A Network Analysis of Depressive Symptoms, Alexithymia and Emotion Regulation Across Developmental Stages of Adolescence

Adolescence is a critical developmental period marked by increased vulnerability to depression. Alexithymia and maladaptive emotion regulation may contribute to depressive symptoms by impairing adolescents’ ability to identify, describe, and regulate emotion. However, their inter-relationships remain unclear across different developmental stages in adolescence. A total of 4771 adolescents aged 10-18 were recruited and categorized into the early (10-12), middle (13-15), and late (16-18) developmental stages. Participants completed the Children’s Depression Inventory (CDI), Perth Alexithymia Questionnaire (PAQ) and Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA). Two levels of network construction among above variables were conducted using network analysis. One examined the interplays among CDI total score, PAQ and ERQ-CA subscales. Another model replaced CDI total score with its 27 individual items to explore symptom-level interactions. Network comparisons were further performed across different developmental stages. In the networks with the CDI total score, Positive-Difficulty identifying feelings was the most central node in the whole sample and in early and middle adolescence, while Positive-Difficulty describing feelings was most central in late adolescence. In the CDI item-level networks, self-hatred and loneliness emerged as central nodes in the whole sample, with self-hatred being central in early adolescence and loneliness in middle and late adolescence. Structural difference was significant between early and middle adolescence in the symptom-level networks. This study identifies core nodes at each stage of adolescence and suggest the middle adolescence as particular vulnerable period. Our findings highlight the need for stage-specific intervention for depressive symptoms in adolescents.