Exploring which symptom should be targeted first in the comorbidity of anxiety and depression among adolescents with nomophobia: insight from a simulation network analysis

Objectives: To identify central and bridge symptoms linking anxiety and depression and to determine intervention-priority symptoms using simulation in Chinese college students with nomophobia. Methods: A cross-sectional online survey recruited 1, 638 college students in China who met at least mild criteria for nomophobia. Depressive and anxiety symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). Ising networks were estimated for depression, anxiety, and their comorbidity. Expected influence and bridge expected influence were computed, and accuracy and stability were examined via nonparametric and case-dropping bootstraps. Network Intervention simulated analysis, symptom-specific alleviating and aggravating interventions to rank targets. Results: Motor agitation/retardation (PHQ-8) and restlessness (GAD-5) were the most central symptoms in the depression and anxiety networks and remained central in the comorbidity network. Irritability (GAD-6) and feeling afraid (GAD-7) showed the highest bridge centrality, linking anxiety with depressive symptoms. NIRA indicated that reducing fatigue/low energy (PHQ-4) and excessive worry (GAD-3) would yield the largest decreases in overall network activation, whereas activating suicidal ideation (PHQ-9) and restlessness (GAD-5) would most strongly aggravate the network. Bootstrap results supported acceptable accuracy and stability (e.g., EI CS-C ≈.67 for depression;.60 for anxiety; bridge EI CS-C ≈.44 in the comorbidity network). Conclusions: Symptom-level analysis highlights actionable leverage points in nomophobia-related comorbidity. Longitudinal and experimental studies are warranted to confirm causal pathways and validate network-informed treatment sequencing.