Perceived stress shapes symptom and social network dynamics: a network analysis of depression, anxiety, and relationship-specific support and strain.

BACKGROUND

Depression and anxiety frequently co-occur and exhibit overlapping symptoms and shared psychosocial risk and protective factors. Relationship-specific social support and strain are known to confer protective and risk effects, respectively, yet their role in shaping the symptom-level structure of depression and anxiety remains insufficiently understood. This study employed a network analytic approach to examine the structure of depression-anxiety comorbidity and its associations with perceived stress and relationship-specific social support and strain. We also examined whether these associations varied by level of perceived stress.

METHODS

Data were drawn from a community sample of South Korean adults (N = 449; M = 55.17 years; 49.67% male), all of whom were married and had at least one child and one sibling, based on targeted recruitment and inclusion criteria. Participants completed standardized measures of depression (CES-D), anxiety (GAD-7), perceived stress, and social support and strain across four relationship types (spouse, child, friend, sibling). Regularized partial correlation networks were estimated to examine symptom-to-symptom associations, links with psychosocial variables, and identification of central and bridge symptoms. Network Comparison Tests were conducted to evaluate structural differences between low and moderate-to-high perceived stress groups.

RESULTS

Depressed affect (CES-D) and nervousness (GAD-7) emerged as the most central symptoms, while bridge symptoms included depressed affect, somatic complaints (CES-D), and trouble relaxing (GAD-7). Perceived stress was the most influential risk factor, and spousal support showed the strongest protective association, particularly with anhedonia (CES-D). In the integrated symptom-social network, stress was broadly linked to both depressive and anxiety symptoms, with the strongest edge observed between stress and anhedonia. Interpersonal problems (CES-D) also served as a key bridge node connecting social strain with internalizing symptoms. Compared to the low-stress group, the moderate-to-high stress group showed greater global network strength, denser clustering of depressive symptoms, and stronger cross-links with anxiety. Additionally, the protective associations between social support and anhedonia were more pronounced, and social strain was more strongly linked to interpersonal problems under elevated stress.

CONCLUSIONS

This study highlights the complex symptom-level and social network pathways linking depression, anxiety, and relationship-specific support and strain, particularly under differing levels of perceived stress. Findings underscore the importance of considering stress as a moderator of social influences on internalizing symptoms and suggest that personalized interventions targeting central and bridge symptoms-and strengthening close social ties-may be especially beneficial for individuals under high stress.