Longitudinal relationships between anxiety and fear of progression in post-CABG patients: a cross-sectional and cross-lagged panel network analysis
- 1Department of Nursing, Xinjiang Medical University
- 2Department of Cardiac Surgery, People’s Hospital of Xinjiang Uygur Autonomous Region
- 3Department of Cardiac Surgery, First Affiliated Hospital of Xinjiang Medical University
Abstract
Background: Patients following coronary artery bypass grafting (CABG) frequently experience elevated anxiety and fear of progression (FoP), which has a high comorbidity and significantly increases adverse postoperative event risks. This prospective study explored the dynamic longitudinal associations between anxiety and FoP in post-CABG patients using network analysis methods.
Methods: A prospective longitudinal design enrolled first-time CABG patients from three tertiary hospitals in Urumqi, China. Anxiety and FoP were assessed using the Generalized Anxiety Disorder-7 (GAD-7) and the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) at three time points: hospital discharge (T1), 1 month (T2), and 3 months (T3) post-discharge. Cross-sectional Gaussian Graphical Models were constructed at each time point, and cross-lagged panel network (CLPN) analysis was performed to examine longitudinal symptom associations. Six a priori selected covariates (age, gender, educational level, duration of CHD, chronic comorbidities, and NYHA functional classification) were residualized prior to network estimation.
Results: A total of 343 patients were included in the network analysis. From T1 to T3, total GAD-7 scores demonstrated a notable downward trend, whereas FoP-Q-SF scores exhibited a continuous upward trend. The core node at both T1 and T2 was FoP11 “Worrying about what will become of the family if something should happen to the patient, “ which shifted to FoP2 “Being nervous prior to doctors’ appointments or periodic examinations” at T3. In the T1-T2 CLPN, the strongest cross-lagged edge was from GAD7 “Feeling afraid as if something awful might happen” to FoP2 “Being nervous prior to doctors’ appointments or periodic examinations”. In the T2-T3 CLPN, the strongest cross-lagged edge was from GAD2 “Not being able to stop or control worrying” to FoP6 “Being afraid of the possibility that the children could contract disease”. In the T1-T3 network, the strongest cross-lagged edge was from GAD4 “Trouble relaxing” to FoP3 “Being afraid of pain”. Anxiety nodes generally exhibited higher Out-Expected Influence, while FoP nodes showed higher In-Expected Influence.
Conclusion: Anxiety levels gradually decreased during early rehabilitation, whereas fear of progression increased over time. Early anxiety symptoms showed positive cross-lagged associations with later fear of progression. These findings suggest that clinical nurses should consider phased, precision-based psychological interventions targeting stage-specific symptoms during different rehabilitation stages.
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BibTeX
@article{luo2026longitudinal,
title = {{Longitudinal relationships between anxiety and fear of progression in post-CABG patients: a cross-sectional and cross-lagged panel network analysis}},
author = {Zhengwei Luo and Fenghui Chen and Huihui Li and Weilong Wang and Duohuan Chen and Yongzhong Guo and Juan Xing and Fang Liang and Jianshuang Tao},
journal = {Frontiers in Psychiatry},
year = {2026},
month = oct,
doi = {10.3389/fpsyt.2026.1937200},
url = {https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1937200/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Longitudinal relationships between anxiety and fear of progression in post-CABG patients: a cross-sectional and cross-lagged panel network analysis
AU - Zhengwei Luo
AU - Fenghui Chen
AU - Huihui Li
AU - Weilong Wang
AU - Duohuan Chen
AU - Yongzhong Guo
AU - Juan Xing
AU - Fang Liang
AU - Jianshuang Tao
PY - 2026
DA - 2026/10/14
JO - Frontiers in Psychiatry
DO - 10.3389/fpsyt.2026.1937200
UR - https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1937200/full
AB - Background: Patients following coronary artery bypass grafting (CABG) frequently experience elevated anxiety and fear of progression (FoP), which has a high comorbidity and significantly increases adverse postoperative event risks. This prospective study explored the dynamic longitudinal associations between anxiety and FoP in post-CABG patients using network analysis methods. Methods: A prospective longitudinal design enrolled first-time CABG patients from three tertiary hospitals in Urumqi, China. Anxiety and FoP were assessed using the Generalized Anxiety Disorder-7 (GAD-7) and the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) at three time points: hospital discharge (T1), 1 month (T2), and 3 months (T3) post-discharge. Cross-sectional Gaussian Graphical Models were constructed at each time point, and cross-lagged panel network (CLPN) analysis was performed to examine longitudinal symptom associations. Six a priori selected covariates (age, gender, educational level, duration of CHD, chronic comorbidities, and NYHA functional classification) were residualized prior to network estimation. Results: A total of 343 patients were included in the network analysis. From T1 to T3, total GAD-7 scores demonstrated a notable downward trend, whereas FoP-Q-SF scores exhibited a continuous upward trend. The core node at both T1 and T2 was FoP11 “Worrying about what will become of the family if something should happen to the patient, “ which shifted to FoP2 “Being nervous prior to doctors’ appointments or periodic examinations” at T3. In the T1-T2 CLPN, the strongest cross-lagged edge was from GAD7 “Feeling afraid as if something awful might happen” to FoP2 “Being nervous prior to doctors’ appointments or periodic examinations”. In the T2-T3 CLPN, the strongest cross-lagged edge was from GAD2 “Not being able to stop or control worrying” to FoP6 “Being afraid of the possibility that the children could contract disease”. In the T1-T3 network, the strongest cross-lagged edge was from GAD4 “Trouble relaxing” to FoP3 “Being afraid of pain”. Anxiety nodes generally exhibited higher Out-Expected Influence, while FoP nodes showed higher In-Expected Influence. Conclusion: Anxiety levels gradually decreased during early rehabilitation, whereas fear of progression increased over time. Early anxiety symptoms showed positive cross-lagged associations with later fear of progression. These findings suggest that clinical nurses should consider phased, precision-based psychological interventions targeting stage-specific symptoms during different rehabilitation stages.
SN - 1664-0640
ER -