ArticleBMJ open2026
Network structure of depression, anxiety and stress in patients with non-Hodgkin's lymphoma receiving chemotherapy: a multicentre cross-sectional study.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo estimate the item-level conditional association network of depression, anxiety and stress symptoms in patients with non-Hodgkin's lymphoma (NHL) during a prespecified chemotherapy intercycle period and to identify symptoms with comparatively high expected influence, bridge expected influence and predictability.
designMulticentre cross-sectional study.
settingOncology departments of four tertiary hospitals in Jiangsu Province, China, from October 2024 to June 2025.
participantsA total of 798 adults with pathologically confirmed NHL were assessed during the prespecified chemotherapy intercycle period. PRIMARY AND SECONDARY OUTCOME MEASURES: The 21 items of the Depression Anxiety Stress Scales-21 (DASS-21) were modelled as nodes in a regularised partial-correlation network. Primary network measures were edge weights, expected influence and bridge expected influence; secondary measures were node predictability and bootstrap indices of accuracy and stability.
resultsThe strongest conditional association was between difficulty initiating tasks (D2) and lack of enthusiasm (D5; edge weight=0.282). Irritability (S7; expected influence=1.106), depression/dejection (D4; 1.065) and nervous energy (S3; 1.051) had the highest expected influence and also the highest bridge expected influence (0.972, 0.803 and 0.720, respectively). Trembling (A3; predictability=0.561), irritability (S7; 0.481) and intolerance of hindrance (S6; 0.476) had the highest predictability. Correlation-stability coefficients for expected influence and bridge expected influence were both 0.67.
conclusionsIrritability, depression/dejection and nervous energy showed comparatively high signed connectivity within and across the prespecified DASS-21 domains, while the D2-D5 pair had the strongest conditional association. These cross-sectional findings are descriptive and hypothesis-generating and do not establish temporal, causal or treatment effects.
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