A Visual Analysis of Domestic Research on Acute Stress Disorder Using CiteSpace ()
1. Introduction
Acute stress disorder refers to a series of stress-related symptoms that occur within 2 to 28 days of an individual experiencing a traumatic event [1]. Research indicates that the overall prevalence of ASD following a traumatic event is 20.4 per cent, the prevalence of ASD associated with disaster-related trauma is 21.9 per cent, and the prevalence of ASD among people with life-threatening illnesses is 20.7 per cent [2]. If not identified and addressed at an early stage, ASD can progress to post-traumatic stress disorder [3], which not only undermines patients’ physical and mental health but also increases the risk of suicide and the incidence of physical comorbidities, causing long-term damage to patients’ social functioning and quality of life [4]. In recent years, with the increasing frequency of natural disasters, road traffic accidents, occupational injuries and public emergencies, the number of people exposed to trauma has been rising, and the mental health issues and public health risks associated with ASD have become increasingly prominent. To date, researchers have utilised Citespace software to conduct visual analyses of trauma-related disorders [5] [6]; however, such analyses in the field of ASD remain scarce. It is therefore necessary to systematically review the existing literature in this field to clarify current research directions, key areas of focus, emerging research trends and future developments in ASD, with a view to providing a scientific basis for subsequent research, clinical interventions and nursing practice.
2. Materials and Methods
2.1. Data Sources and Processing
China National Knowledge Infrastructure (CNKI), Wanfang, and VIP are currently the three most comprehensive and authoritative databases in China for Chinese-language journals in medicine, psychology, and nursing. They cover all domestic journals listed in the Peking University Core Journal List, the Science and Technology Core Journal List, and general journals, and are able to fully encompass domestic research on acute stress disorder published by researchers from the Chinese mainland. As such, they serve as the standard data sources for conducting visualization analyses in the field of Chinese bibliometrics. This study utilised China National Knowledge Infrastructure (CNKI), Wanfang Medical Network and the VIP Chinese Journal Full-Text Database as sources for literature collection, conducting subject or keyword searches on each platform respectively. The scope of journal sources was restricted to journal articles. The search terms were: “acute stress disorder” OR “acute stress reaction” OR “ASD”. The search period spanned from the establishment of the databases to 8 March 2026. NoteExpress software was used to remove duplicate records, and articles for which full text was unavailable or that were irrelevant to the topic were excluded. Before CiteSpace analysis, author names and institution names were standardized to reduce errors caused by inconsistent records. Two researchers independently checked the exported records and unified different forms of the same author or institution, such as abbreviations, spacing differences, name-order variations, and different institutional expressions. For authors with identical names, affiliations, co-authors, and research topics were used for manual disambiguation. Uncertain cases were not forcibly merged. Disagreements were resolved through discussion or consultation with a third researcher. After data cleaning and standardization, a total of 617 articles were ultimately included (Figure 1). It should be noted that this study utilised only CNKI, Wanfang and VIP as data sources, and included only Chinese-language literature; this may have resulted in database coverage bias and language bias. Consequently, the findings of this study primarily reflect the research hotspots and trends found in Chinese-language literature indexed in Chinese databases; readers should exercise caution when assessing the scope and generalisability of this bibliometric analysis.
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Figure 1. Flowchart of the study.
2.2. Data Conversion and Analysis
This study employed CiteSpace 6.4.R2 software to conduct a visual analysis of the relevant literature. The eligible literature was exported in RefWorks format; the exported data was named “download”. Using the format converter built into CiteSpace, the included literature was converted into the required format. Cluster analysis was then performed on the institutions, authors and keywords of the included literature, and emergent keywords were identified. Based on the publication date distribution of the included literature, the time span was set to 1996-2026, with a time slice of one year. Node types were set to “Author”, “Institution” and “Keyword”, whilst the remaining parameters were left at their default values. By running the programme, we generated collaboration maps for authors and institutions, co-occurrence maps for keywords, and keyword clustering maps, thereby analysing the collaborative networks, key themes and evolving trends in ASD research in China [7].
3. Results
3.1. Analysis of Annual Publication Volume
Figure 2. Trend chart showing the annual number of publications in the field of ASD in China.
The number of publications provides a clear indication of the current state of research and the level of interest in a particular field over a given period [8]. By collating the publication dates of the included literature, we have compiled a graph illustrating the annual trend in the number of publications in the field of ASD in China (Figure 2). The findings of this study indicate that the annual output of publications in this field has generally shown an upward trend. Based on publication patterns, this period can be divided into three phases: (1) The initial phase (1996-2007): Publication output was low, with fewer than 10 papers published annually, and research was in its preliminary exploratory stage. (2) Steady growth phase (2008-2019): The average annual output was around 20 papers. Following the “5·12” Wenchuan earthquake in 2008, the psychological trauma experienced by the affected population became a key focus of national and societal attention, driving a shift in the field from theoretical exploration towards practical application. (3) Rapid Development Phase (2020-2025): The volume of published literature has risen significantly, with annual output reaching 30 or more articles. In particular, a peak in publications occurred following the outbreak of the COVID-19 pandemic. Research directions have become more diverse, with a substantial amount of research conducted on the prevalence, influencing factors and psychological interventions for ASD. This study included only four relevant publications for the year 2026; as this constitutes incomplete data for the statistical period, it is not representative of the publication activity for that year and has therefore been excluded from the trend analysis for that year.
3.2. Analysis of Author Co-Occurrence Networks
Figure 3. Collaborative Visualisation map of authors in the domestic ASD field.
The nodes were designated as authors, and a visualisation of author collaboration was generated using CiteSpace software. This resulted in a total of 279 network nodes and 316 links, with a network density of 0.0081 (Figure 3). Each point in the diagram represents an author, with the diameter of the point reflecting the number of papers they have published; the lines connecting the nodes symbolise collaborative relationships between authors; the thicker the lines and the greater their number, the more extensive and close the collaboration between the authors; the network density is calculated from the nodes and connecting lines, with a higher value indicating more widespread and close connections between authors [9]. The top five authors by number of publications are Jie Cheng (22), Changxiang Chen (17), Weiliang Wang (12), Pingping Liu (12) and Lihuan Dong (9). This study involved a total of 279 authors. Based on the formula for identifying core authors [10],
In the formula:
represents the minimum number of papers published by a core author during the statistical period;
represents the number of papers published by the author with the highest number of publications during the statistical period. The calculation results show that 26 authors, accounting for 9.3% of the total number of authors, were identified as core authors based on having published four or more papers. The network density of this collaboration network is 0.0081, indicating that a collaboration network of a certain scale has been established; however, existing collaborations are primarily concentrated within small teams, with relatively limited cross-team collaboration.
3.3. Co-Occurrence Analysis of Institutional Networks
Figure 4. Visualisation of publishing organisations in the field of ASD in China.
By designating nodes as institutions and using CiteSpace software to conduct a visual analysis of the publishing institutions, a total of 291 nodes and 105 links were generated, with a network density of 0.0025 (Figure 4). The top five institutions by number of publications were the School of Nursing and Rehabilitation at North China University of Science and Technology (19 papers), the Department of Neurosurgery at the Affiliated Hospital of North China University of Science and Technology (15 papers), North China University of Science and Technology (9 papers), the Affiliated Hospital of North China University of Science and Technology (8 papers), and the Mental Health Centre at West China Hospital, Sichuan University (6 papers). The largest group of collaborating institutions comprised North China University of Science and Technology and its affiliated hospital. Collaboration between other institutions was relatively loose, with no stable collaborative groups. The core publishing institutions are primarily universities and their affiliated hospitals. The predominant form of collaboration is “academic-clinical” cooperation between universities and their affiliated hospitals. A collaborative network spanning multiple institutions and regions has yet to be established, and the overall collaborative structure remains relatively loose.
3.4. Distribution of Publishing Journals
A statistical analysis of the distribution of journals publishing the included articles revealed that the top ten journals were: *Chinese Journal of Health Psychology* (22 articles), *International Journal of Psychiatry* (15 articles), *Modern Preventive Medicine* (13 articles), *Chinese Journal of Mental Health* (12 articles), *Chinese Journal of Gerontology* (11 articles), *General Practice Nursing* (10 articles), *Chinese Journal of Modern Nursing* (10 articles), *Chongqing Medicine* (10 articles), *International Journal of Nursing* (9 articles), and *Psychological Monthly* (9 articles). It is evident from this that journal articles in this field are primarily published in psychology and nursing journals.
3.5. Research Highlights
3.5.1. Keyword Co-Occurrence Network Analysis
Keyword co-occurrence analysis identifies high-frequency terms and their interrelationships by quantifying the frequency with which keywords appear together in the literature over a specific research period, thereby revealing core research directions. When several keywords appear together within the same document, this indicates an intrinsic connection between these terms; this phenomenon is known as keyword co-occurrence. Document keywords provide a concise summary of the content and effectively highlight the research themes of the article as well as the knowledge base of the field [11]. This co-occurrence network encompasses 266 keywords and 431 links, with a network density of 0.0122 (Figure 5). Node size represents the frequency of keyword occurrence, whilst link thickness indicates the strength of co-occurrence. The top 15 keywords are listed according to their frequency of occurrence (Table 1).
Table 1. The top 15 keywords in ASD research in China.
Rank |
Frequency |
Centrality |
Keywords |
1 |
40 |
0.10 |
Stress-related disorder |
2 |
37 |
0.20 |
Factors influencing |
3 |
30 |
0.19 |
earthquake |
4 |
29 |
0.26 |
stress response |
5 |
27 |
0.08 |
Anxiety |
6 |
27 |
0.16 |
Psychological intervention |
7 |
26 |
0.04 |
Depression |
8 |
24 |
0.18 |
Stress |
9 |
23 |
0.08 |
Risk factors |
10 |
19 |
0.08 |
Social support |
11 |
18 |
0.06 |
Psychological resilience |
12 |
18 |
0.07 |
Nursing |
13 |
17 |
0.06 |
Psychological stress |
14 |
15 |
0.04 |
Brain injury |
15 |
14 |
0.12 |
Crisis intervention |
Figure 5. Emerging trends in domestic ASD literature: word graphs.
3.5.2. Keyword Clustering Analysis
This study employed the LLR algorithm to perform a cluster analysis of keywords, resulting in a total of 11 clusters, namely: #0 Depression, #1 Influencing Factors, #2 Stress Disorders, #3 Stress, #4 Mental Disorders, #5 Psychological Stress, #6 Earthquake, #7 Psychological Crisis, #8 Psychotherapy, #9 Psychological State, and #10 Major Earthquake. The keyword cluster analysis revealed that Q = 0.6422 (>0.3) indicates a reasonable cluster structure, whilst S = 0.8924 (>0.7) indicates high cluster distinctiveness, suggesting that the clustering results are reliable [12]. The cluster labels and core keywords are shown in the table below (Table 2).
Table 2. Cluster labels and core keywords.
Cluster |
Size |
Silhouette |
mean (Year) |
Label(LLR) |
0 |
42 |
0.882 |
2016 |
depression, anxiety, stress reactions, psychological resilience, insomnia |
1 |
34 |
0.834 |
2019 |
contributing factors, risk factors, nursing care, traumatic brain injury, middle-aged and young adults |
2 |
28 |
0.834 |
2010 |
stress disorder, traumatic, acute, post-traumatic, acute stress disorder |
3 |
21 |
0.934 |
2010 |
stress, trauma, children |
4 |
17 |
0.912 |
2005 |
mental disorders, nursing interventions, diagnostic criteria, disorientation |
5 |
16 |
0.92 |
2011 |
psychological stress, psychological intervention, crisis intervention, complications, stressful events |
6 |
14 |
0.93 |
2008 |
earthquakes, military personnel, disaster victims, the injured, mental health |
7 |
9 |
0.874 |
2012 |
psychological crises, interventions, emergencies, sudden incidents |
8 |
8 |
0.992 |
2006 |
psychotherapy, symptomatic characteristics, post-traumatic stress disorder, close relationships, nursing insights |
9 |
7 |
0.998 |
2001 |
mental state, surgical patients, special forces, comparative study, cardiac surgery |
10 |
7 |
0.979 |
2008 |
major earthquake, return to normal, incident details, incidence rate, intervention efforts |
3.5.3. Keyword Co-Occurrence Analysis
Figure 6. Visualisation of co-occurrence networks for keywords in the field of ASD in China.
Keyword emergence analysis is used to identify research frontiers and emerging trends in this field [13]. Based on keyword clustering, an analysis of keyword emergence reveals that, among the top 16 keywords ranked by emergence intensity in the field of ASD research from 1996 to 2026, “earthquake” is the keyword with the highest emergence intensity. Furthermore, “military personnel”, “traumatic” and “brain injury” reflect the focus of ASD research on different population groups. The medium-to-high emergence intensity of “crisis intervention”, “psychological intervention” and “psychological care” indicates that the field of ASD research has consistently centred on intervention practices as a core objective. In recent years, the research focus has gradually shifted towards “risk factors”, “quality of life” and “psychological stress” (Figure 6).
4. Discussion
4.1. Analysis of the Current State of Publishing
The analysis in this study indicates that the volume of publications in the field of ASD in China is generally on the rise, reflecting the growing interest of domestic scholars in this area. The authors of these publications are primarily from medical schools and their affiliated medical institutions, reflecting the research characteristic of “integration of medical care, teaching and research”. The main publishing institutions are North China University of Science and Technology and the Mental Health Centre of West China Hospital, Sichuan University, with collaboration primarily taking the form of academic and clinical partnerships between universities and their affiliated hospitals. However, the scope of collaboration among authors remains relatively narrow, often confined to within the same team or institution. The network of inter-institutional collaboration is generally sparse and relatively loose, and a close-knit collaborative system has yet to be established. In the future, it will be necessary to strengthen cooperation and exchange between different institutions to promote the circulation and sharing of knowledge within this field, expand the size of research samples, and conduct multidisciplinary and multi-centre integrated research. This will enhance the scientific rigour, universality and innovation of research, with a view to forming a closely connected and highly efficient inter-institutional collaborative network.
4.2. Analysis of the Current State of Research
4.2.1. Key Research Themes
As indicated by keyword co-occurrence, stress-related disorders, influencing factors, earthquakes, stress responses, anxiety, psychological interventions and depression appear frequently and constitute the core themes of domestic ASD research. The high frequency of “stress-related disorders”, “influencing factors” and “risk factors” suggests that risk prevention and control, as well as the exploration of mechanisms, are key research priorities in this field. “Earthquakes” represent a significant origin scenario for domestic ASD research and are a typical example of sudden traumatic events. Stress, stress response and psychological intervention rank as the top three central keywords; they serve as core hub nodes within the co-occurrence network, playing a key role in connecting different research themes. Together, these three elements constitute the primary research network of “basic research-clinical symptoms-intervention practice” in domestic ASD research. However, existing studies predominantly employ cross-sectional research methods and rely heavily on foreign assessment scales [14] [15]. Differences in assessment tools, types of exposure and geographical location collectively contribute to the heterogeneity of ASD prevalence within various traumatic events [2]. Consequently, the development and validation of ASD assessment tools tailored to the Chinese context are of particular importance.
4.2.2. Research Development
From the perspective of the temporal dimension of keyword clustering, this period can be divided into three phases. The first phase, spanning 2001-2008, was dominated by #4 mental disorders, #6 earthquakes, #8 psychotherapy, #9 psychological state and #10 major earthquakes, focusing primarily on the introduction of research concepts and the study of stress responses and psychotherapy in disaster scenarios. The second phase, from 2009 to 2016, was characterised by #2 stress-related disorders, #3 stress and #5 psychological stress, with research shifting towards exploring the prevalence of ASD across various population groups. Thirdly, from 2017 onwards, centred on cluster #1 (influencing factors), research has deepened into the mechanisms of comorbidity, risk factor analysis, precise prediction and nursing interventions. This indicates that the focus of research in this field is gradually shifting from basic theoretical exploration toward clinical practice and intervention applications. According to the Australian Clinical Practice Guidelines (CPGs) for Acute Stress Disorder [16], the treatment of ASD is primarily based on psychotherapy. Research indicates that cognitive behavioural therapy [17] [18], psycho-cognitive dual-track interventions [19], psychological crisis intervention [20], anticipatory care interventions [21], and mindfulness-based stress reduction are all effective interventions for ASD [22] [23]. Meanwhile, relevant pharmacological intervention studies have been conducted abroad [24], and corresponding clinical practice guidelines have been formulated [25] [26]. Currently, domestic intervention studies in China are largely concentrated on non-randomised controlled nursing and psychological interventions. In the future, China needs to conduct large-scale, multi-centre studies to validate the efficacy and safety of intervention programmes [27], establish localised clinical practice guidelines and relevant consensus documents [28], explore other novel intervention measures and research into traditional Chinese medicine [29]-[31], and construct a comprehensive, full-cycle intervention system.
4.2.3. Cutting-Edge Research Areas
The findings of this study indicate that the emergence strength of “influencing factors” is as high as 7.75, making it a cutting-edge core area in current domestic research on ASD. Corresponding to Cluster #1 (influencing factors), the research focuses on influencing factors, risk factors, nursing care, traumatic brain injury and young and middle-aged adults, reflecting a shift in the research focus within this field from understanding the disease itself towards the prevention and control of disease risks. In practical research, scholars have systematically reviewed the multifaceted factors influencing the onset, development and prognosis of ASD. The research population is no longer limited to early-stage victims of natural disasters and trauma patients, but has gradually expanded to include patients with various conditions, such as stroke patients [32], myocardial infarction patients [33], patients with upper gastrointestinal haemorrhage [34], ICU inpatients [35] and HIV/AIDS patients [36]. The range of influencing factors has also broadened from a single dimension to multiple levels, encompassing personal factors such as age [37], gender [1] and monthly household income [38], as well as social support [37] [39], psychological resilience [40], pain [41] and disease-related factors [1]. Based on these risk factors, many researchers have also developed ASD risk prediction models for different populations, enabling precise screening and stratified interventions for high-risk groups, and providing a scientific basis for ‘early identification and early intervention’ in clinical practice. “Quality of life” and “psychological stress” have emerged as the latest cutting-edge keywords, representing the expanding direction of ASD research and reflecting a shift in research philosophy from “symptom relief” to “full-cycle health management”. On the one hand, research has begun to focus on assessing the quality of life of individuals with ASD following rehabilitation, with a view to optimising long-term intervention programmes; on the other hand, it has deepened research into the long-term management of psychological stress, expanding research settings and populations to refine a comprehensive, life-course-based psychological stress prevention and control system, thereby better meeting current demands for psychosocial services. However, research in this field remains limited, with most studies being single-centre cross-sectional studies employing relatively limited methodologies. In the future, there is a need to conduct multi-centre, large-sample studies, utilising methods such as qualitative research and longitudinal studies to further enhance the scientific rigour and reliability of the research.
5. Summary
This study employs visual analytics to examine the key research areas and trends in ASD research in China over the past three decades, with the aim of providing guidance for the development of the field and future research. The overall volume of ASD-related publications in China has shown an upward trend, and the focus of research has shifted from theoretical knowledge towards practical applications. University-affiliated hospitals constitute the main body of research, with collaboration within the same institution being relatively concentrated; however, cross-regional and cross-institutional author collaboration remains insufficient. Future improvements could be made in the following areas: firstly, research methods need to be diversified by introducing more qualitative and longitudinal research designs; secondly, the development and promotion of localised assessment tools should be accelerated, and relevant professional guidelines for the field should be formulated; thirdly, multi-centre and multidisciplinary collaboration should be strengthened to actively explore more targeted intervention methods, thereby providing stronger academic support for mental health services in China.
This study included only formal journal articles from the three major Chinese databases—CNKI, Wanfang, and VIP—and the conclusions drawn reflect only the characteristics of research published in Chinese mainland journals; they do not comprehensively cover all relevant academic output in China; There are potential biases in the standardization of bibliographic data; manual standardization cannot completely eliminate all subtle statistical deviations, which may slightly affect the frequency statistics of author collaboration and institutional co-occurrence networks. Bibliometric methods themselves have descriptive limitations, as they can only objectively present the superficial characteristics of research hotspots, collaboration networks, and evolutionary timelines. In the future, combining multiple analytical methods could enable deeper, multifaceted analysis, thereby further advancing research in the field of ASD.
Funding
Yangtze University 2021 University-level General Teaching and Research Project, “Exploration and Practice of Ideological and Political Education in the Course ‘Surgical Nursing’” (Project No. JY2021050); Science and Technology Guidance Project of Jingzhou Central Hospital, Affiliated Jingzhou Hospital of Yangtze University, “Construction of discharge readiness for elderly patients undergoing hip arthroplasty based on the i-PARIHS evidence-based framework” (Grant No. 2024HD25).