Network Analysis of Anxiety and Depression Symptoms in Individuals With Oral Lichen Planus and Evaluation of Salivary Biomarkers: A New Approach

To estimate the network structure of 21 symptoms of anxiety and depression in individuals diagnosed with oral lichen planus (OLP) and compare it with salivary biomarkers, cortisol and alpha-amylase. A case-control study was conducted with 21 OLP cases and 21 controls matched by sex and age. Beck Anxiety and Depression Inventories were administered, and salivary cortisol and alpha-amylase levels were determined. Descriptive analysis used the Mann-Whitney U test to compare participants' responses and the Benjamini-Hochberg Method to control the False Discovery Rate (FDR). Network analysis was performed using regularized partial correlation network models. A significant association was found between anxiety (p = 0.001) and depression (p = 0.004) scores and OLP. The "shaky/unsteady" symptom was most central in the anxiety network for OLP patients, while "feelings of punishment" and "self-criticism" were central in the depression network. Weak correlations were observed between cortisol and alpha-amylase in anxiety and depressive symptoms. Cortisol awekening response (CAR) had a negative correlation with alpha-amylase awakening response (AAR) (-0.54), as like AAR and Faint/lightheaded (-0.57) in anxiety network. Anxiety network structures did not differ between groups (p = 0.18), but the depression network was more connected in controls than in OLP cases (overall strength 69.29 vs. 27.35, p < 0.000). This study reveals the distinct network structures of anxiety and depression symptoms in OLP patients, highlighting a new methodological approach to exploring symptom configurations. When exploring the relationship with cortisol and alpha-amylase, weak relationships were found between them. The findings may prompt further network studies involving biomarkers and their interaction with anxiety and depression.