Structural changes in adolescent mental health networks from the pandemic to the post-pandemic period: a network comparison study

Abstract

Objective To examine the structural changes in adolescent mental health symptom networks between the COVID-19 pandemic and post-pandemic periods in South Korea using nationally representative data and network analysis. Methods We analyzed data from the Korean Youth Risk Behavior Survey collected during the pandemic (2020; N = 46,387) and post-pandemic (2023; N = 48,936). Thirty theoretically selected variables were included, covering anxiety symptoms, smartphone overdependence, sleep quality, suicidality, substance use, and demographic characteristics. Regularized partial correlation networks were estimated using LASSO with extended Bayesian information criterion selection. Network comparison tests were used to assess structural differences, and three centrality indices (strength, betweenness, and closeness) were calculated. Sex-stratified networks were also examined to explore potential differences in symptom configurations. Results Symptom networks showed marked reorganization from the pandemic to the post-pandemic period. Suicidal ideation and planning demonstrated higher centrality in the post-pandemic network, particularly within the female subgroup, whereas suicide attempts showed reduced centrality. Irritability became more prominent within the anxiety domain among females, while worry-related symptoms gained centrality among males. Family-related smartphone conflict and sleep timing variables showed stronger integration within the female network, suggesting greater integration into the mental health network and heightened vulnerability among girls in the post-pandemic context. Conclusion Adolescent mental health networks in South Korea have changed substantially between the pandemic and post-pandemic periods. Beyond changes in prevalence, network restructuring highlighted shifts in how symptoms relate to one another, with notable sex-specific patterns. These findings underscore the value of symptom-level, network-based approaches for understanding post-pandemic mental health and emphasize the need for sex-sensitive and developmentally informed screening and interventions.