Character strengths, psychological distress, anxiety, and depression in adolescents and young adults with gynecologic cancer: A network analysis

Adolescents and young adults with gynecologic cancer face distinctive psychosocial challenges. We examined associations between character strengths and psychological distress, anxiety, and depression and identified candidate strength-related nodes for future psychosocial research. This cross-sectional study included 271 participants diagnosed with gynecologic cancer during adolescence or young adulthood. Gaussian graphical models estimated conditional associations and central and bridge nodes. Bayesian networks explored directed probabilistic dependencies under theory-constrained and unconstrained specifications. In silico simulations estimated model-implied outcome changes following hypothetical 1-standard deviation (SD) increases in individual character strengths. The prespecified character-strength and psychological-outcome communities showed dense within-community and sparse between-community connections. Leadership, Creativity, Curiosity, and Teamwork had the highest strength centrality among character strengths. Psychological distress had the highest bridge strength among psychological-outcome nodes (0.148); Curiosity and Zest had the highest bridge strengths among character-strength nodes (both = 0.112). Results were similar after covariate adjustment. The theory-constrained and unconstrained Bayesian networks each retained 31 directed edges, 28 of which overlapped. The Curiosity-depression dependency was retained in both models, whereas the orientation of the Zest-distress dependency varied by model specification. A hypothetical 1-SD increase in Curiosity corresponded to the largest model-implied decrease in overall outcome severity (-0.230 SD), including depression (-0.306 SD); the model-implied change for Zest was primarily observed for distress (-0.123 SD). Curiosity and Zest were candidate strength-related nodes with distinct, model-dependent associations with psychological outcomes. These hypothesis-generating findings require confirmation in longitudinal and intervention studies before clinical application.