A cross-sectional network analysis of appearance-related anxiety and psychosocial protective factors in adolescent idiopathic scoliosis patients: core symptoms and bridging analysis.

BACKGROUND

Adolescent idiopathic scoliosis (AIS) patients frequently experience appearance-related anxiety and psychological distress. However, previous studies largely focused on variable-centered analyses, failing to capture the complex interplay among these symptoms and protective factors.

OBJECTIVE

To construct an integrated network of appearance anxiety, fear of negative evaluation, psychological distress, and psychosocial protective factors in AIS patients, identifying core symptoms and key bridge nodes connecting risk and protective communities.

METHODS

This cross-sectional study included 349 AIS patients (aged 10-18 years, 64.76% female) recruited from a tertiary general hospital in Northeast China. Participants completed measures of appearance anxiety (SAAS), fear of negative evaluation (BFNES), psychological distress (K10), perceived social support (PSSS), and resilience (RSCA). A Gaussian Graphical Model estimated a 30-node network. Centrality and bridge centrality analyses identified core symptoms and key connectors, with network stability tested across sex and disease severity using Network Comparison Tests.

RESULTS

Node S6 ("Fear of lacking attractiveness due to appearance") exhibited the highest strength (1.14) and expected influence (1.01). "Emotional Control" demonstrated the strongest bridge strength (0.47), exceeding other protective factors (Positive Cognition = 0.29). Network structure was robust (CS-coefficient = 0.673) and invariant across sex (M = 0.22, p = 0.687) and severity subgroups (M = 0.24, p = 0.445).

CONCLUSION

Appearance-related attractiveness concerns are the most central symptom, while emotional control is the key bridge node linking risk and protective factors in AIS patients. These findings highlight precise cognitive and emotion regulation targets for psychosomatic interventions.