{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T15:05:16Z","timestamp":1790003116089,"version":"4.0.1"},"reference-count":55,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"unspecified","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"2025 Hebei Provincial Medical Science Research Project","award":["20250872"],"award-info":[{"award-number":["20250872"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,8,27]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>This study systematically examines the prevalence and inter-relationships of depressive symptoms, resilience and illness uncertainty in patients with primary angle-closure glaucoma (PACG), elucidating their dynamic, bidirectional mechanisms over time to inform the development of integrated biopsychosocial management strategies for PACG in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>A prospective longitudinal study design will be employed. A total of 610 patients undergoing primary PACG surgery at the Ophthalmology Department of Chengde Medical College Affiliated Hospital will be recruited by convenience sampling between November 2025 and January 2027. Participants will be assessed at three time points\u2014on admission (T1), 1\u2009month after discharge (T2) and 3\u2009months after discharge (T3)\u2014using the Patient Health Questionnaire-9, Connor-Davidson Resilience Scale, and Mishel Uncertainty in Illness Scale to evaluate levels of depressive symptoms, resilience and illness uncertainty. Demographic and baseline clinical data will also be collected.<\/jats:p>\n                    <jats:p>For statistical analyses, Harman\u2019s single-factor test for common method bias and longitudinal measurement invariance analyses will first be conducted. Subsequently, Pearson correlation analysis will be performed to explore associations among variables. A cross-lagged panel model will then be constructed to estimate autoregressive paths, cross-lagged paths and contemporaneous covariances among the three variables. Finally, a parallel multiple mediation model will be established to examine the indirect effects of illness uncertainty on subsequent depressive symptoms through depressive symptoms and resilience as mediators, using bootstrapping. Covariates will be selected through univariate screening and multicollinearity diagnostics and included in all models; continuous covariates will be mean-centred before entering the models, while categorical variables will be dummy-coded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study has been approved by the Ethics Committee of Chengde Medical College Affiliated Hospital (Approval No.: CYFYLL2025447). Written informed consent will be obtained from all participants before enrolment. All study data will be anonymised and kept strictly confidential, with access restricted to authorised members of the research team. The findings will be submitted to peer-reviewed, open-access journals and presented at academic conferences to facilitate broad dissemination.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-120089","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T14:29:25Z","timestamp":1790000965000},"page":"e120089","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Depression symptoms, resilience and perceived disease uncertainty in Chinese glaucoma patients: a cross-lagged panel tracking study protocol"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7402-1903","authenticated-orcid":false,"given":"Mengyuan","family":"Xiang","sequence":"first","affiliation":[{"name":"Chengde Medical University, Chengde, Hebei, 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