Network analysis of fear of progression, anxiety, and depression in parents of children with malignant solid tumors: A cross-sectional study.
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OBJECTIVE: Fear of progression (FoP), anxiety, and depression are common emotional distresses for parents of children with cancer, but yet these concerns often lack attention. This study explored the network connections between FoP, anxiety, and depression in parents of children with malignant solid tumors. METHODS: This study that included 447 parents of children with malignant solid tumors. All participants completed the Fear of Progression Questionnaire-parent version (FoP-Q-SF/PR), the 2-item Generalize Anxiety Disorder Scale (GAD-2) and the 2-item Patient Health Questionnaire (PHQ-2). We estimated two network models: regularized partial correlation network and Bayesian Directed Acyclic Graph (DAG). RESULTS: The regularized partial correlation network demonstrated a correlation between FoP, anxiety, and depressive symptoms, with a stronger association observed between anxiety and depression. The results of the Network Centrality Indicator showed that the top three symptoms in terms of expected impact (EI) were "fear of major treatment", "life anxiety", and "feeling tense, anxious, or eager". The DAG showed that the symptoms of FoP activated each other, which in turn activated anxiety and depressive symptoms. In particular, "fear of major treatment" was at the top of the DAG and therefore has the highest predictive priority in the network. CONCLUSION: "Fear of major treatment" was a core symptom in the regularized partial correlation network and an upstream symptom in the DAG. The findings suggest that strengthening health education, building confidence in overcoming the disease, and reinforcing positive coping may help to improve negative emotions in parents of children with malignant solid tumors.