University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands.
University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands; University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands.
J Psychosom Res. 2024 Dec;187:111932. doi: 10.1016/j.jpsychores.2024.111932. Epub 2024 Sep 13.
Comorbidities between internalizing disorders (IDs) and functional disorders (FDs) are well-documented, indicating shared pathways. However, their symptom-level relationships have been largely unexplored. This exploratory study employs a network approach to investigate symptoms of major depressive disorder (MDD), generalized anxiety disorder (GAD), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), fibromyalgia (FM), and irritable bowel syndrome (IBS) to identify bridge symptoms explaining comorbidity between the two domains.
We used cross-sectional data on 72,919 adult subjects from the Lifelines Cohort Study, a Dutch general population sample. A total of 38 symptoms representing diagnostic criteria of IDs and FDs were assessed with validated questionnaires. Network models were estimated using eLasso, based on the Ising model, to identify bridge symptoms. The Network Comparison Test (NCT) was used to test whether there were differences in network structure and strength across sex and age.
Symptoms were moderately connected, with a network density of 52.7%. ID and FD symptoms clustered in their respective domains, but were connected through the bridge symptoms, fatigue, difficulty concentrating, trouble sleeping, and unrefreshing sleep. Fatigue and difficulty concentrating had the most connections, associated with 86.6% and 78.9% of the other symptoms, respectively. NCTs indicated no differences in network connectivity between females versus males or younger versus older adults (>50 years).
ID and FD symptoms are moderately interconnected. Bridge symptoms displaying strong connections to multiple disorders may play a central role in the mechanisms underpinning the comorbidity between IDs and FDs.
内化障碍（IDs）和功能障碍（FDs）之间的共病现象已有充分记录，表明存在共同的发病途径。然而，它们的症状水平关系在很大程度上尚未得到探索。本探索性研究采用网络方法研究重度抑郁症（MDD）、广泛性焦虑症（GAD）、慢性疲劳综合征/肌痛性脑脊髓炎（ME/CFS）、纤维肌痛（FM）和肠易激综合征（IBS）的症状，以确定解释两个领域共病的桥梁症状。
我们使用来自 Lifelines 队列研究的 72919 名成年受试者的横断面数据，这是一个荷兰一般人群样本。使用经过验证的问卷评估代表 IDs 和 FDs 诊断标准的 38 种症状。基于伊辛模型，使用 eLasso 估计网络模型，以识别桥梁症状。使用网络比较测试（NCT）来测试性别和年龄是否会导致网络结构和强度存在差异。
症状中度相关，网络密度为 52.7%。ID 和 FD 症状分别聚集在其各自的领域，但通过桥梁症状、疲劳、注意力集中困难、睡眠困难和睡眠质量差相互连接。疲劳和注意力集中困难的连接最多，分别与其他 86.6%和 78.9%的症状相关。NCT 表明，女性与男性或年轻与年长（>50 岁）成年人之间的网络连通性没有差异。
ID 和 FD 症状中度相关。显示与多种疾病有强烈联系的桥梁症状可能在 IDs 和 FDs 共病的发病机制中发挥核心作用。
