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Network Structure of Dyspnea-Related Fear in Older Adults with Acute Exacerbation of COPD: A Biopsychosocial Network
Yuqing Yang1, Yu Zhang2,3, Qi Wu4
1Huzhou Central Hospital, Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, Zhejiang, People's Republic of China.
Objective:
This study aimed to construct a biopsychosocial network model of dyspnea-related fear in older adults with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), identify central and bridge nodes within the psychological system, and explore structural associations linking fear symptoms to emotional distress and functional impairment.
Methods:
A total of 317 hospitalized older adults with AECOPD were enrolled. Eight variables were assessed, including fear of dyspnea (Fear-D), fear of activity (Fear-A), anxiety (Anx), depression (Dep), psychological resilience (Psy-R), self-efficacy (Self-E), social support (Social-S), and activities of daily living (ADL). Gaussian Graphical Models (GGM) were estimated using EBICglasso. Centrality indices, bridge strength, node predictability (R2), and non-parametric bootstrap procedures were applied to evaluate network stability and accuracy.
Results:
Anxiety demonstrated the highest expected influence (z = 1.34), functioning as the most central node. Fear-D and Fear-A formed a cohesive dyad (edge weight = 0.51), while Anx and Dep exhibited the strongest edge (0.76). Protective factors (Self-E and Psy-R) showed negative associations with fear and anxiety nodes and significant bridge strength across communities. ADL was structurally embedded between psychological and emotional domains. Network stability analysis confirmed high robustness (CS coefficient > 0.70). The topology reflects a "indicating a structured pattern of fear-emotion co-occurrence and resource-related associations" configuration. Social support (Social-S) demonstrated near-zero centrality, suggesting minimal structural integration within the network under acute hospitalization conditions.
Conclusion:
Dyspnea-related fear in older AECOPD patients operates within a structured pattern of emotional and resource co-occurrence rather than a simple linear fear-disability pathway. Anxiety serves as the most central node, whereas self-efficacy functions as a cross-domain bridge node. Targeting high-centrality emotional nodes and strengthening resource bridges may optimize precision psychological intervention in AECOPD.
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