Looking at individual symptoms: the dynamic network structure of depressive symptoms in cancer survivors and their preferences for psychological care

Abstract

Purpose: The majority of depressed cancer survivors do not receive psychological care, possibly because offered care does not align with their experiences and preferences. We examined (1) which depressive symptoms cancer survivors would like to receive psychological care for; (2) how distinct depressive symptoms are related to each other in the contemporaneous and temporal network of depressive symptoms; and (3) whether survivors’ care needs correspond to the interconnectedness of these specific symptoms. Method: Fifty-two cancer survivors suffering from at least mild depressive symptoms and were not receiving psychological care filled out a baseline questionnaire about their care needs for distinct depressive symptoms, followed by ecological momentary assessments (EMA) assessing depressive symptoms (14 days, five times a day). Multi-level vector autoregression analysis was used to estimate associations between distinct depressive symptoms as well as their centrality within the network. Results: Cancer survivors most strongly preferred to receive care for fatigue, feeling down, little enjoyment, and sleep problems. Fatigue, together with worry and lack of concentration, most strongly predicted the onset of other symptoms. Little enjoyment and feeling down were two of the most central symptoms (i.e., strongly connected to other symptoms) in the contemporaneous network and were most strongly influenced by other symptoms in the temporal network. Conclusions: Clinicians can offer specific interventions that target fatigue, as these played an important role in the onset of symptoms and would align with survivors’ needs. Implications for Cancer Survivors: Offering such symptom-specific care may increase the uptake of psychological interventions in cancer survivors.