Li WX, Huang YS, Luo LL, Yue DS. Psychiatric symptoms in patients with lung cancer following postoperative acute respiratory distress syndrome. World J Psychiatry 2026; 16(11): 122492 [DOI: 10.5498/wjp.122492]
Corresponding Author of This Article
Dong-Sheng Yue, PhD, Associate Chief Physician, Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, No. 1 North Huanhu West Road, Sports Institute, Hexi District, Tianjin 300060, China. dongshy1111@163.com
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Li WX, Huang YS, Luo LL, Yue DS. Psychiatric symptoms in patients with lung cancer following postoperative acute respiratory distress syndrome. World J Psychiatry 2026; 16(11): 122492 [DOI: 10.5498/wjp.122492]
Wen-Xing Li, Department of Anesthesiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China
Wen-Xing Li, Department of Anesthesiology, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
Wen-Xing Li, Department of Anesthesiology, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
Yu-Sheng Huang, Department of Respiratory Diseases, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, Fujian Province, China
Lin-Lin Luo, The Second Department of Respiratory Disease, Jiangxi Provincial People’s Hospital (The First Affiliated Hospital of Nanchang Medical College), Nanchang 330006, Jiangxi Province, China
Dong-Sheng Yue, Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China
Dong-Sheng Yue, Department of Lung Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
Dong-Sheng Yue, Department of Lung Cancer, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
Author contributions: Li WX and Yue DS contributed equally to this study, they contributed to conceptualization, investigation, data curation; Li WX contributed to methodology and writing - original draft; Li WX, Huang YS, Luo LL, and Yue DS contributed to writing - review and editing; Li WX and Luo LL contributed to formal analysis and visualization; Huang YS contributed to data collection and literature search; Yue DS contributed to supervision, project administration, funding acquisition and corresponding author. All the authors have read and approved the final version of the manuscript.
AI contribution statement: All of us authors confirm that this manuscript was written, revised, and approved by ourselves without the use of any AI tools. All authors are fully responsible for the completeness, accuracy, originality, and scientificity of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Medical Ethics Committee of Tianjin Medical University Cancer Institute and Hospital (approval No. 2026-02-19).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No available data.
Corresponding author: Dong-Sheng Yue, PhD, Associate Chief Physician, Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, No. 1 North Huanhu West Road, Sports Institute, Hexi District, Tianjin 300060, China. dongshy1111@163.com
Received: May 22, 2026 Revised: June 30, 2026 Accepted: July 28, 2026 Published online: November 19, 2026 Processing time: 159 Days and 17.9 Hours
Abstract
BACKGROUND
Patients with acute respiratory distress syndrome (ARDS) after lung cancer surgery experience critical illness, prolonged hospitalization, and intensive monitoring, resulting in substantial physical and psychological stress. The actual psychological and sleep data of lung cancer patients with postoperative ARDS after discharge are still limited, and further clinical evidence is needed to clarify the anxiety, depression, and sleep disorders of this high-risk population. Current clinical management prioritizes respiratory support and multi-organ function preservation; however, structured evidence regarding post-discharge anxiety, depression, and sleep disturbance remains insufficient.
AIM
To investigate the distribution of anxiety, depression, and sleep disturbance within one month after discharge in patients with lung cancer complicated by postoperative ARDS and to explore associated clinical factors.
METHODS
This was a retrospective observational study. A total of 200 patients with ARDS after lung cancer surgery who were treated from January 2024 to December 2025 were included. Clinical data were collected from medical records, nursing records, intensive care unit (ICU) monitoring data, and one-month postdischarge follow-up assessments. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, and sleep disturbance was assessed using the Pittsburgh Sleep Quality Index. Delirium was defined as at least one positive Confusion Assessment Method for the ICU assessment during ICU stay. Baseline Hospital Anxiety and Depression Scale/Pittsburgh Sleep Quality Index scores were unavailable; therefore, outcomes were interpreted as postdischarge symptom positivity rather than confirmed new-onset morbidity.
RESULTS
In a retrospective cohort of 200 patients, 43 (21.50%) had anxiety symptoms, 36 (18.00%) had depressive symptoms, 71 (35.50%) had sleep disturbances, and 113 (56.50%) had at least one psychological sleep outcome. The proportions of composite outcomes in mild, moderate, and severe ARDS were 43.53%, 61.33%, and 75.00%, respectively (χ2 = 10.432, P = 0.005). Multivariable logistic regression analysis for the composite outcome showed associations with female sex [odds ratio (OR) = 2.525, 95% confidence interval (CI): 1.284-4.964, P = 0.007], severe ARDS (OR = 3.481, 95%CI: 1.356-8.938, P = 0.010), thoracotomy (OR = 2.289, 95%CI: 1.098-4.773, P = 0.027), and postoperative delirium (OR = 2.330, 95%CI: 1.048-5.181, P = 0.038). Exploratory outcome-specific models suggested that sleep disturbances were mainly associated with severe ARDS, thoracotomy, pain, prolonged ventilation, and delirium, whereas anxiety and depression showed partially different patterns.
CONCLUSION
In this retrospective cohort, sleep disturbance was the most frequent postdischarge abnormality after postoperative ARDS in patients with lung cancer. These findings should be interpreted as exploratory findings rather than causal clinical evidence. Strengthened sleep and mood screening, standardized delirium documentation, and prospective longitudinal studies with baseline psychological and sleep assessments are recommended.
Core Tip: This retrospective observational study explored anxiety, depression, and sleep disturbance after postoperative acute respiratory distress syndrome in patients with lung cancer. Sleep disturbance was the most frequent outcome and appeared to drive many of the composite psychological-sleep endpoints. Female sex, severe acute respiratory distress syndrome, thoracotomy, and postoperative delirium were associated with the composite endpoint, whereas outcome-specific analyses suggested different patterns of anxiety, depression, and sleep disturbance. The findings support standardized screening and prospective validation rather than direct causal inference.
Citation: Li WX, Huang YS, Luo LL, Yue DS. Psychiatric symptoms in patients with lung cancer following postoperative acute respiratory distress syndrome. World J Psychiatry 2026; 16(11): 122492
Lung cancer is one of the malignancies with the highest mortality burden in China[1]. Recent studies have also emphasized the rapidly expanding treatment landscape for lung cancer, including nanomedicine delivery and nano-assisted radiotherapy strategies, which further highlights the need to consider survivorship, symptom burden, and rehabilitation outcomes beyond tumor control[2,3]. Surgical resection remains an important method for patients in the resectable stage to achieve long-term survival; however, perioperative complications still directly affect hospitalization and subsequent rehabilitation[4]. Among the severe complications of thoracic surgery, acute respiratory distress syndrome (ARDS) is characterized by acute onset, severe illness, and high reliance on respiratory support, which not only increases the risk of organ dysfunction but also prolongs intensive care unit (ICU) and total hospital stay[5,6]. Previous studies on ARDS have mainly focused on the respiratory physiology, ventilation strategies, and short-term mortality risk; however, less attention has been paid to psychological and sleep problems after survival[7,8]. Tumor rehabilitation studies have indicated that anxiety, depression, and sleep disturbances can intertwine with pain, dyspnea, fatigue, and fear of disease recurrence, thereby affecting treatment compliance, quality of life, and long-term recovery[9,10]. Following lung cancer surgery, surgical trauma, pathological staging, concerns about recurrence, chest tightness, shortness of breath, nocturnal cough, and interrupted sleep can jointly increase the symptom burden[11,12]. If postoperative ARDS involves mechanical ventilation, sedation, delirium, and ICU environmental exposure, the risk of post-discharge mood and sleep symptoms may further increased[13,14]. At present, studies on postoperative psychological symptoms in patients with lung cancer in China have mainly focused on the general perioperative population or patients with non-small cell lung cancer following surgery[15,16]. However, evidence specific to the high-risk subgroups of patients with lung cancer complicated by postoperative ARDS remains limited. Therefore, this retrospective study aimed to investigate the distribution of anxiety, depression, and sleep disturbance within one month after discharge in patients with lung cancer complicated by postoperative ARDS and to explore associated clinical factors.
MATERIALS AND METHODS
Study objects
This was a retrospective observational study. Patients with ARDS after lung cancer surgery who were admitted to the critical care department of Tianjin Medical University Cancer Institute and Hospital from January 2024 to December 2025 were retrospectively screened. A total of 200 eligible patients were included according to the inclusion and exclusion criteria. Clinical data were collected from medical records, nursing records, ICU monitoring data, and one-month postdischarge follow-up assessments. The study was reviewed and approved by the Medical Ethics Committee of Tianjin Medical University Cancer Institute and Hospital (approval No. 2026-02-19). A flowchart of the retrospective cohort construction is shown in Figure 1.
Figure 1 Retrospective cohort selection and analysis flow chart.
ARDS: Acute respiratory distress syndrome; ICU: Intensive care unit; CAM-ICU: Confusion Assessment Method for the Intensive Care Unit; HADS: Hospital Anxiety and Depression Scale; PSQI: Pittsburgh Sleep Quality Index.
As the analysis used patient-level data and did not include identifiable individual records, the requirement for informed consent was waived because this was a retrospective study using medical record data, and no identifiable personal information was disclosed. The study was conducted in accordance with the Declaration of Helsinki.
The inclusion criteria were as follows: (1) Age ≥ 18 years; (2) Primary lung cancer confirmed by postoperative pathology; (3) Complete segmentectomy/wedge resection, lobectomy, or pneumonectomy; (4) ARDS occurring within 7 days after surgery and meeting the Berlin definition and domestic diagnostic guidance for ARDS; and (5) Complete clinical variables for medical records, nursing records, ICU monitoring data, and one-month postdischarge Hospital Anxiety and Depression Scale (HADS)/Pittsburgh Sleep Quality Index (PSQI) assessment. The exclusion criteria were as follows: (1) Clearly diagnosed anxiety disorder, depression disorder, insomnia disorder, or long-term use of antipsychotic drugs and sedative-hypnotics before surgery; (2) Brain metastasis or persistent delirium preventing assessment using the scale; (3) Death within 30 days after surgery; and (4) Missing key outcome variables.
Diagnostic criteria and grouping method
The diagnosis of ARDS was based on Berlin’s definition: Onset within one week after an identified clinical insult, bilateral pulmonary infiltrates on imaging, and respiratory failure not fully explained by cardiogenic pulmonary edema. Mild, moderate, and severe ARDS was graded according to the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2)[17-19]. The ARDS classification and respiratory support information also referred to domestic guidelines for noninvasive and invasive respiratory support in perioperative ARDS scenarios.
Psychological and sleep outcomes were assessed at the first return visit or through structured telephone follow-up within one month after discharge. For both pathways, the HADS and PSQI administration processes were standardized; follow-up personnel received unified instructions on item explanation, neutral prompting, and score recording, and a fixed telephone script was used when in-person completion was unavailable. The HADS was used to evaluate anxiety and depressive symptoms[20]. HADS-Anxiety (HADS-A) and HADS-Depression (HADS-D) contain seven items, with a total score of 0-21 points. HADS-A ≥ 8 was considered as having anxiety symptoms, and HADS-D ≥ 8 was considered as having depressive symptoms. The PSQI was used to evaluate sleep status in the previous month, with a total score of 0-21 points, and a PSQI score > 7 was considered as having sleep disturbance[21]. Because baseline HADS/PSQI and pre-discharge scores were unavailable, the outcomes represented symptom positivity at one month rather than confirmed new-onset psychiatric or sleep disorders.
The primary screening-oriented outcome was defined as any positive anxiety symptoms, depressive symptoms, or sleep disturbances and was termed the composite psychological-sleep outcome. Because anxiety, depression, and sleep disturbance differ in pathophysiology and time trajectory, each outcome was analyzed separately as an exploratory secondary endpoint.
Observation indicators
(1) General data: Age, sex, body mass index, smoking history, chronic obstructive pulmonary disease, hypertension, and diabetes; (2) Tumor and surgical data: Pathological type, tumor-nodes-metastasis stage, surgical method (thoracoscope/thoracotomy), and resection range (pulmonary segment/wedge resection, lobectomy, or pneumonectomy); (3) ARDS and perioperative severity indicators: ARDS classification, mechanical ventilation time, ICU stay time, albumin level on the third postoperative day, postoperative delirium, and postoperative pulmonary complications. Postoperative delirium was defined as at least one positive Confusion Assessment Method (CAM) for ICU assessment during the ICU stay, with assessments performed twice daily by trained ICU nurses or physicians; and (4) Symptom and scale indicators: Postoperative pain numerical rating scale (NRS), HADS-A, HADS-D, and PSQI scores. The single incidence, overlapping pattern, and distribution of anxiety, depression, and sleep disturbance according to ARDS severity were determined, and outcome-specific regression models were added for anxiety, depression, and sleep disturbance.
Statistical analysis
SPSS 27.0 (IBM Corporation, Armonk, NY, United States) was used for statistical analysis. Measurement data were expressed as mean ± SD, and between-group comparisons were examined by independent-sample t test. Enumeration data were expressed as n (%), and intergroup comparisons were performed using χ2 test. The variables were organized a priori into four domains: Patient factors (sex, age, and comorbidities), ARDS severity (ARDS grade, mechanical ventilation duration, and ICU stay), surgical trauma and symptom burden (surgical approach and postoperative pain), and acute brain dysfunction (postoperative delirium). The composite psychological sleep outcome was used as the dependent variable in the primary logistic model, and anxiety, depression, and sleep disturbance were separately used as dependent variables in the exploratory secondary models. Variables with clinical relevance or P < 0.05 in univariate analysis were considered, and collinearity was checked using the variance inflation factor. Model discrimination was assessed using the area under the receiver operating characteristic curve, and calibration was assessed using the Hosmer-Lemeshow test. Two-sided P < 0.05 was considered statistically significant. As this was a retrospective cohort analysis, all inferential statistics were interpreted as exploratory findings.
RESULTS
General data
Among the 200 patients with ARDS following lung cancer surgery, 135 were male (67.50%) and 65 were female (32.50%); their age was 63.99 ± 7.88 years, and body mass index was 23.53 ± 3.00 kg/m2. There were 43 patients (21.50%) with anxiety symptoms, 36 (18.00%) with depression symptoms, 71 (35.50%) with sleep disturbances, and 113 (56.50%) with at least one composite psychological sleep outcome. Compared to the negative outcome group, the positive outcome group had a higher proportion of female patients, older age, more thoracotomies, more severe ARDS, longer mechanical ventilation duration and ICU stay, higher postoperative pain score, and more postoperative delirium (all P < 0.05) (Tables 1 and 2). These results describe associations in this retrospective cohort and should not be interpreted as evidence of causality.
Table 1 Comparison of general data between the positive and negative composite outcome groups, n (%)/mean ± SD.
Table 2 Comparison of perioperative and acute respiratory distress syndrome-related variables between groups in the retrospective cohort, n (%)/mean ± SD.
The distribution characteristics of anxiety, depression, and sleep disturbances
From the perspective of symptom overlapping patterns, simple sleep disturbance was the most common, in 43 cases (21.50%); there were 22 cases (11.00%) of simple anxiety, 15 cases (7.50%) of simple depression, and 4 cases (2.00%) with all three symptoms. The incidence of composite outcomes increased with ARDS progression when stratified according to severity. The incidence of sleep disturbance in patients with severe ARDS was 60.00%, which was significantly higher than that in patients with mild and moderate ARDS. Although the difference in anxiety positivity among the three groups was not statistically significant, the average HADS-A score increased with ARDS severity (Tables 3 and 4, Figure 2). As sleep disturbance occurred more frequently than anxiety and depression, the composite endpoint was likely influenced mainly by PSQI positivity; therefore, separate outcome-specific regression models were used.
Figure 2 Incidence rates of anxiety, depression, and sleep disturbance in patients with different severities of acute respiratory distress syndrome.
ARDS: Acute respiratory distress syndrome.
Table 3 Distribution of anxiety, depression, and sleep disturbance in patients with different severity of acute respiratory distress syndrome, n (%)/mean ± SD.
Univariate analysis of factors associated with the composite psychological-sleep outcome
Univariate analysis was performed with the composite psychological sleep outcome as the dependent variable and candidate influencing factors as independent variables. The results showed that female sex, thoracotomy, severe ARDS, mechanical ventilation time ≥ 5 days, postoperative pain NRS ≥ 5 points, and postoperative delirium were associated with the composite outcome (all P < 0.05) (Table 5). Age ≥ 65 years and ICU stay ≥ 7 days were retained as clinically relevant variables for sensitivity consideration but were not statistically significant in the univariate model.
Table 5 Univariate logistic analysis of factors associated with the composite psychological sleep outcome.
Multivariable and outcome-specific analyses of psychological sleep outcomes
After incorporating female sex, thoracotomy, severe ARDS, mechanical ventilation time ≥ 5 days, postoperative pain NRS ≥ 5 points, and postoperative delirium into the multivariable logistic regression model, female sex, severe ARDS, thoracotomy, and postoperative delirium remained associated with the composite psychological-sleep outcome (P < 0.05) (Table 6). Collinearity assessment showed variance inflation factor values < 2.0 for the included variables. The model showed moderate discrimination (area under the curve = 0.739) and acceptable calibration (Hosmer-Lemeshow χ2 = 4.682, P = 0.791). Exploratory outcome-specific models showed that anxiety was mainly associated with female sex, severe ARDS, and postoperative delirium; depression was mainly associated with severe ARDS and postoperative delirium; and sleep disturbance was associated with severe ARDS, thoracotomy, postoperative pain NRS ≥ 5 points, mechanical ventilation time ≥ 5 days, and postoperative delirium (Table 7). These secondary analyses support the need to interpret anxiety, depression, and sleep disturbance separately rather than relying only on the composite endpoint.
Table 6 Multivariable logistic regression analysis of factors associated with the composite psychological sleep outcome.
Recovery from postoperative ARDS in patients with lung cancer goes beyond oxygenation improvement and image absorption[22]. In this retrospective study, patients with lung cancer complicated by postoperative ARDS showed a considerable burden of anxiety, depression, and sleep disturbance within one month after discharge. More than half of the included patients had at least one abnormal psychological or sleep outcome, and sleep disturbance accounted for the highest proportion. This pattern is consistent with previous reports[23,24] indicating that patients after lung cancer surgery may experience persistent symptom burden[25-30] and that ICU survivors frequently report sleep impairment after discharge[31-33]. Because baseline HADS/PSQI scores were unavailable, the present findings should be interpreted as postdischarge symptom positivity rather than confirmed new-onset psychiatric or sleep disorders.
In the retrospective cohort, the proportion of composite outcomes increased successively in patients with mild, moderate, and severe ARDS, reaching 75.00% in the severe ARDS subgroup. This suggests that the severity of ARDS may serve as a useful marker for identifying patients who require closer post-discharge sleep and mood screening. Mechanistically, severe ARDS is commonly accompanied by longer respiratory support, greater treatment invasiveness, stronger inflammation and hypoxic exposure, and more pronounced physical discomfort. Nevertheless, the present dataset does not prove that the severity of ARDS directly affects psychological or sleep outcomes. Future prospective studies should collect baseline mood and sleep scores, ICU exposure details, sedative and analgesic use, and repeat post-discharge assessments to determine whether the symptoms are new, persistent, or worsened after ARDS.
Sleep disturbance was the most prominent manifestation in the present study. Sleep disturbance only (21.50%) was more frequent than anxiety and depression only, and the observed proportion of sleep disturbance in patients with severe ARDS reached 60.00%. This finding is clinically plausible because patients with postoperative ARDS may experience circadian rhythm disruption, nighttime monitoring interference, changes in sleep structure after sedation withdrawal, pain, cough, dyspnea, and chest tube-related discomfort[34]. In patients undergoing lung cancer surgery, thoracic incision pain, restricted sleeping position, fear of coughing, reduced respiratory reserve, and concerns about tumor prognosis may cause sleep impairment to appear earlier than diagnosable anxiety or depression[35]. Therefore, the composite endpoint in this study should not be interpreted as a uniform psychological disorder. Rather, it should be treated as an early screening signal in which sleep disturbance plays a major role.
Sex and surgical approach showed different associations with psychological and sleep outcomes in the retrospective analyses. Female sex was associated with the composite endpoint and anxiety, which may reflect differences in symptom perception, pain sensitivity, help-seeking behavior, and psychosocial burden reported in previous lung cancer studies. However, this study cannot determine whether sex itself is a causal factor. Thoracotomy was more strongly associated with sleep disturbance than with anxiety or depression. This distinction is important because open-chest surgery may cause larger chest wall trauma, more persistent incision pain, greater limitation in turning and coughing, and slower recovery of respiratory function, all of which can interrupt sleep through a “pain-respiratory discomfort-sleep fragmentation” pathway[36]. In patients requiring thoracotomy or complex resection, sleep screening and symptom management should be considered, along with routine analgesia and respiratory rehabilitation[37].
Postoperative delirium was associated with the composite and separate outcomes to varying degrees in the retrospective analyses. To improve variable reliability, the revised methods define delirium as at least one positive CAM-ICU assessment during an ICU stay, with a twice-daily assessment by trained ICU nurses or physicians. Delirium reflects acute brain dysfunction and is associated with hypoxia, inflammation, sedation, sleep deprivation, pain, and vulnerability in older patients. In clinical practice, delirium may also be a marker of more severe ICU exposure, rather than an isolated cause of later symptoms. Therefore, postoperative delirium should be considered a risk marker prompting closer follow-up, but the causal mechanisms require prospective studies with standardized delirium documentation and longitudinal mental health assessments[38].
The clinical implication of this retrospective study is that standardized screening for sleep and mood symptoms should be strengthened in patients with lung cancer after postoperative ARDS. Short HADS and PSQI screenings may be embedded in discharge preparation and the first postdischarge visit. Pain intensity, analgesic use, sedative exposure, sleep medication, delirium assessment, and respiratory symptoms should be collected simultaneously in future studies. Patients with severe ARDS, thoracotomy, postoperative delirium, high pain scores, or prolonged mechanical ventilation may require closer early follow-up for sleep and mood problems. However, interventional strategies such as sleep hygiene guidance, respiratory rehabilitation, psychological referral, and cognitive-behavioral approaches still require prospective validation before being recommended as routine interventions.
This study had several limitations. First, this was a retrospective single-center study, and the possibility of selection bias cannot be excluded. Second, baseline HADS and PSQI scores were unavailable, so the study could not determine whether anxiety, depression, or sleep disturbance was newly developed after ARDS. Third, the one-month follow-up provided only a short-term postdischarge assessment and could not evaluate long-term psychological and sleep trajectories. Fourth, some potentially important variables, such as sedative exposure, analgesic use, sleep medication, and cancer-related distress, were not fully available. Therefore, prospective longitudinal studies are needed to validate these findings.
CONCLUSION
In this retrospective cohort of patients with lung cancer after postoperative ARDS, sleep disturbance was the most frequent abnormality within one month after discharge, and the composite psychological-sleep endpoint was associated with female sex, severe ARDS, thoracotomy, and postoperative delirium. Because this was a retrospective study without baseline and longitudinal psychological sleep assessments, the findings should be interpreted cautiously and validated in prospective studies. Future prospective studies should strengthen standardized screening, including preoperative and repeated post-discharge HADS/PSQI assessments; document CAM-ICU delirium consistently; and analyze anxiety, depression, and sleep disturbances separately.
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Footnotes
Peer review: Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Psychiatry
Country of origin: China
Peer-review report’s classification
Scientific quality: Grade B, Grade B, Grade C
Novelty: Grade B, Grade B, Grade B
Creativity or innovation: Grade B, Grade B, Grade C
Scientific significance: Grade B, Grade C, Grade C
P-Reviewer: Dogan S, MD, PhD, Türkiye; Saintila J, MD, United States; Zheng YH, Additional Professor, Director, MD, Senior Scientist, Tenured Professor, China S-Editor: Hu XY L-Editor: A P-Editor: Zhao YQ
