Guangdong Mental Health Center, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou 510080, China.
Department of Radiotherapy, Cancer Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China.
J Affect Disord. 2022 Jul 15;309:358-367. doi: 10.1016/j.jad.2022.04.119. Epub 2022 Apr 25.
Fear of cancer recurrence (FCR), anxiety, and depression are common psychological disturbances that frequently occur together among cancer patients. This study investigated network connectivity between FCR, anxiety, and depressive symptoms in a large representative sample of breast cancer patients.
This was a multicenter, cross-sectional study of 803 women with breast cancer. All participants completed the 4-item FCR scale, Generalized Anxiety Disorder Scale (GAD-7), and Patient Health Questionnaire (PHQ-9). Network analysis was conducted to investigate the network structure, central symptoms, bridge symptoms, and network stability of these disturbances.
The generated network model indicated that anxiety and depression symptom communities were well-connected with each other, while FCR emerged as a distinct cluster with only a few weak links to anxiety and depression communities. Depressive and anxiety symptoms were more central than FCR symptoms were in the model. 'Having trouble relaxing' (#GAD4, strength = 1.147) was the most central node within the whole network, and 'strong feelings about recurrence' (#FCR4, strength = 0.531) was the least central node. Several anxiety symptoms (e.g., 'feeling afraid', 'uncontrollable worry', and 'restlessness') acted as important bridging symptoms connecting FCR, depression and anxiety communities. 'Uncontrollable worry' (#GAD2) had the highest node-specific predictive betweenness value. The network stability of this model was high.
Depression and anxiety symptoms are highly interactive with each other among women with breast cancer. Conversely, FCR may have attenuated relations with anxiety and depression communities and emerged as a relatively independent, unique experience. Anxiety symptoms, particularly 'uncontrollable worry', acted as important trans-diagnostic symptoms that connected different communities. Findings suggested interventions to alleviate excessive worries and enhance feelings of personal control might be helpful in preventing or reducing related symptoms of FCR, anxiety and depression.
癌症复发恐惧（FCR）、焦虑和抑郁是癌症患者常见的心理困扰，这些困扰常常同时发生。本研究调查了大样本乳腺癌患者中 FCR、焦虑和抑郁症状之间的网络连接。
这是一项多中心、横断面研究，共纳入 803 例乳腺癌患者。所有参与者完成了 4 项 FCR 量表、广泛性焦虑障碍量表（GAD-7）和患者健康问卷（PHQ-9）。网络分析用于研究这些障碍的网络结构、中心症状、桥梁症状和网络稳定性。
生成的网络模型表明，焦虑和抑郁症状社区彼此之间连接良好，而 FCR 则作为一个单独的集群出现，与焦虑和抑郁社区仅有少数弱连接。模型中抑郁和焦虑症状比 FCR 症状更具中心性。“难以放松”（#GAD4，强度=1.147）是整个网络中最中心的节点，而“强烈的复发感”（#FCR4，强度=0.531）是最不中心的节点。一些焦虑症状（如“感到害怕”、“无法控制的担忧”和“不安”）作为重要的桥梁症状，连接 FCR、抑郁和焦虑社区。“无法控制的担忧”（#GAD2）具有最高的节点特定预测桥接值。该模型的网络稳定性较高。
乳腺癌女性中，抑郁和焦虑症状彼此高度交互。相反，FCR 与焦虑和抑郁社区的关系可能较弱，并且呈现出相对独立、独特的体验。焦虑症状，特别是“无法控制的担忧”，作为连接不同社区的重要跨诊断症状。研究结果表明，减轻过度担忧和增强个人控制感的干预措施可能有助于预防或减少相关的 FCR、焦虑和抑郁症状。
