(PS5-68) Differential Effects of Anhedonia on Generalized and Social Anxiety in Adolescent Depression

Anhedonia is the reduced ability to derive pleasure, motivation, or interest from usual activities or experiences. A core feature of major depressive disorder (MDD), anhedonia recently has been found to extend to anxiety disorders such as generalized anxiety disorder (GAD) and social anxiety disorder (SAD), suggesting it may be a mechanism driving the comorbidity of depression and anxiety across development. Adolescence is a critical developmental period characterized by heightened rates of depression and anxiety. However, the role of anhedonia in GAD and SAD among depressed youth remains largely unexplored. Here, we examined cross-sectional and longitudinal associations between anhedonia and anxiety symptoms in adolescents with MDD. We hypothesized significant bidirectional relations between anhedonia and both social and generalized anxiety.

The sample comprised 159 adolescents diagnosed with MDD at baseline (M age=15.4; 72% female). All participants completed a series of laboratory research visits (naturalistic dataset; N=159, M visits=8.6); some also completed weekly sessions of outpatient cognitive behavioral therapy (CBT) for depression and comorbidities (CBT dataset; N=64, M sessions=7.1). Anhedonia, GAD, and SAD were assessed using the self-report Snaith-Hamilton Pleasure Scale (SHAPS) and the generalized and social anxiety subscales of the Screen for Child Anxiety Related Disorders (SCARED), respectively. Given the nested structure of the data, multilevel models tested within-person cross-sectional and time-lagged associations between anhedonia and anxiety symptoms.

In a first set of cross-sectional models, both GAD and SAD symptoms were significantly associated with anhedonia (naturalistic: bs=.36-.59, p< .001; CBT: bs=.28-.33, p< .001). However, in temporally-lagged models, only SAD symptoms significantly predicted anhedonia at the subsequent timepoint within the naturalistic dataset (b=.20, p=.005); GAD symptoms did not. Anhedonia did not predict GAD or SAD symptoms at the subsequent timepoint in either dataset (ps >.240).

These results replicate and extend prior research on concurrent links between anhedonia and anxiety symptoms to adolescents with MDD. Significant associations emerged both naturalistically during research visits and in weekly transdiagnostic CBT targeting these symptoms. However, the impact of social anxiety was particularly noteworthy, as it not only showed concurrent associations with anhedonia but also temporally predicted greater levels of anhedonia. These associations underscore the importance of addressing both anhedonia and anxiety symptoms in clinical interventions, and highlight the need for tailored treatments that address the unique contributions of social anxiety to the development and maintenance of anhedonia in adolescents with MDD.