away from your report?

 Response: We highlighted the central role of bridge symptoms in the developmental process leading to long-term anxiety. For example, our results suggest that girls may present symptoms such as “kicking”, “telling lies”, “destroying things”, but as long as the bridge symptoms such as “not liked by other children” or “irritable” are not activated, the risk of later developing anxiety disorders remains stable. Clinicians may wish to focus on bridge symptoms when assessing patients as these symptoms appear to have potential relevance as early targets in disease-prevention or health-promotion interventions. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: The network perspective, because it focuses at the symptom level, allows to reveal information inaccessible to methods traditionally used in classic psychometrics. More research is necessary to replicate our findings but the network approach appears to provides a natural language for clinicians and patients to use when discussing symptoms and therapeutic options. Future research should also investigate whether the bridge symptoms we identified are also key predictors of other mental disorders.

MedicalResearch.com: Is there anything else you would like to add?

Response: This work was supported by a grant from the OpenHealth Institute allocated to Dr Rouquette. The Quebec Longitudinal Study of Kindergarten Children was supported by the Quebec Fund for Research on Society and Culture (Fonds Québecois de la Recherche sur la Société et la Culture), the Social Sciences and Humanities Research Council of Canada, the Canadian Institutes of Health Research (National Health Research and Development Program/Canadian Institutes of Health Research), the US National Science Foundation, the US National Institute of Mental Health, and the National Consortium on Violence Research supported by the National Science Foundation.

We have no other financial disclosures. 


Rouquette A, Pingault J, Fried EI, et al. Emotional and Behavioral Symptom Network Structure in Elementary School Girls and Association With Anxiety Disorders and Depression in Adolescence and Early AdulthoodA Network AnalysisJAMA Psychiatry. Published online August 15, 2018. doi:10.1001/jamapsychiatry.2018.2119

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Aug 22, 2018 @ 9:18 pm

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