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Fear of cancer recurrence (FCR), anxiety, and depression are common psychological disturbances that frequently occur together among cancer patients. This study investigated network connectivity between FCR, anxiety, and depressive symptoms in a large representative sample of breast cancer patients.This was a multicenter, cross-sectional study of 803 women with breast cancer. All participants completed the 4-item FCR scale, Generalized Anxiety Disorder Scale (GAD-7), and Patient Health Questionnaire (PHQ-9). Network analysis was conducted to investigate the network structure, central symptoms, bridge symptoms, and network stability of these disturbances.The generated network model indicated that anxiety and depression symptom communities were well-connected with each other, while FCR emerged as a distinct cluster with only a few weak links to anxiety and depression communities. Depressive and anxiety symptoms were more central than FCR symptoms were in the model. 'Having trouble relaxing' (#GAD4, strength = 1.147) was the most central node within the whole network, and 'strong feelings about recurrence' (#FCR4, strength = 0.531) was the least central node. Several anxiety symptoms (e.g., 'feeling afraid', 'uncontrollable worry', and 'restlessness') acted as important bridging symptoms connecting FCR, depression and anxiety communities. 'Uncontrollable worry' (#GAD2) had the highest node-specific predictive betweenness value. The network stability of this model was high.Depression and anxiety symptoms are highly interactive with each other among women with breast cancer. Conversely, FCR may have attenuated relations with anxiety and depression communities and emerged as a relatively independent, unique experience. Anxiety symptoms, particularly 'uncontrollable worry', acted as important trans-diagnostic symptoms that connected different communities. Findings suggested interventions to alleviate excessive worries and enhance feelings of personal control might be helpful in preventing or reducing related symptoms of FCR, anxiety and depression.

Wengao Li,1,* Yining Xu,2,* Xian Luo,3,* Youlu Wen,1 Kairong Ding,4,5 Wenjing Xu,6,7 Samradhvi Garg,8 Yuan Yang,5 Hengwen Sun7 1Department of Psychiatry, Guangdong 999 Brain Hospital, Guangzhou, Guangdong, 510515, People’s Republic of China; 2Department of Nursing, Guangzhou First People’s Hospital, the Second Affiliated Hospital, South China University of Technology, Guangzhou, Guangdong, 510000, People’s Republic of China; 3Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, 510515, People’s Republic of China; 4Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, 510515, People’s Republic of China; 5Guangdong Mental Health Center,Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, 510080, People’s Republic of China; 6The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, People’s Republic of China; 7Department of Radiotherapy, Cancer Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, Guangdong, 510080, People’s Republic of China; 8School of Health in Social Science, University of Edinburgh, Edinburgh, EH8 9BL, UK*These authors contributed equally to this workCorrespondence: Hengwen Sun, Department of Radiotherapy, Cancer Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, 510080, People’s Republic of China, Email sunrise761114@foxmail.com Yuan Yang, Guangdong Mental Health Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, 510080, People’s Republic of China, Email 306850475@qq.comObjective: Anxiety, depression, and pain are highly interactive with each other in adolescent and young adult (AYA) cancer patients. This study aims to map out the connectivity between anxiety, depression and pain symptoms amongst Chinese AYA cancer patients from the perspective of a network model.Methods: Two hundred and eighteen AYA patients, aged between 15 and 39 years at diagnosis; completed the Patient Health Questionnaire (PHQ), Generalized Anxiety Disorder (GAD), and McGill Pain Questionnaire-Visual Analogue Scale (MPQ-VAS). Network analyses were performed.Results: In all, 38.07% (95% CI = 31.58– 44.57%) of the participants reported depression, 30.73% (95% CI = 24.56– 36.91%) reported anxiety, and 14.22% (95% CI = 9.55– 18.89%) reported current pain. The generated network illustrated that anxiety, depression and pain community were well connected. In the network, “having trouble relaxing” (GAD4, node strength = 1.182), “uncontrollable worry” (GAD2, node strength = 1.165), and “sad mood” (PHQ2, node strength = 1.144) were identified as the most central symptoms, while “uncontrollable worry” (GAD2, bridge strength = 0.645), “guilty” (PHQ6, bridge strength = 0.545), and “restlessness” (GAD5, bridge strength = 0.414) were the key bridging symptoms that connected different communities.Conclusion: Anxiety, depression and pain symptoms are highly interactive with each other. Alleviating AYA cancer patient’s excessive worries might be helpful in improving the patient’s co-occurring anxiety, depression and pain symptoms.Keywords: adolescent, anxiety, cancer, depression, network, pain, young adult

BackgroundFear of cancer recurrence (FCR) is a significant issue for most cancer patients. Until now, a detailed investigation of the structure of FCR and the interaction among its constituent elements is lacking. This study aims to investigate the phenomenon of FCR by means of network analysis in Chinese cancer patients.MethodsThis is a multi-center, cross-sectional study that included 996 cancer patients from southern China. All participants were assessed by the 7-item Chinese version Fear of Cancer Recurrence Scale (FCR-7). Multivariate logistic regression, and network analyses were conducted. Central symptoms (nodes) in the FCR network were identified.ResultsAmong the 996 patients, 543 (54.52%) reported moderate FCR, and 137 (13.76%) reported high FCR. Chemotherapy (OR = 2.954, P = 0.016), and childhood severe illness experience (OR = 2.331, P = 0.016) were positively associated with high FCR, while higher monthly income (OR = 0.403, P = 0.046) was negative associated with high FCR. The node #FCR2 (Worried/anxious about recurrence) was the most central node within the FCR network (Strength = 1.190), while node #FCR6 (Examining for physical signs) was the least central node (Strength = 0.373). The edge FCR1-FCR2 (“Afraid”-“Worried/anxious”) was the thickest and most saturated edge in the network. After controlling for age and gender, an almost identical network was obtained with respect to edges magnitude and strength.ConclusionFear of recurrence is a frequently reported issue among Chinese cancer patients. Patients with chemotherapy and childhood severe illness experience were more vulnerable and should be particularly monitored. Compared to behavioral component (i.e., body checking, overscreening and overtreatment) and cognitive component (i.e., intrusions), emotional component (i.e., worry/anxious) is more central to identify FCR and might be potential targets for further interventions.

Zhang Y, Sun H, Li W, et al. Neuropsychiatr Dis Treat. 2021;17:2269–2280. The authors have advised the affiliation list on page 2269 is incorrect. The correct author list and affiliations are as follows. Yongfu Zhang1,* Hengwen Sun2,* Wengao Li3 Xian Luo4 Ting Liu4 Fan Fang5 Julan Xiao5 Samradhvi Garg6 Yuan Yang4,7,8 Yu Chen5 1Department of Anesthesiology, Guangzhou Women and Children’s Medical Centre, Guangzhou, Guangdong, People’s Republic of China; 2Department of Radiotherapy, Cancer Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, Guangdong, People’s Republic of China; 3Department of Psychiatry, 999 Brain Hospital, Guangzhou, Guangdong, People’s Republic of China; 4Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, People’s Republic of China; 5School of Nursing, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China; 6School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland, UK; 7Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macau, SAR, People’s Republic of China; 8Center for Cognition and Brain Sciences, University of Macau, Macau, SAR, People’s Republic of China *These authors contributed equally to this work Read the original article

Funding: President Foundation of Nanfang Hospital, Southern Medical University (2017L001); Guangzhou Science and Technology Project (201804010132); Key Item of Guangzhou bureau of education (2019KC106), and Innovation Item of Guangdong Provincial Department of Education (2018A043442). This article investigates the reliability and validity of the Chinese version of the 7-item Fear of Cancer Recurrence Questionnaire (FCR-7). A total of 1,025 cancer patients were recruited and asked to complete the Chinese FCR-7, Fear of Progression Questionnaire—Short Form (FoP-Q–SF), 9-item Patient Health Questionnaire (PHQ-9), and 7-item General Anxiety Disorder Questionnaire (GAD-7). The internal consistency and test–retest reliabilities were examined. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted on random split-half samples. Overall relationships of FCR-7 with other psychological constructs were examined. The Chinese FCR-7 showed good internal consistency (Cronbach’s alpha = .87), test–retest reliability (r = .90), and item–total correlations (range = .583–.872). The unitary factor structure was supported by the EFA and the CFA fit statistics (comparative fit index = .99, root-mean-square error of approximation = .039, 95% confidence interval [.01, .07]). The total score of FCR-7 was positively associated with FoP-Q–SF (r = .756, p < .01), PHQ-9 (r = .522, p < .01), and GAD-7 (r = .553, p < .01). Patients with low monthly income (p < .001) and family cancer history (p = .012) and those who had gone through chemotherapy (p = .001) tended to report higher fear of cancer recurrence (FCR). The FCR-7 has been translated and successfully culturally adapted into a Chinese version. It is a reliable and valid measurement for assessing FCR. Postprint

Yongfu Zhang,1,&ast; Hengwen Sun,2,&ast; Wengao Li,3 Xian Luo,4 Ting Liu,4 Fan Fang,5 Julan Xiao,5 Samradhvi Garg,6 Yuan Yang,4 Yu Chen5 1Department of Anesthesiology, Guangzhou Women and Children’s Medical Centre, Guangzhou, Guangdong, People’s Republic of China; 2Department of Radiotherapy, Cancer Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, Guangdong, People’s Republic of China; 3Department of Psychiatry, 999 Brain Hospital, Guangzhou, Guangdong, People’s Republic of China; 4Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, People’s Republic of China; 5School of Nursing, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China; 6School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland, UK&ast;These authors contributed equally to this workCorrespondence: Yu Chen Email truelife2010@126.comYuan Yang Email yangyuan_yangyuan@163.comBackground: Depression is a commonly seen mental health concern for mothers and fathers during their transition to parenthood. This study aims to provide new insights into the prevalence of maternal and paternal depression, its demographic and clinical correlates, and its symptom network among Chinese pregnant women and their partners.Methods: In this multicenter, cross-sectional study, 769 pregnant women and their partners were assessed by Edinburgh Postnatal Depression Scale (EPDS) from June 15th to Sep 15th, 2020 in southern China. Convenient sampling method was used. Univariate analyses, multivariate logistic regression, and network analyses were conducted. Networks of maternal and paternal depression were compared.Results: In total, 60 (EPDS total score ≥ 13, 7.80%, 95% CI: 5.90– 9.70%) women and 23 (2.99%, 95% CI: 1.78– 4.20%) of these women’s partners reported depression. Physical comorbidities (OR=2.664, P=0.003) was the only factor that was found to significantly correlate with maternal depression. Network analyses showed that the resulting networks were well connected and that there was significant difference of network structure between maternal and paternal depression (M=0.330, P< 0.001). Centrality plot indicated that “sad or miserable” (strength=1.097) was the most central symptom in the maternal depression network, while “scared or panicky” (strength=1.091) was the most central node in the paternal network. The edge between “things have been getting on top of me” – “able to laugh and see the funny side of things” (difference: 0.153, P=0.020), and “scared or panicky” – “the thought of harming myself” (difference: 0.084, P< 0.001) was significantly stronger in women’s partners than that in pregnant women.Conclusion: Maternal and paternal depression during pregnancy could result in significant negative consequences. Symptoms like “sad or miserable” and “scared or panicky” are critical and might be potential targets for further interventions. Evidence-based treatments, such as pharmacology, psychotherapy, community reinforcement and family training, might be beneficial for parents with depression during and after the pregnancy.Keywords: depression, maternal, network, paternal, pregnancy

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Background Since the middle of March, the COVID-19 outbreak has been well contained in China. The prevention and control measures for the outbreak have been downgraded to a normalized level. However, until now, the change in level of psychological health amongst perinatal women during the remission phase of the COVID-19 outbreak has not been investigated in China. The aim of this current study was to assess the symptoms of anxiety, depression, insomnia and quality of life (QOL) in perinatal women and to identify potential risk factors associated with these symptoms. Methods This was a cross-sectional, hospital-based survey conducted between March 25th till June 5th, 2020 in southern China. Convenient sampling method was adopted. Women’s anxiety, depression, insomnia symptoms and QOL was examined through standardized measurements. Multivariate logistic regression and Analysis of Covariance (ANCOVA) was conducted for the same. Results A total of 625 perinatal women completed the study; of them, 195 women (31.2%, 95%CI=27.56%–34.84%) reported anxiety, 120 (19.2%, 95%CI=16.10%–22.30%) reported depression, and 87 (13.9%, 95%CI=11.20%–16.64%) experienced symptoms of insomnia. Previous adverse experiences during pregnancy was a significant risk factor for anxiety (OR=1.628, 95%CI=1.069–2.480, P=0.023), depression (OR=1.853, 95%CI=1.153–2.977, P=0.011), and insomnia (OR=2.160, 95%CI=1.290-3.616, P=0.003). Participants having infected friends/families/colleagues were more likely to report anxiety (OR=2.195, 95%CI=1.245–3.871, P=0.007) and depression (OR=2.666, 95%CI=1.482–4.794, P=0.001). Those women whose regular check-ups were severely interrupted by the COVID-19 were also more likely to experience symptoms of anxiety (OR=2.935, 95%CI=1.701–5.062, P

Objective: Suicide is one of the main reasons cited behind the death rate of cancer, and suicidal ideation (SI) is the first step towards it. This study aimed to investigate the prevalence and associates of suicidal ideation in newly-diagnosed Chinese cancer patients. Methods: This multicenter study was conducted from January 2018 to September 2019. Eligible participants were asked to complete a Case Record Form (CRF), the Patient Health Questionnaire (PHQ-9), General Anxiety Disorder Questionnaire (GAD-7), Fear of Cancer Recurrence Questionnaire (FCRQ-7), and McGill Pain Questionnaire-Visual Analogue Scale (MPQ-VAS). Univariate analyses and multivariate logistic regression analyses were conducted for assessment. Results: Out of 603 patients, 91 (15.1%, 95%CI: 12.23%-17.96%) reported suicidal ideation in the last two weeks. Physical comorbidities (OR=1.808, P=0.039), childhood adversity experience (OR=5.999, P=0.001), cancer pain (OR=1.828, P=0.047), depression (OR=2.811, P=0.013) and anxiety (OR=6.532, P

Background This study investigated the prevalence and factors associated with counselling and psychotherapy service use among Chinese sexual minority populations. Methods A nationwide cross-sectional study was performed using snowball sampling method, which led to the inclusion of 18,193 participants. Participants’ sociodemographic background, clinical, and psychological data were gathered. Multivariate logistic regression analysis was performed to explore any associated factors. Results There were 2007 participants who had used counselling and psychotherapy service out of the total population. Among those who had used psychotherapy services, 80.2% participants perceived discrimination, 1.1% reported that they had been refused treatment by a counsellor and/or psychotherapist, 1.6% had experienced verbal harassment, and 8.4% reported that their counsellor and/or psychotherapist lacked knowledge and experience in treating sexual minorities. In addition, regression analyses indicated that those who were divorced/widowed, had religious beliefs, and those who had experienced discrimination, verbal harassment, and rejection for treatment by health professionals all had an increased likelihood of utilising counselling and psychotherapy service. Conclusions Service providers and policy makers in China should improve the quality and availability of counselling and psychotherapy services to address the mental health needs of sexual minority populations.