Comorbid Depression and Anxiety Symptoms in Chinese Adolescents: Testing the Explanatory Power of a Diathesis-Anxiety Model

Jae Wan Choi, Wei Hong, John R Z Abela, Joseph R Cohen

Research output: Contribution to journalArticlepeer-review


Anxiety and depressive symptoms frequently co-occur in adolescence and confer greater distress compared to experiencing either symptom alone. A causal model (anxiety symptoms predicting depressive symptoms), a correlated liabilities model (vulnerabilities interacting with stressors to predict both symptoms), and a diathesis-anxiety model (vulnerabilities interacting with anxiety symptoms to predict depressive symptoms) have all been proposed as explanations for the relation between depression and anxiety. To date, however, research has mostly examined these models among North American/Western European adolescents. In response, the present study sought to identify the best explanatory model concerning the relationship between anxiety and depressive symptoms among Chinese adolescents. 494 10th grade students were assessed for their perceived levels of family cohesion and conflict, stressors, and depressive and anxiety symptoms. Every 3 months for 18 months, youth reported their symptoms and stressors. Symptoms and stressors were person-mean and grand-mean centered to compare nomothetic and idiographic conceptualizations of vulnerability. Overall, evidence suggested a reciprocal, versus causal, relation between anxiety and depressive symptoms. Further, while cohesion and conflict independently predicted anxiety and depressive symptoms, their interactions with stressors were not supported. Ultimately, strong support was found for a diathesis-anxiety model using an idiographic conceptualization of anxiety, such that low perceived family cohesion interacted with within-subject fluctuations of anxiety to predict prospective depressive symptoms. This study provides cross-cultural support for a diathesis-anxiety model and shows the importance of distinguishing between positive and negative family functioning when examining vulnerability in Chinese adolescents. Research and clinical implications of these findings are discussed.

Original languageEnglish (US)
Pages (from-to)503-517
Number of pages15
JournalResearch on Child and Adolescent Psychopathology
Issue number4
Early online dateNov 25 2020
StatePublished - Apr 2021


  • Adolescents
  • Anxiety
  • China
  • Comorbidity
  • Depression
  • Idiographic assessment

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Developmental and Educational Psychology


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