European journal of oncology nursing : the official journal of European Oncology Nursing Society · 2026
Education moderates the structural architecture and plasticity of post-traumatic stress disorder symptoms in breast cancer survivors: A network analysis.
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Li Hongman, Xiong Ying, Zhang Qihan, Chen Qiaoling, Wu Siqi, Deng Yiguo, Huo Ziqing, Wen Luhong, Tong Weiwei, Li Jiaying, Ye Zengjie
Аннотация
PURPOSE: Many breast cancer survivors develop post-traumatic stress disorder (PTSD) symptoms. Educational level has been associated with differences in mental health outcomes, but its role in the structure and plasticity of PTSD symptom networks remains unclear. To compare PTSD symptom network structure and network plasticity between breast cancer patients with low versus high educational attainment.
METHODS: In this cross-sectional study (n = 677) drawn from the "Be Resilient to Breast Cancer" project, participants were classified into low-education (n = 323) and high-education (n = 354) groups. Network structure, global strength, and network plasticity were compared between low- and high-education groups using the Network Comparison Test. Bayesian network analysis was conducted to examine potential causal relationships.
RESULTS: In the low-education group, "ongoing thoughts triggered by various things" was the most central symptom (Str = 2.000), whereas "unintentional thoughts" showed the highest centrality in the high-education group (Str = 0.826). The low-education group exhibited higher plasticity (plasticity index = 0.158), while the high-education group had lower plasticity (plasticity index = 0.147, p = 0.073, ES = 2.794).
CONCLUSIONS: Educational level moderates plasticity of PTSD symptom networks among breast cancer survivors. Lower education is associated with higher network plasticity, more negative connections, and a different pattern of central and potentially causal symptoms compared with higher education.
METHODS: In this cross-sectional study (n = 677) drawn from the "Be Resilient to Breast Cancer" project, participants were classified into low-education (n = 323) and high-education (n = 354) groups. Network structure, global strength, and network plasticity were compared between low- and high-education groups using the Network Comparison Test. Bayesian network analysis was conducted to examine potential causal relationships.
RESULTS: In the low-education group, "ongoing thoughts triggered by various things" was the most central symptom (Str = 2.000), whereas "unintentional thoughts" showed the highest centrality in the high-education group (Str = 0.826). The low-education group exhibited higher plasticity (plasticity index = 0.158), while the high-education group had lower plasticity (plasticity index = 0.147, p = 0.073, ES = 2.794).
CONCLUSIONS: Educational level moderates plasticity of PTSD symptom networks among breast cancer survivors. Lower education is associated with higher network plasticity, more negative connections, and a different pattern of central and potentially causal symptoms compared with higher education.