{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T12:28:10Z","timestamp":1786364890963,"version":"build-2736575974"},"reference-count":44,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"unspecified","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"The scientific research projects of Nantong Commission of Health","award":["MSZ2025081"],"award-info":[{"award-number":["MSZ2025081"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,7,31]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To estimate the item-level conditional association network of depression, anxiety and stress symptoms in patients with non-Hodgkin\u2019s lymphoma (NHL) during a prespecified chemotherapy intercycle period and to identify symptoms with comparatively high expected influence, bridge expected influence and predictability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Multicentre cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Oncology departments of four tertiary hospitals in Jiangsu Province, China, from October 2024 to June 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 798 adults with pathologically confirmed NHL were assessed during the prespecified chemotherapy intercycle period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The 21 items of the Depression Anxiety Stress Scales-21 (DASS-21) were modelled as nodes in a regularised partial-correlation network. Primary network measures were edge weights, expected influence and bridge expected influence; secondary measures were node predictability and bootstrap indices of accuracy and stability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The strongest conditional association was between difficulty initiating tasks (D2) and lack of enthusiasm (D5; edge weight=0.282). Irritability (S7; expected influence=1.106), depression\/dejection (D4; 1.065) and nervous energy (S3; 1.051) had the highest expected influence and also the highest bridge expected influence (0.972, 0.803 and 0.720, respectively). Trembling (A3; predictability=0.561), irritability (S7; 0.481) and intolerance of hindrance (S6; 0.476) had the highest predictability. Correlation-stability coefficients for expected influence and bridge expected influence were both 0.67.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Irritability, depression\/dejection and nervous energy showed comparatively high signed connectivity within and across the prespecified DASS-21 domains, while the D2\u2013D5 pair had the strongest conditional association. These cross-sectional findings are descriptive and hypothesis-generating and do not establish temporal, causal or treatment effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-120768","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T11:30:35Z","timestamp":1786361435000},"page":"e120768","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Network structure of depression, anxiety and stress in patients with non-Hodgkin\u2019s lymphoma receiving chemotherapy: a multicentre cross-sectional study"],"prefix":"10.1136","volume":"16","author":[{"given":"Yanchi","family":"Wang","sequence":"first","affiliation":[{"name":"The Sixth People\u2019s Hospital of Nantong, Nantong, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoli","family":"Liu","sequence":"additional","affiliation":[{"name":"Nantong University, Nantong, 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