The network structure of major depressive disorder, generalized anxiety disorder and somatic symptomatology

E Bekhuis, R A Schoevers, C D van Borkulo, J G M Rosmalen, L Boschloo

Research output: Contribution to JournalArticleAcademicpeer-review


BACKGROUND: Major depressive disorder (MDD) and generalized anxiety disorder (GAD) often co-occur with somatic symptomatology. Little is known about the contributions of individual symptoms to this association and more insight into their relationships could help to identify symptoms that are central in the processes behind the co-occurrence. This study explores associations between individual MDD/GAD symptoms and somatic symptoms by using the network approach.

METHOD: MDD/GAD symptoms were assessed in 2704 participants (mean age 41.7 years, 66.1% female) from the Netherlands Study of Depression and Anxiety using the Inventory of Depressive Symptomatology. Somatic symptoms were assessed with the somatization scale of the Four-Dimensional Symptom Questionnaire. The technique eLasso was used to estimate the network of MDD/GAD and somatic symptoms.

RESULTS: The network structure showed numerous associations between MDD/GAD and somatic symptoms. In general, neurovegetative and cognitive/affective MDD/GAD symptoms showed a similar strength of connections to the somatic domain. However, associations varied substantially across individual symptoms. MDD/GAD symptoms with many and strong associations to the somatic domain included anxiety and fatigue, whereas hypersomnia and insomnia showed no connections to somatic symptoms. Among somatic symptoms, excessive perspiration and pressure/tight feeling in chest were associated with the MDD/GAD domain, while muscle pain and tingling in fingers showed only a few weak associations.

CONCLUSIONS: Individual symptoms show differential associations in the co-occurrence of MDD/GAD with somatic symptomatology. Strongly interconnected symptoms are important in furthering our understanding of the interaction between the symptom domains, and may be valuable targets for future research and treatment.

Original languageEnglish
Pages (from-to)2989-2998
Number of pages10
JournalPsychological Medicine
Issue number14
Publication statusPublished - Oct 2016


  • Adult
  • Anxiety Disorders/epidemiology
  • Comorbidity
  • Depressive Disorder, Major/epidemiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Netherlands/epidemiology
  • Somatoform Disorders/epidemiology


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