Network Analysis of Anxiety and Depression Symptoms in Individuals With Oral Lichen Planus and Evaluation of Salivary Biomarkers: A New Approach.

Objective: To estimate the network structure of 21 symptoms of anxiety and depression in individuals diagnosed with oral lichen planus (OLP) and compare it with salivary biomarkers, cortisol and alpha-amylase.

Materials and methods: A case-control study was conducted with 21 OLP cases and 21 controls matched by sex and age. Beck Anxiety and Depression Inventories were administered, and salivary cortisol and alpha-amylase levels were determined. Descriptive analysis used the Mann-Whitney U test to compare participants' responses and the Benjamini-Hochberg Method to control the False Discovery Rate (FDR). Network analysis was performed using regularized partial correlation network models.

Results: A significant association was found between anxiety (p = 0.001) and depression (p = 0.004) scores and OLP. The "shaky/unsteady" symptom was most central in the anxiety network for OLP patients, while "feelings of punishment" and "self-criticism" were central in the depression network. Weak correlations were observed between cortisol and alpha-amylase in anxiety and depressive symptoms. Cortisol awekening response (CAR) had a negative correlation with alpha-amylase awakening response (AAR) (-0.54), as like AAR and Faint/lightheaded (-0.57) in anxiety network. Anxiety network structures did not differ between groups (p = 0.18), but the depression network was more connected in controls than in OLP cases (overall strength 69.29 vs. 27.35, p < 0.000).

Conclusion: This study reveals the distinct network structures of anxiety and depression symptoms in OLP patients, highlighting a new methodological approach to exploring symptom configurations. When exploring the relationship with cortisol and alpha-amylase, weak relationships were found between them. The findings may prompt further network studies involving biomarkers and their interaction with anxiety and depression.