Gender-Specific Depression-Anxiety Symptom Networks and the Impact of Weight Status: Insights From a Large-Scale Study

The relationship between body mass index (BMI), gender, and specific depression-anxiety symptoms remains unclear. This study examined how BMI and gender are associated with depression-anxiety symptom networks in 9091 Chinese adults aged 19–65 years using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) scales. Participants were categorized into four BMI subgroups: underweight, normal weight, overweight, and obesity groups. Network analysis identified core symptoms, including “motor problems” (PHQ8), “uncontrollable worry” (GAD2), and “trouble relaxing” (GAD4). Differences in network structure were observed across BMI groups, with males showing variations between the underweight, normal weight, and obesity groups, and females demonstrating significant differences in both network structure and global strength between the underweight and overweight groups. Gender differences were also found in the global strength of the overall network and in the network structure of the normal weight group. Limitations include potential residual confounders, the cross-sectional design, reliance on self-reported data, and unbalanced sample sizes. These findings suggest that BMI may be associated with the depression-anxiety symptom network in Chinese adults, with distinct gender-specific patterns, highlighting the importance of considering both BMI and gender in developing targeted mental health interventions.