Mapping psychophysiological associations among perceived stress, resilience, and the cortisol/DHEA ratio in people living with HIV: A network analysis

Objectives This study applied network analysis to characterize an integrated psycho-physiological stress network, identify central and bridge nodes, and determine psychological nodes most proximally associated with stress biomarkers among people living with HIV (PLWH). Methods Baseline data were drawn from 800 PLWH in Guangxi, China. Perceived stress and resilience were assessed using validated scales, and cortisol/DHEA ratio was quantified from hair samples. Gaussian graphical models integrating cortisol/DHEA, perceived stress, and resilience were estimated using EBICglasso. Expected influence, bridge centrality, and network stability were evaluated. Sex-based differences were examined using the Network Comparison Test. Two sensitivity analyses examined robustness to biomarker skewness and sociodemographic confounding. Results “Achieving despite obstacles” (EI = 1.226) was the most central node, followed by “Coping with uncertainty” (EI = 1.185) and “Growth through stress” (EI = 1.105). “Mastery over life” (Bridge EI = 0.142) emerged as the key bridge node. Among the weak biomarker-related edges, “Upset by unexpected events” showed the largest positive partial correlation with cortisol/DHEA, whereas “Growth through stress” showed the largest negative partial correlation. All cortisol/DHEA-related edges were small in magnitude (|partial r| < 0.04). No significant sex differences were found in global network structure; however, “Growth through stress” showed nominally higher centrality in males than females (1.126 vs. 0.839, uncorrected p = 0.032), a tentative difference not corrected for multiple comparisons. Conclusion Resilience occupies a central role in the stress–psychophysiological network among PLWH. Key central and bridge nodes may serve as hypothesis-generating candidates for future longitudinal and intervention research.