The network and interactive pattern of social adjustment and psychological symptoms in patients with spinal cord injury: A network analysis

Abstract Background: The network approach offers a novel framework for conceptualizing depression, anxiety and social adaptability as a causal system, which helps for the understanding of what may be relevant targets for treatment. Objective：To find the network and interactive pattern of social adjustment and psychological symptoms in patients with spinal cord injury(SCI). Methods: A cross-sectional parent-reported study was conducted to use an online survey disseminated from February to April 2023. The survey including Medical Coping Modality Questionnaire (MCMQ), Social Spuport Rate Scale (SSRS), Patient Health Questionnaire-9(PHQ-9), and Generalized Anxiety Disorder-7(GAD-7). 251 subjects were completed . Graphical lasso networks and directed acyclic graph (DAG) were used to visualize and analyze the associations between symptom levels corresponding to the four scales. Results: The average age of patients with SCI was 54.96 years, 61.4% were male. Network analysis results showed that "Concentration" in depression symptoms and "Trouble relaxing" in anxiety symptoms had the highest centrality strength. Anxiety symptom "Nervousness" and depression symptom "Failure" exhibited the highest bridge strength. The result of directed acyclic graph indicated a key triggering role for "Nervousness" symptoms. Conclusion: "Concentration" in depression symptoms and "Trouble relaxing" in anxiety symptom play a key role in psychological and social adjustment of patients with SCI. It is essential to pay attention to "Nervousness" as it is at the upper end of the symptom response cascade.