Symptom network analysis in elderly patients with chronic gastritis at two time points: a repeated cross-sectional study

Based on the biopsychosocial model and the Comprehensive Geriatric Assessment framework, this study employed network models to compare symptom association patterns at two time points (hospital admission and 6-month follow-up) and to examine differences in symptom network structure between these time points. A longitudinal design with convenience sampling was used to recruit 360 hospitalized chronic gastritis patients aged ≥ 60 years. Assessments were conducted at admission (T1) and 6 months after discharge (T2). Data were collected using a general information questionnaire, the Comprehensive Geriatric Assessment, and the Gastrointestinal Symptom Rating Scale. Symptom networks were estimated using R, and centrality indices were calculated to identify high-centrality symptoms and structural changes. Network analysis of physical and psychological symptoms in elderly patients with chronic gastritis revealed that anxiety, depression, and cognitive function (MD9, MD10, MD11) constituted high-centrality correlational nodes at T1, whereas frailty, self-care ability, and fall risk (MD8, MD6, MD7) emerged as the most strongly interconnected nodes at T2. It is important to note that these designations solely reflect partial correlation strength and do not imply causal relationships or establish clinical priority. The centrality of gastrointestinal symptoms (abdominal pain, diarrhea, constipation) and activities of daily living (Barthel Index) significantly decreased at T2 (strength C = − 0.176 to − 0.824, P < 0.05), whereas psychosocial factors (anxiety, depression, well-being) remained stable ( P > 0.05). Global network strength increased from 4.75 (T1) to 5.95 (T2) ( P < 0.001). The symptom network demonstrated temporal shifts in its statistical connectivity structure, characterized by evolving correlational hubs. While psychological indicators (anxiety, depression, cognitive function) emerged as the most strongly connected nodes at T1, somatic functional status indicators (frailty, self-care capacity, fall risk) exhibited heightened connectivity at T2. Notably, psychosocial factors persisted as stable correlational hubs within the bidirectional mind-body network across both time points, albeit not necessarily representing definitive primary clinical targets. These findings offer descriptive empirical support and potential clinical reference points for designing whole-cycle, stratified, integrated traditional Chinese and Western medicine interventions for older adults with chronic gastritis.