Sex differences in global and local connectivity of adolescent posttraumatic stress disorder symptoms

Gender differences in early posttraumatic stress disorder symptoms: a network analysis

Background: Despite known gender/sex differences in the prevalence of posttraumatic stress disorder (PTSD), potential differences in the associations among PTSD symptoms between men and women in the early post-trauma period are not well-characterized.Objective: This study utilized network analysis to assess potential differences in the associations among PTSD symptom clusters between men and women during the early post-trauma period.Method: We included n = 475 participants (57.5% self-identified women) who recently (≤2 months) experienced an interpersonal or motor vehicle potential traumatic event in the Netherlands. Past month PTSD symptoms were measured with the PTSD Checklist for DSM-5 (PCL-5) and composited according to the five-node PTSD symptom cluster dysphoric arousal model. We estimated the network as well as indices of centrality (strength and predictability) and assessed the stability of the modelled networks in subsamples of men (n = 202) and women (n = 273). We compared network structures using the Network Comparison Test (NCT).Results: Results largely demonstrated adequate correlation stability for the estimated network structures for women and men. For both men and women, avoidance symptoms were among the strongest nodes with greatest predictability in the networks. In men, anxious arousal additionally showed high strength whereas re-experiencing showed high predictability. In women, re-experiencing symptoms demonstrated both high strength and predictability. The NCT demonstrated nonsignificant differences in global network structure (M = 0.08, p = .054) and strength (S = .073, p = .067). Post hoc comparisons showed an association of re-experiencing symptoms with negative alterations in cognitions and mood in men but not women (E = .038, p = .005).Conclusion: Results demonstrated possible modest gender differences in aspects of network structure although most elements of the network structure were similar across genders. These results help to characterize gender differences in associations among PTSD symptom clusters during the early post-trauma period, which may inform the potential relevance of future gender-sensitive early intervention strategies to ameliorate the risk for long-term PTSD.

The Intrinsic Association of Posttraumatic Stress Symptoms Among Chinese Police Officers During COVID-19: Evidence From Network Perspective

BACKGROUND

The current study aimed to identify the core posttraumatic stress symptoms (PTSS) and to explore the longitudinal predictive relationships of these symptoms among Chinese police officers during COVID-19. Identifying the important symptoms of PTSS could help with informing future research to alleviate police officers' psychological problems.

METHODS

In this study, a two-wave on-line investigation (4 months interval; T1 and T2) was conducted with a sample of 891 Chinese police officers who completed the Chinese version of PTSD Checklist for DSM-5 (PCL-5). Cross-sectional network and cross-lagged panel network (CLPN) analyses were adopted.

RESULTS

The results showed that: (1) The most central nodes all belonged to the hyper-arousal and the negative cognition and emotion alteration clusters in both T1 and T2. (2) The strongest positive predictive paths were apparent from symptoms in hyper-arousal cluster to symptoms in negative cognition and emotion alteration cluster and intrusions cluster.

CONCLUSIONS

Hyperarousal is the core symptom cluster among police officers during COVID-19, and it positively predict negative cognition and emotion alteration symptoms and intrusions symptoms over time. Future research could focus more on these symptoms and examine their role in the onset and development of PTSS in police officers following traumatic events.

Network analysis of peer attachment and internet addiction among chinese adolescents

Previous studies have found a correlation between peer attachment and Internet addiction. The three dimensions (peer trust, peer communication, and peer alienation) of peer attachment reflect different needs in peer relationships. This study used network analysis to construct a network model of the three dimensions of peer attachment and Internet addiction. The primary aim was to identify which peer relationship needs are most significantly associated with Internet addiction in adolescents. A total of 782 adolescents (413 girls and 369 boys, Mean age = 13.52, SD age = 1.17) from school participated in this study. Basic demographic information was obtained through a questionnaire. Inventory of Parent and Peer Attachment and Young Internet Addiction Test were used to measure peer attachment and Internet addiction in adolescents. Internet addiction was negatively correlated with the three dimensions of peer attachment: peer trust (r = -0.22), peer communication (r = -0.17), and peer alienation (r = -0.47). Peer trust was the central factor in the network model. Prominent symptoms in the network model included IA2 ("How often do you neglect household chores to spend more time online?") and IA12 ("How often do you fear that life without the Internet would be boring, empty, and joyless?"). Peer communication acted as a bridge between peer attachment and Internet addiction in the network model. Less trust in peers is associated with a higher risk of becoming addicted to the Internet. Fostering peer trust may encourage adolescents to engage in real-life social activities, thus reducing their reliance on the Internet for social fulfillment.

Longitudinal network analysis of depression, anxiety, and post-traumatic stress disorder comorbidities among adolescents in regional China

Purpose

The network theory of mental disorders offers a new perspective for the understanding of comorbidities, but the research on the comorbidities among depression, anxiety, and post-traumatic stress disorder (PTSD) is still insufficient. The aim of this study was to explore the internal relationship by establishing and analyzing the comorbidity networks, and to provide suggestions for the intervention after traumatic events.

Methods

We utilized data from the second and third wave of the Chengdu Positive Child Development cohort (N = 3,189, 47.79% female), we estimated to network models of depression, anxiety and PTSD. To assess difference in global connectivity between the two networks, we conducted invariance test.

Results

K27 (Somatic 10), K37 (Generalized Anxiety 9), K15 (Somatic 5), K33 (Generalized Anxiety 7), K24 (Somatic 9) were the most central nodes in both networks, P13 (Sleep problem) had the highest Bridge Expected Influence value. The structural difference between the two networks was statistically significant (M = 0.229, p = 0.010), and the global strength of the network at wave 2 was higher than the network at wave 3 (35.1 vs. 33.9, S = 1.20, p = 0.010).

Conclusion

The correlation in symptoms of the three disorders underscores the need for more comprehensive treatment options for intervention after traumatic events. Central and bridge nodes could inform targeted interventions or policy decisions. Anxiety disorders, especially Som and Gen dimensions, should be the focus of intervention. The Arousal dimension in PTSD, especially sleep disorders, may contribute to the comorbidities. In addition, this study highlights the importance of staged post-traumatic interventions.

The network analysis of anxiety, depression and academic burnout symptom relationships throughout early, middle, and late adolescence

BACKGROUND

Previous research has explored the associations between anxiety, depression, and academic burnout primarily from a variable-level perspective. However, there is limited understanding of which symptoms might play a significant role in anxiety, depression, and academic burnout among adolescents at different stages.

METHODS

This study included 7,286 adolescents aged 10 to 18. Questionnaires assessed participants' anxiety, depression, and academic burnout. Network analysis was conducted on the overall sample and segmented by early, middle, and late adolescence to explore relationships between symptoms and variations in symptom expression across these stages, aiming to propose effective interventions targeting anxiety, depression, and academic burnout symptoms in early, middle, and late adolescence.

RESULTS

The study found that "feeling that studying is meaningless" emerged as a core symptom in the overall sample. Additionally, "acting or speaking slowly" emerged as a core symptom in early adolescence, while "the thought of dying or hurting" and "feeling bad about yourself, letting your family down" were prominent in middle adolescence, and "easily annoyed or irritable" and "feeling tired" may be prioritized in late adolescence. The varying central symptoms across different adolescent stages suggest the need for targeted interventions.

CONCLUSION

These findings underscore the importance of interventions tailored to specific symptoms to meet the unique needs of adolescents at different developmental stages.

Coexisting patterns of posttraumatic stress disorder and depression symptoms in college students who experienced childhood maltreatment: Different types of maltreatment exposure

BACKGROUND

Childhood maltreatment is often associated with comorbid posttraumatic stress disorder (PTSD) and depression, but the impact of different types of maltreatment on this comorbidity is not well understood.

METHODS

Using network analysis, we examined differences in comorbidity patterns of PTSD and depression symptoms among college students who experienced different forms of childhood maltreatment. We selected a subsample of 2968 students (Mage = 19.38, SD = ±1.45) who reported exposure to childhood maltreatment from a larger sample of 5231 students.

RESULTS

This study showed that symptoms of negative emotions and cognitive change, intrusive symptoms, and increased alertness might play a significant role in the diagnosis and prognosis of comorbid PTSD and depression. The most central nodes in the network of physical maltreatment were flashbacks, and irritability, whereas the most central nodes in the network of emotional and compound trauma, were low mood and sadness. Moreover, network structure and strength differed significantly between maltreatment types, and differences in specific symptom associations were also observed.

CONCLUSION

Network analysis provides insights into which symptoms contribute to the development of comorbidities in individuals with different childhood maltreatment types, as well as how specific symptoms are interconnected in the network. This information can aid in developing targeted and effective interventions for different maltreatment forms.

Posttraumatic stress disorder and spousal relationships in natural disaster victims: a longitudinal study

BACKGROUND

Posttraumatic stress disorder (PTSD) symptoms after natural disaster can have a detrimental effect on marital relationships, which may be through parenting-related factor.

AIMS

The study aimed to examine the mechanism underlying the long-term effects of PTSD symptoms on marital satisfaction via coparenting, and its differences between men and women following the Super Typhoon Lekima.

METHODS

Participants were 465 married victims with children. They reported their PTSD, coparenting, and marital satisfaction at three and fifteen months after the tropical cyclone.

RESULTS

The results showed that for women, only higher negative cognitive and emotional alterations (NCEA) symptoms were associated with lower marital satisfaction through conflict coparenting. For men, higher intrusion, NCEA, and hyperarousal symptoms were associated with marital satisfaction through different coparenting. To be specific, for men, higher intrusion symptoms were associated with lower marital satisfaction via less reprimand coparenting; higher NCEA symptoms were associated with lower marital satisfaction via less integrity coparenting, and associated with higher marital satisfaction via less conflict coparenting; higher hyperarousal symptoms were associated with lower marital satisfaction via more conflict coparenting.

CONCLUSIONS

These findings suggested that the long-term effect of PTSD symptoms on marital satisfaction via coparenting mainly showed for men.

Trajectories and comorbid symptom networks of posttraumatic stress symptoms in frontline rescuers: A longitudinal study

BACKGROUND

Previous research has largely lacked studies that explore the trajectories of Posttraumatic stress symptoms (PTSS) and the structure of comorbid psychiatric symptom networks following traumatic event, while controlling for the severity of traumatic exposure. The present study aims to explore the characteristic trajectories of PTSS, in the context of ensuring controlled levels of traumatic exposure. Furthermore, the PTSS, depressive, and anxiety comorbid symptom networks of different PTSS trajectory subgroups are also investigated.

METHODS

A total of 296 frontline rescue personnel were enrolled into our study. In an effort to control for variations in traumatic exposure severity, this study ensured that all participants had same responsibilities and cumulative operational duration at the post-disaster rescue circumstance. Growth mixture models (GMMs) were employed to scrutinize the trajectories of PTSS. Additionally, network analysis was used to examine the comorbid symptom network of PTSS, depression, and anxiety.

RESULTS

Four distinct PTSS trajectories were identified, namely Persisting Symptom, Gradual Recovery, Gradual Aggravation, and Asymptomatic. Although both the Persisting Symptom and Gradual Aggravation groups belong to the high-risk subgroups for persistent PTSS, they exhibit differences in core symptoms within their respective networks. The core symptom for the Persisting Symptom Network is flashbacks, while for the Gradual Aggravation Network, it is sleep disturbances.

CONCLUSION

To the best of our knowledge, the present study represents the first research endeavor to integrate longitudinal trajectory analysis of PTSS with longitudinal symptom network analysis, clarifying the evolving features of PTSS but also offering valuable insights for early screening and intervention strategies.

Mapping gender networks of music self-concept and music emotions: A network analysis study of music majors in China

BACKGROUND

Students' music self-concept and music emotions are becoming prominent topics within the area of music education.

AIMS, SAMPLES AND METHODS

The majority of previous research on self-concept and music emotions has examined the two constructs independently and focused on gender differences in externalizing behaviours in music learning, but has neglected the internal interactions between individual music self-concept and music emotions. Network analysis is a promising method for visually examining music self-concept and music emotions as part of a network of interactions to identify core features and interrelationships among nodes in the network. In this study, 515 students majoring in music from a Chinese university were recruited.

RESULTS

The results showed that high music self-concept and boredom were the common features at the core of the network for both men and women college students. The boredom exhibited by women differed from that of men in that men's boredom was directed at the entire music course, while boredom in women manifested as daydreaming and boredom with learning materials.

CONCLUSIONS

This study is the first to explore gender differences in the music self-concept and music emotions from a holistic perspective. The findings could help music teachers gain insight into the complex system of music self-concept and music emotions. Music teachers could capture the respective features of men and women to design individualized teaching strategies.

Exploring the differential effects of psychological resilience and social support in mitigating post-traumatic psychiatric symptoms: real-world network analysis of front-line rescuers

BACKGROUND

Although both psychological resilience and social support are widely believed to be effective in alleviating post-traumatic psychiatric symptoms in individuals with traumatic events, there has been a lack of comparative analysis of their intervention effects on different post-traumatic psychiatric symptoms. Furthermore, previous studies have mostly failed to control for potential confounding effects caused by different traumatic events.

AIMS

We used the novel network analysis approach to examine the differential moderating effects of psychological resilience and social support on post-traumatic psychiatric symptoms, controlling for the confounding effects of traumatic events.

METHOD

We recruited 264 front-line rescuers who experienced the same traumatic event. Quantified edge weights and bridge expected influence (BEI) were applied to compare the alleviating effects of psychological resilience and social support.

RESULTS

Our study revealed distinct correlations in a sample of front-line rescuers: social support negatively correlates more with psychosomatic symptoms, notably fatigue in depressive networks and sleep disturbance in post-traumatic stress disorder (PTSD) networks, whereas psychological resilience shows fewer such correlations. Quantitative analysis using BEI indicated that psychological resilience more effectively suppresses depressive and anxiety symptom networks, whereas social support more significantly inhibits PTSD symptom networks.

CONCLUSIONS

The current study represents the first attempt to examine the differential effects of psychological resilience and social support on post-traumatic outcomes in real-world emergency rescuers, controlling for the confounding effect of traumatic events. Our results can act as the theoretical reference for future precise and efficient post-trauma psychological interventions.

A network analysis of Hurricane Maria-related traumatic stress and substance use among Puerto Rican youth

Youth exposed to natural disasters are at risk of developing trauma-related symptoms as well as engaging in substance use. Although previous research has established associations between disaster-related stressors and substance use in youth, less has focused on how symptoms of posttraumatic stress disorder (PTSD) may underpin this association. The current study used network analysis to identify specific PTSD symptoms associated with substance use following a natural disaster. Participants were 91,732 youths (Grades 3-12) from across Puerto Rico who completed a needs assessment 5-9 months after Hurricane Maria made landfall in September 2017. We examined associations between PTSD symptoms and substance use, identified clusters of symptoms and bridges between them, and explored age- and binary gender-related differences in associations between specific PTSD symptoms and substance use. Analyses identified two symptom communities: (a) arousal and reactivity, negative alterations in cognition and mood, and substance use, and (b) avoidance and intrusion. Broader findings suggested that substance use was most strongly associated with PTSD-related irritability and angry outbursts among youths. Surrounding nodes explained only 4.1% of the variance in substance use, but this was higher among youths who reported not having a supportive adult, R2 = 8.5; friend, R2 = 7.9; or teacher/counselor, R2 = 7.7, in their life. The bridge symptoms of sleep disruption and physiological reactivity were identified as potentially critical intervention targets for disrupting PTSD symptom networks after a natural disaster. Implications for triaged mental health care following natural disasters and directions for future research are discussed.

Symptom structure of posttraumatic stress disorder in workplace trauma: A "distraction-avoidance" pattern

BACKGROUND

Individuals who experience a workplace trauma are at a high risk of developing posttraumatic stress disorder (PTSD). Most of these people return to work soon after the trauma (i.e., experience early-stage natural exposure). This study aims to explore the response pattern of workers who have experienced a workplace trauma and early-stage natural exposure through network analysis and provide insights into the potential impact of early-stage natural exposure.

METHODS

Our study included 278 workers directly experiencing the workplace explosion in the Tianjin Economic and Technological Development Zone. A partial correlation network analysis was used to explore the PTSD symptoms relationship and identify central symptoms.

RESULTS

The results suggest that emotional numbness, difficulty in concentration, re-experiencing symptoms, and avoidance of thoughts are the most central symptoms, reflecting a "distraction-avoidance" pattern.

CONCLUSIONS

The current study found that workers who experienced workplace trauma exhibited a "distraction-avoidance" pattern, which helps deepen our understanding of the PTSD network and leads to some suggestions on intervention measures.

The Neurotransmission Basis of Post-Traumatic Stress Disorders by the Fear Conditioning Paradigm

Fear conditioning constitutes the best and most reproducible paradigm to study the neurobiological mechanisms underlying emotions. On the other hand, studies on the synaptic plasticity phenomena underlying fear conditioning present neural circuits enforcing this learning pattern related to post-traumatic stress disorder (PTSD). Notably, in both humans and the rodent model, fear conditioning and context rely on dependent neurocircuitry in the amygdala and prefrontal cortex, cingulate gyrus, and hippocampus. In this review, an overview of the role that classical neurotransmitters play in the contextual conditioning model of fear, and therefore in PTSD, was reported.

Sex Differences in Complex Posttraumatic Stress Disorder Network among Chinese Young Adults

Evidence suggests that sex differences commonly occur in trauma-related disorders. The current study aims to explore sex differences in complex posttraumatic stress disorder (CPTSD) symptom networks among Chinese young adults with childhood trauma. The current study utilized a representative sample of college students in Beijing and included 1416 participants (409 men and 907 women) who had childhood trauma experience. CPTSD symptoms were evaluated using the International Trauma Questionnaire. Regularized partial correlation network analysis and Bayesian network analysis were used to estimate the network structure and possible causality of CPTSD symptoms for both sexes. Male and female CPTSD symptom networks had differences in strength centrality and bridge centrality. Nightmares and feelings of failure had the highest strength centrality, and long-term upset and nightmares had the highest bridge centrality for men. Hypervigilance and feelings of failure had the highest strength centrality, and long-term upset and exaggerated startle response had the highest bridge centrality for women. The current study provides the first evidence of sex differences in the CPTSD symptom network among Chinese young adults with childhood trauma. Young men and women differed in highly central symptoms, which may speak to sex specificity in the main manifestations of CPTSD symptoms.

Prospective network of post-traumatic stress disorder (PTSD) symptoms across adolescent survivors with distinct trajectories of PTSD: A cohort study of the Wenchuan earthquake

There are multiple trajectories of post-traumatic stress disorder (PTSD) symptoms following disasters. Unraveling the patterns of interactions between PTSD symptoms across distinct PTSD trajectories is crucial. This study was aimed at investigating the temporal sequences, changes, and predictive symptoms in PTSD networks over time across distinct PTSD trajectory groups. Data were exacted from the Wenchuan Earthquake Adolescent Health Cohort (WEAHC) study. The current study included 1022 adolescents (424 males) who participated in follow-up surveys at 12 months and 24 months post-earthquake. Self-reported PTSD symptoms were assessed with the Post-traumatic Stress Disorder Self-Rating Scale. The between-person network revealed significant differences across distinct trajectories. In the chronic dysfunction group, "Intrusive thoughts" had the strongest value in predicting on other PTSD symptoms. In contrast, "Difficulty in study or work" in the recovery group and "Physiological cue reactivity" in the resistance group were highly associated with the remission of other PTSD symptoms. These findings underscore the importance of "Difficulty in study or work" and "Physiological cue reactivity" for promoting the spontaneous remission of PTSD and further suggest that "Intrusive thoughts" maybe helpful to minimize the subsequent presence of other PTSD symptoms. Future research should investigate the causality and associations between within-person networks.

Networks of Neuropsychological Functions in the Clinical Evaluation of Adult ADHD

This study applied network analysis to explore the relations between neuropsychological functions of individuals in the clinical evaluation of attention-deficit/hyperactivity disorder (ADHD) in adulthood. A total of 319 participants from an outpatient referral context, that is, 173 individuals with ADHD (ADHD group) and 146 individuals without ADHD (n-ADHD group), took part in this study and completed a comprehensive neuropsychological assessment. A denser network with stronger global connectivity was observed in the ADHD group compared to the n-ADHD group. The strongest connections were consistent in both networks, that is, the connections between selective attention and vigilance, and connections between processing speed, fluency, and flexibility. Further centrality estimation revealed attention-related variables to have the highest expected influence in both networks. The observed relationships between neuropsychological functions, and the high centrality of attention, may help identify neuropsychological profiles that are specific to ADHD and optimize neuropsychological assessment and treatment planning of individuals with cognitive impairment.

The network structure of posttraumatic stress symptoms in war-affected children and adolescents

Background

It is unclear whether findings from previous network analyses of posttraumatic stress disorder (PTSD) symptoms among children and adolescents are generalizable to youth living in war-torn settings and whether there are differences in the structure and connectivity of symptoms between children and adolescents. This study examined the network structure of PTSD symptoms in a sample of war-affected youth and compared the symptom networks of children and adolescents.

Methods

The overall sample comprised 2007 youth (6-18 years old) living in Burundi, Democratic Republic of Congo, Iraq, Palestine, Tanzania, and Uganda amid or close to war and armed conflict. Youth reported their PTSD symptoms using a self-report questionnaire in Palestine and structured clinical interviews in all other countries. We computed the networks of the overall sample and of two sub-samples of 412 children (6-12 years) and 473 adolescents (13-18 years) and compared the structure and global connectivity of symptoms among children and adolescents.

Results

In both the overall sample and the sub-samples, re-experiencing and avoidance symptoms were most strongly connected. The adolescents' network had a higher global connectivity of symptoms than the children's network. Hyperarousal symptoms and intrusions were more strongly connected among adolescents compared to children.

Conclusion

The findings lend support to a universal concept of PTSD among youth characterized by core deficits in fear processing and emotion regulation. However, different symptoms may be particularly important in different developmental stages, with avoidance and dissociative symptoms dominating in childhood and intrusions and hypervigilance gaining importance in adolescence. Stronger symptom connections may render adolescents more vulnerable to the persistence of symptoms.

Comorbidity of posttraumatic stress disorder and depression among adolescents following an earthquake: A longitudinal study based on network analysis

BACKGROUND

High comorbidity between posttraumatic stress disorder (PTSD) and depression among adolescents often follows severe traumatic events. Models on the pathway to comorbidity dispute greatly and how PTSD and depression get comorbidity, remain unclear.

METHODS

A follow-up investigation was conducted of 424 adolescent survivors of the Jiuzhaigou earthquake at 12 months (T1) and 27 months (T2).

RESULTS

Contemporaneous network analysis and cross-lagged panel network analysis showed that PTSD and depression are two separate disorders with strong associations via links between dysphoric symptoms of PTSD and somatic or non-somatic symptoms of depression. However, the association weakened from T1 to T2, and internal connections between symptoms within each disorder became stronger.

LIMITATION

We only measured the comorbidity of PTSD and depression at two time points following the earthquake, which may limit the long-term applicability of our findings following trauma.

CONCLUSIONS

The findings also showed that the centrality in contemporaneous networks may indicate node connectivity rather than the influence or potential causality among nodes. These results help to elucidate the relationship between PTSD and depression and could contribute to the development of appropriate therapies.

Post-traumatic stress disorder and depressive symptoms among firefighters: a network analysis

Background

Firefighters, as first responders with a high risk of occupational exposure to traumatic events and heavy working stress, have a high prevalence of PTSD symptoms and depressive symptoms. But no previous studies analyzed the relationships and hierarchies of PTSD and depressive symptoms among firefighters. Network analysis is a novel and effective method for investigating the complex interactions of mental disorders at the symptom level and providing a new understanding of psychopathology. The current study was designed to characterize the PTSD and depressive symptoms network structure in the Chinese firefighters.

Method

The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) and the Self-Rating Depression Scale (SDS) were applied to assess PTSD and depressive symptoms, respectively. The network structure of PTSD and depressive symptoms was characterized using "expected influence (EI)" and "bridge EI" as centrality indices. The Walktrap algorithm was conducted to identify communities in the PTSD and depressive symptoms network. Finally, Network accuracy and stability were examined using the Bootstrapped test and the case-dropping procedure.

Results

A total of 1,768 firefighters were enrolled in our research. Network analysis revealed that the relationship between PTSD symptoms, "Flashback" and "Avoidance," was the strongest. "Life emptiness" was the most central symptom with the highest EI in the PTSD and depression network model. Followed by "Fatigue" and "Interest loss." Bridge symptoms connecting PTSD and depressive symptoms in our study were "Numb," "High alertness," "Sad mood," and "Compunction and blame," successively. The data-driven community detection suggested the differences in PTSD symptoms in the clustering process. The reliability of the network was approved by both stability and accuracy tests.

Conclusion

To the best of our knowledge, the current study first demonstrated the network structure of PTSD and depressive symptoms among Chinese firefighters, identifying the central and bridge symptoms. Targeting interventions to the symptoms mentioned above may effectively treat firefighters suffering from PTSD and depressive symptoms.

Sex-based variations of prefrontal structure and longitudinal symptoms in pediatric posttraumatic stress disorder

BACKGROUND

Pediatric posttraumatic stress disorder (pPTSD) is more than three times as likely to develop in trauma-exposed female youth than males. Despite the staggering sex differences in the prevalence rates of pPTSD and symptom expression, relatively little is known about the underlying biomarkers of these sex-based variations in pPTSD as compared to typically development.

METHODS

The Youth PTSD study recruited 97 youth, ages of 7 and 18, to undergo comprehensive clinical assessments and T1-weighted MRI to evaluate the extent to which sex can explain PTSD-related variations in brain structure. Whole-brain VBM as well as whole-brain estimates of cortical thickness and surface area were analyzed to identify group-by-sex interactions. Finally, we tested whether current or future symptom severity was predictive of regions exhibiting sex-based variations.

RESULTS

Clinically, females with PTSD were significantly more likely to report exposure to and higher severity of interpersonal violence and symptoms of hyperarousal. Sex and PTSD status were predictive of gray matter across the lateral prefrontal cortex (PFC), including the ventrolateral PFC and frontal pole, where increased volume and surface area was found in PTSD females as compared to PTSD males. Interestingly, the ventrolateral prefrontal cortex and frontal pole were negatively predictive of symptoms 1 year later in only males with PTSD.

CONCLUSIONS

Together, these results establish that youth with PTSD exhibit sex-based variations in clinical and trauma characteristics and prefrontal cortical structure relative to normative development. This work demonstrates the importance of examining the role that sex may play in the behavioral and neurobiological presentation of pPTSD.

Six-year changes of posttraumatic stress symptoms and depressive symptoms among Chinese earthquake survivors: A network analysis

BACKGROUND

The risk factors of Posttraumatic Stress Symptoms (PTSS) and depressive symptoms have been well-established, but whether the network structure of their symptoms changes over time remains unclear. This study aims to examine the six-year changes of network structure of PTSS and depressive symptoms among Wenchuan earthquake adult survivors in China.

METHODS

In this pooled cross-sectional study, respondents were sampled from the same population at each of the five waves (N = 1343, 1205, 1177, 1376, and 1339). The network structure of them was investigated using network analyses.

RESULTS

The study shows network connections stable across waves were the positive connections between hyperarousal and intrusions, hyperarousal and somatic symptoms, and two dimensions of positive effects. Stable negative connections were those between depressed affects and positive effects, avoidance and depressed affects, avoidance with interpersonal symptoms and avoidance with somatic symptoms. Across waves, fearful emotion consistently was the strongest bridge symptom connecting with PTSS symptoms. However, for PTSS the strongest bridge symptom varied across time as it was avoidance in wave 1 but were hyperarousal in other four waves.

LIMITATIONS

This study was based on a pooled cross-sectional survey, which inhibits conclusions regarding causal influences between symptoms at the individual patient level.

CONCLUSIONS

The network structure of PTSS and depressive symptoms was partly stable, yet also varied across survey waves. Core symptom clusters for PTSS and depressive symptoms were avoidance and depressed affect, respectively. The central role of these clusters in PTSS and depressive symptoms has important implications to future psychiatric programs.

Network analysis on the relationship between posttraumatic stress disorder, psychiatric co-morbidity and posttraumatic growth among Chinese adolescents

BACKGROUND

This study investigated the association between posttraumatic stress disorder (PTSD), psychiatric co-morbidity and posttraumatic growth (PTG) among Chinese adolescents using network analysis.

METHODS

867 Chinese adolescents (male = 424, female = 443) were recruited from three secondary schools. They completed the Posttraumatic Stress Disorder Checklist for DSM-5, the Posttraumatic Growth Inventory, and the General Health Questionnaire-28.

RESULTS

Domains of each construct mainly clustered within their respective communities with several bridging edges identified. The prominent roles of bridging nodes and edges (positive and negative) were highlighted. Key bridging nodes were negative alterations in cognitions and mood for PTSD, anxiety and insomnia for psychiatric co-morbidity and appreciation of life for PTG.

LIMITATIONS

The cross-sectional nature of the present study may preclude the identification of real causal relationships between nodes.

CONCLUSIONS

Following a trauma, adolescents displayed posttraumatic stress along with general psychological disorder symptoms. These distress reactions could affect the way they appreciated life and their motivation to seek future life possibilities. Findings from the current study may provide some clue for the facilitation of posttraumatic growth among clinical patients.

Network structure of PTSD symptoms in Chinese male firefighters

The network perspective of mental disorder offers a novel way of understanding the psychopathology of post-traumatic stress disorder (PTSD). In this framework, PTSD may arise from direct interactions between its symptoms. In the present study, we used the Post-Traumatic Stress Disorder Checklist-civilian Version (PCL-C) to investigate the network structure of PTSD symptoms in 994 Chinese male firefighters. We also calculated the micro (i.e., edges weight and node expected influence) and middle (i.e., community) indicators of the final network. Nine strongest edges existed in the final network were from the same dimension of PCL-C, like "avoidance of thoughts" and "avoidance of reminders". Symptoms "emotional reactivity", "avoidance of reminders" and "exaggerated startle response" had the highest expected influence. As for the results of community detection, the spinglass and walktrap algorithm detected the same three communities which are slightly different from the original dimensions of PCL-C (i.e., symptoms "avoidance of thoughts", "avoidance of reminders" and "trauma-related amnesia" of avoidance dimension of PCL-C were added to the intrusion dimension of PCL-C). The present study explored the network structure of PTSD symptoms in Chinese male firefighters and provided several implications for clinical prevention and intervention to address the mental health needs in this special group.

Using network analysis to explore the key bridge symptoms between posttraumatic stress symptoms and posttraumatic growth among survivors 10 years after the Wenchuan earthquake in China

Despite previous research has illustrated there is high-coexistence between posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) in the aftermath of traumatic events, few studies have conceptualized the coexistence mechanism of the two psychological phenomena. Using the network analysis, this study aimed to identify the key bridge symptoms and compare sex differences between PTSD symptoms and PTG elements in survivors 10 years after the Wenchuan earthquake in China. A total of 744 survivors 10 years after the Wenchuan earthquake in China completed self-reported questionnaires on demographics, PTSD symptoms (4-item of Posttraumatic Stress Disorder Checklist), and PTG (10-item of Posttraumatic Growth Inventory). Network analysis was used to identify the network structure of PTSD symptoms and elements of PTG, along with bridge symptoms. Additionally, sex differences in the network structure were compared by the Network Comparison Test. Results revealed that the network of PTSD symptoms and elements of PTG was robust to stability and accuracy tests. The key bridge symptoms in the network were "Stronger religious faith", "Changed priorities", and "Easily startled". There were significant differences in network global strength across sex, and network structure across the severity of property loss other than house damage. Future interventions targeting the three key bridge symptoms are expected to relieve the severity of PTSD and promote growth following exposure to traumatic events.

The Network Structure of Trauma Symptoms of Abuse-exposed Children and Adolescents in South Africa

Network theory promises new ways for conceptualizing, methods for investigating, and state-of-the-art lines of research that will improve our knowledge of mental health in high-risk children and adolescents. This study constructed a symptom network to examine associations between a wide range of trauma symptoms in a sample of children and adolescents (N = 270; M_age = 12.55 yrs, SD = 1.19; 67% = Female) who experienced different forms of abuse (i.e., sexual, physical, emotional and neglect). Symptom-pairs regularized partial correlations, with the Extended Bayesian Information Criterion Graphical Least Absolute Shrinkage and Selection Operator (EBICglasso), were computed to estimate the network structure and centrality measures of the TSCC-SF items. Results show sadness, dissociative amnesia, and sexual arousal to be the most central symptoms in the network, while suicidality was found to be the shortest pathway across all other symptoms (domains). By providing clinicians with specific symptoms to target in interventions, the network framework has the potential to guide and enhance the effectiveness of psychological therapies in high-risk populations.

Network analysis of cognitive emotion regulation strategies and depressive symptoms in young adults after recent stressful events: The moderation of childhood maltreatment

BACKGROUND

The present study explored the interrelations between cognitive emotion regulation strategies (CERS) and depressive symptoms to better understand how young adults with childhood maltreatment (CM) are more prone to depression after recent stressful events.

METHODS

The sample consisted of 342 young adults (M = 19.51 years, range = 17-28 years, 64% female) who had experienced stressful events in the last six months. Network analysis was used to examine the interrelations between nine CERS and four depressive symptom clusters in exposed ('CM'; n = 182) and not exposed to CM groups ('non-CM'; n = 160).

RESULTS

We found that somatic symptoms, rumination, putting into perspective, and catastrophizing had high expected influence (EI) in the whole sample network. Global and local connectivity differed between the CM and non-CM groups. More specifically, the structure of the CM network had higher overall connectivity than the structure of the non-CM network. Considering local connectivity, depressed affect, rumination, positive refocusing, and putting into perspective had marginally significantly higher levels of EI in the CM network. We found some significant differences in partial correlations among CERS, such as stronger positive correlations between positive refocusing-catastrophizing, rumination-refocus on planning, and putting into perspective-blaming others in the CM group.

LIMITATIONS

This study was cross-sectional and limited by the use of retrospective self-report tools.

CONCLUSIONS

The findings shed light on the complex interrelations between CERS and depressive symptoms in the context of recent stressful events. Additionally, they highlight potential directions for population-based interventions.

Network analysis of comorbid posttraumatic stress disorder and depression in adolescents across COVID-19 epidemic and Typhoon Lekima

BACKGROUND

Network analytic studies indicate that posttraumatic stress disorder (PTSD) may be comorbid with depression at the symptom level, but it remains unclear whether these findings are replicable and generalizable across trauma types.

OBJECTIVE

This study aim was to examine and compare PTSD-depression comorbidity networks of two types of trauma related to Typhoon Lekima and COVID-19 epidemic.

METHODS

Participants were 1605 and 601 adolescents recruited following Typhoon Lekima and the COVID-19 outbreak, respectively.

RESULTS

COVID-19 and Lekima PTSD-depression networks had considerable similarities, including adequate stability and accuracy, connected symptoms of PTSD and depression, symptoms with high centralities, and bridge symptoms. PTSD-depression comorbid symptoms were more complicated in the COVID-19 network but may show more persistence in the Lekima network. Distinct bridge symptoms contributed to the heterogeneity of PTSD-depression comorbidity characteristics between the two networks. Specifically, restricted affect and felt down and unhappy were two important bridge symptoms with high centrality unique to the COVID-19 network.

CONCLUSIONS

PTSD-depression comorbidity network has considerable replicability across trauma types, but specific symptom-level associations and some bridge symptoms may vary across trauma types. These findings also highlight the importance of negative emotions to comorbid PTSD and depression in adolescents following the COVID-19 outbreak compared with Typhoon Lekima.

Relationship Between Gaming Disorder, Self-Compensation Motivation, Game Flow, Time Spent Gaming, and Fear of Missing Out Among a Sample of Chinese University Students: A Network Analysis

Background and Aims: In previous correlational research, the relationship between gaming disorder (GD), compensation motivation, game flow, time spent gaming, and fear of missing out (FoMO) has been examined. However, network analysis has rarely been applied to explore the relationship between GD, self-compensation motivation, game flow, time spent gaming, and FoMO. Therefore, the present study used network analysis to examine the relationship between the aforementioned variables among a sample of gamers. Methods: The present study comprised gamers (N = 1,635) recruited from three Chinese universities, who completed an online survey including the Gaming Disorder Test, Self-Compensation Motivation Questionnaire, Game Flow Questionnaire, and Trait-State Fear of Missing Out Scale, as well as four items related to time spent gaming. Results: Self-compensation motivation, game flow, time spent gaming, and FoMO were all significantly and positively associated with GD. In the domain-level and facet-level networks, weekday gaming hours and weekend gaming hours had the strongest edge intensity. The domain-level, facet-level, and item-level networks analysis also showed that GD was connected with self-compensation motivation, game flow, time spent gaming, and FoMO. The network structure demonstrated a significant difference between males and females (2.33 vs. 2.81, p = 0.001) using the domain-level network comparison test (NCT). Conclusions: The results suggest that GD is closely associated with self-compensation motivation, game flow, time spent gaming, and FoMO. FoMO and gaming motivation (i.e., self-compensation and game flow) may increase time spent gaming and facilitate GD. Therefore, interventions that decrease game immersion and time spent gaming are likely to decrease GD.

Individual Differences in Conditioned Fear and Extinction in Female Rats

The inability to extinguish a traumatic memory is a key aspect of post-traumatic stress disorder (PTSD). While PTSD affects 10–20% of individuals who experience a trauma, women are particularly susceptible to developing the disorder. Despite this notable female vulnerability, few studies have investigated this particular resistance to fear extinction observed in females. Similar to humans, rodent models of Pavlovian fear learning and extinction show a wide range of individual differences in fear learning and extinction, although female rodents are considerably understudied. Therefore, the present study examined individual differences in fear responses, including freezing behavior and ultrasonic vocalizations (USVs), of female Long–Evans rats during acquisition of fear conditioning and cued fear extinction. Similar to prior studies in males, female rats displayed individual variation in freezing during cued fear extinction and were divided into extinction competent (EC) and extinction resistant (ER) phenotypes. Differences in freezing between ER and EC females were accompanied by shifts in rearing during extinction, but no darting was seen in any trial. Freezing behavior during fear learning did not differ between the EC and ER females. Vocalizations emitted in the 22 and 50 kHz ranges during fear learning and extinction were also examined. Unlike vocalizations seen in previous studies in males, very few 22 kHz distress vocalizations were emitted by female rats during fear acquisition and extinction, with no difference between ER and EC groups. Interestingly, all female rats produced significant levels of 50 kHz USVs, and EC females emitted significantly more 50 kHz USVs than ER rats. This difference in 50 kHz USVs was most apparent during initial exposure to the testing environment. These results suggest that like males, female rodents show individual differences in both freezing and USVs during fear extinction, although females appear to vocalize more in the 50 kHz range, especially during initial periods of exposure to the testing environment, and emit very few of the 22 kHz distress calls that are typically observed in males during fear learning or extinction paradigms. Overall, these findings show that female rodents display fear behavior repertoires divergent from males.

Bayesian Estimation for Gaussian Graphical Models: Structure Learning, Predictability, and Network Comparisons

Gaussian graphical models (GGM; "networks") allow for estimating conditional dependence structures that are encoded by partial correlations. This is accomplished by identifying non-zero relations in the inverse of the covariance matrix. In psychology the default estimation method uses ℓ1-regularization, where the accompanying inferences are restricted to frequentist objectives. Bayesian methods remain relatively uncommon in practice and methodological literatures. To date, they have not yet been used for estimation and inference in the psychological network literature. In this work, I introduce Bayesian methodology that is specifically designed for the most common psychological applications. The graphical structure is determined with posterior probabilities that can be used to assess conditional dependent and independent relations. Additional methods are provided for extending inference to specific aspects within- and between-networks, including partial correlation differences and Bayesian methodology to quantify network predictability. I first demonstrate that the decision rule based on posterior probabilities can be calibrated to the desired level of specificity. The proposed techniques are then demonstrated in several illustrative examples. The methods have been implemented in the R package BGGM.

Psychological State Among the General Chinese Population Before and During the COVID-19 Epidemic: A Network Analysis

Background: The infectious disease Coronavirus Disease 2019 (COVID-19) outbroke in 2019 spread to multiple countries. The quick spread of the virus and isolation strategies may trigger psychological problems. Our aim was to explore the dynamic network structure of the psychological state before and during the epidemic. Methods: A web-based survey was conducted in two stages: the T1 stage (1 January 2019 to 31 December 2019) and the T2 stage (1 February 2020 to 8 March 2020). In both stages, the Patient Health Questionnaire-9, General Anxiety Disorder-7, and Pittsburgh Sleep Quality Index were used to assess depression, anxiety, and sleep, respectively. Results: We matched the data based on IP addresses. We included 1,978, 1,547, and 2,061 individuals who completed the depression, anxiety, and sleep assessments, respectively, at both stages. During epidemics, psychomotor agitation/retardation, inability to relax, restless behavior, and the frequency of using medicine had high centrality. Meanwhile, the network structure of psychological symptoms becomes stronger than before the epidemic. Conclusion: Symptoms of psychomotor agitation/retardation, inability to relax, and restless behavior should be treated preferentially. It is necessary to provide mental health services, including timely and effective early psychological intervention. In addition, we should also pay attention to the way patients use medicines to promote sleep quality.

How do licensed psychotherapists in Germany feel about treating patients with posttraumatic stress symptoms? - an experimental study based on case vignettes

BACKGROUND

Previous research indicates that not all children, adolescents and adults suffering from PTSD receive psychotherapy and if they do, trauma is not always considered during therapy. One reason for this undertreatment might be a limited readiness of licenced psychotherapists (LPTs) to treat patients who have experienced a trauma and thus suffer from PTSD symptoms.

OBJECTIVE

The aim of this study is to explore the association between the readiness of LPTs to treat patients with PTSD symptoms and different patients' and therapists' characteristics.

METHOD

We used case vignettes to assess the readiness of LPTs in Germany in a nationwide online survey (N = 768). The vignettes described patients with PTSD and were adapted to the age group mainly treated by the therapists (children/adolescents vs. adults). The patients' characteristics in the otherwise identical vignettes were randomized for patient gender (female vs. male) and symptom cluster (internalizing vs. externalizing). Rating scales were used to assess readiness. Additionally, therapists' characteristics (age, trauma-specific training, perceived fears/doubts, and objective barriers to treating the vignette patient) were assessed.

RESULTS

The patients' characteristics did not influence the treatment readiness of the LPTs. Regarding therapists' characteristics, LPTs working mainly with children and adolescents, and those who had completed trauma-specific training reported a higher readiness to treat the vignette patient.

CONCLUSIONS

Regarding the treatment of patients suffering from PTSD symptoms of different ages, our study indicated that the assessed therapists' characteristics were more relevant for the treatment readiness of LPTs than the patients' characteristics of age or symptom type.

Posttraumatic Symptoms in 3-7 Year Old Trauma-Exposed Children: Links to Impairment, Other Mental Health Symptoms, Caregiver PTSD, and Caregiver Stress

Few studies have examined how PTSD symptoms in young children are associated with other mental health symptoms and mood and functioning in caregivers. This is an important gap in the literature as such knowledge may be important for assessment and treatment. This study used network analysis to identify how the major symptom domains of PTSD in young trauma-exposed children were related to impairment, internalizing and externalizing symptoms, caregiver PTSD, and caregiver stress. Caregivers of 75 trauma-exposed 3-7 year old children reported on their child's symptoms and impairment and their own PTSD symptoms and caregiver stress. A strong association between the child PTSD domains of intrusions and avoidance emerged, which is in line with theoretical notions of how PTSD onsets and is maintained in adolescents and adults. Externalizing child symptoms were strongly linked to PTSD-related impairment and caregiver stress, highlighting the need to carefully assess and address such symptoms when working with young trauma-exposed children. Internalizing symptoms were uniquely associated with all three of the major childhood PTSD symptom domains with further implications for assessment and treatment.

Network analysis of COVID-19-related PTSD symptoms in China: the similarities and differences between the general population and PTSD sub-population

BACKGROUND AND OBJECTIVES

Prevalent Post-traumatic Stress Disorder (PTSD) negatively affected individuals during the COVID-19 pandemic. Using network analyses, this study explored the construct of PTSD symptoms during the COVID-19 pandemic in China to identify similarities and differences in PTSD symptom network connectivity between the general Chinese population and individuals reporting PTSD.

METHODS

We conducted an online survey recruiting 2858 Chinese adults. PTSD symptoms were measured using the PCL-5 and PTSD was determined according to the DSM-5 criteria.

RESULTS

In the general population, self-destructive/reckless behaviours were on average the most strongly connected to other PTSD symptoms in the network. The five strongest positive connections were found between 1) avoidance of thoughts and avoidance of reminders, 2) concentration difficulties and sleep disturbance, 3) negative beliefs and negative trauma-related emotions, 4) irritability/anger and self-destructive/reckless behaviours, and 5) hypervigilance and exaggerated startle responses. Besides, negative connections were found between intrusive thoughts and trauma-related amnesia and between intrusive thoughts and self-destructive/reckless behaviours. Among individuals reporting PTSD, symptoms such as flashbacks and self-destructive/reckless behaviours were on average most strongly connected to other PTSD symptoms in the network. The five strongest positive connections were found between 1) concentration difficulty and sleep disturbance, 2) intrusive thoughts and emotional cue reactivity, 3) negative beliefs and negative trauma-related emotions, 4) irritability/anger and self-destructive/reckless behaviour, and 5) detachment and restricted affect. In addition, a negative connection was found between intrusive thoughts and self-destructive/reckless behaviours.

CONCLUSION

Our results indicate similarly positive connections between concentration difficulty and sleep disturbance, negative beliefs and negative trauma-related emotions, and irritability/anger and self-destructive/reckless behaviours in the general and PTSD-reported populations. We argue that self-destructive/reckless behaviours are a core symptom of COVID-19 related PTSD, worthy of more attention in future psychiatric programmers.

Evolution of the network pattern of posttraumatic stress symptoms among children and adolescents exposed to a disaster

Growing network approach analyses of posttraumatic stress disorder (PTSD) have enhanced the knowledge of PTSD symptomatology. This study aims to explore changes in network patterns of PTSD symptoms among youth survivors following the Zhouqu debris flow through a network approach. A two-year longitudinal study was conducted to follow 1460 children and adolescents at 3, 15, and 27 months after the disaster. Symptoms with high centrality varied at different time points. Sleep problems and nightmares exhibited high centrality at 3 months, and their centrality decreased over time, while the centrality of physiological cue reactivity and flashbacks increased over time and reached a high level at 27 months. The global connectivity of the network was stronger at 27 months than at 3 and 15 months. These findings provide novel insights into youths' PTSD symptom evolution. Temporal differences in PTSD symptoms merit more attention from researchers. Different core symptoms in acute and chronic PTSD structures should be treated as targets at different stages following trauma in clinical practice.

PTSD networks of veterans with combat versus non-combat types of index trauma

BACKGROUND

Network analysis has become popular among PTSD researchers for studying causal structure or interrelationships among symptoms. However, some have noted that results do not seem to be consistent across studies. Preliminary evidence suggests that trauma type may be one source of variability.

METHODS

The current study sought to examine the PTSD networks of veterans with combat versus non-combat index trauma. Participants included 944 veterans who completed the PTSD Checklist for DSM-5 at intake at two VA PTSD clinics.

RESULTS

There were many similarities between the combat and non-combat trauma networks, including strong edges between symptoms that were theoretically related or similar (e.g., avoidance) and negative emotion being a highly central symptom. However, correlations of edge weights (0.509) and node centrality (0.418) across networks suggested moderate correspondence, and there appeared to be some differences associated with certain symptoms. Detachment was relatively more central and the connections of negative emotion with blame and lack of positive emotion with reckless behavior were stronger for veterans with combat-related index trauma.

LIMITATIONS

The data were cross-sectional, which limits the ability to infer directional relationships between symptoms. In addition, the sample was likely not large enough to directly test for differences between networks via network comparison tests.

CONCLUSIONS

Although there were many similarities, results also suggested some variability in PTSD networks associated with combat versus non-combat index trauma that could have implications for conceptualizing and treating PTSD among veterans.

An exploration of the DSM-5 posttraumatic stress disorder symptom latent variable network

BACKGROUND

Both the latent variable model and the network model have been widely used to conceptualize mental disorders. However, it has been pointed out that there is no clear dichotomy between the two models, and a combination of these two model could enable a better understanding of psychopathology. The recently proposed latent network model (LNM) has provided a statistical framework to enable this combination. Evidence has shown that posttraumatic stress disorder (PTSD) could be a suitable candidate disorder to study the combined model. In the current study, we initiated the first investigation of the latent network of PTSD symptoms.

METHODS

The latent network of DSM-5 PTSD symptoms was estimated in 1196 adult survivors of China's 2008 Wenchuan earthquake. Validation testing of the latent network was conducted in a replication sample of children and adolescent who experienced various trauma types. PTSD symptoms were measured by the PTSD Checklist for DSM-5 (PCL-5). The latent network was estimated using the seven-factor hybrid model of DSM-5 PTSD symptoms, analysed using the R package lvnet.

RESULTS

The latent network model demonstrated good fit in both samples. A strong weighted edge between the intrusion and avoidance dimensions was identified (regularized partial correlation = 0.75). The externalizing behaviour dimension demonstrated the highest centrality in the latent network.

CONCLUSIONS

This study is the first to investigate the latent network of DSM-5 PTSD symptoms. Results suggest that both latent symptom dimension and associations between the dimensions should be considered in future PTSD studies and clinical practices.

A network analysis of posttraumatic stress disorder and dissociation in trauma-exposed adolescents

Posttraumatic stress disorder (PTSD) and dissociation have long been recognized to co-occur, leading the DSM-5 to introduce a dissociative subtype of PTSD into its nomenclature. Most research to date on the dissociative subtype has focused on adults. The current study aimed to extend this research to an adolescent sample and to examine symptom-level associations between PTSD and dissociation using network analysis. The analysis was conducted with 448 trauma-exposed detained US adolescents (24.55% female; mean age 15.98 ± 1.25 years). A network consisting of 20 DSM-5 PTSD symptoms was constructed, followed by a network consisting of 20 PTSD symptoms and five dissociative items. Expected influence bridge centrality was estimated to examine items with the most/strongest cross-construct connections (i.e. between PTSD and dissociation). The PTSD symptoms concentration problems, amnesia and recurrent memories and the dissociative items depersonalization, derealisation and can't remember things that happened had the highest bridge centrality values. These symptom-level associations extend our understanding of the PTSD-dissociation relationship by pointing to specific symptoms of PTSD and dissociation that may drive the co-morbidity between the two constructs. These findings may inform future intervention efforts.

Identifying predictors of probable posttraumatic stress disorder in children and adolescents with earthquake exposure: A longitudinal study using a machine learning approach

BACKGROUND

Evidence has identified risk factors associated with individuals with trauma exposure who develop posttraumatic stress disorder (PTSD). How to combine risk factors to predict probable PTSD in young survivors using machine learning is limited. The study aimed to integrated multiple measures at 2 weeks after the earthquake using machine learning for the prediction of probable PTSD at 3 months after earthquake.

METHODS

A total of 2099 young survivors with earthquake exposure were included. We integrated multiple domains of variables to 'train' a machine learning algorithm (XGBoost). Thirty-one combination types were implemented and evaluated. The resulting XGBoost was utilized in identifying individual participants as either probable PTSD or no PTSD.

RESULTS

Any combination type predicted young survivor probable PTSD, with prediction accuracies ranging between 66%-80% (p < 0.05). In particular, the combination of earthquake experience, everyday functioning, somatic symptoms and sleeping correctly predicted 683 out of 802 cases of probable PTSD, translating to a classical accuracy of 74.476% (85.156% sensitivity and 60.366% specificity) and an area under the curve of 0.80. The most relevant variables (e.g. age, sex, property loss and a sedentary lifestyle) revealed in the present study.

LIMITATIONS

Participants from a specific district might limit the generalizability of our results. Self-report questionnaires and non-standardized measures were used to assess symptoms.

CONCLUSION

Detection of probable PTSD according to self-reported measurement data is feasible, may improve operational efficiencies via enabling targeted intervention, before manifestation of symptoms.

The network approach to posttraumatic stress disorder: a systematic review

Background: The empirical literature of network analysis studies of posttraumatic stress symptoms (PTSS) has grown rapidly over the last years. Objective: We aimed to assess the characteristics of these studies, and if possible, the most and least central symptoms and the strongest edges in the networks of PTSS. Method: The present systematic review, conducted in PsycInfo, Medline, and Web of Science, synthesizes findings from 20 cross-sectional PTSS network studies that were accepted for publication between January 2010 and November 2018 (PROSPERO ID: CRD42018112825). Results: Results indicated that the network studies investigated a broad range of samples and that most studies used similar analytic approaches including stability analysis. Only strength centrality was generally adequately stable. Amnesia was consistently reported to have lowest strength, while there was substantial heterogeneity regarding which nodes had highest strength centrality. The strongest edge weights were typically within each DSM-IV/DSM-5 PTSD symptom cluster. Conclusions: Hypothesis-driven studies are needed to determine whether the heterogeneity in networks resulted from differences in samples or whether they are the product of underlying methodological reasons.

A Network Analysis of Post-traumatic Stress Disorder Symptoms and Correlates During the COVID-19 Pandemic

Background and Objective: The coronavirus disease 2019 (COVID-19) outbreak has been suggested as a collective trauma, which presents a continuing crisis. However, the specific post-traumatic implication of this crisis has not been adequately studied yet. The current study was aimed to ascertain the most central symptom and the strong connections between symptoms of post-traumatic stress disorder (PTSD). At the same time, exploring the relationship between covariates and the network of PTSD symptoms, by taking sex, anxiety, depression, suicidal ideation, quality of life, and social support as covariates, may help us to know the arise and maintenance of PTSD symptoms and give specified suggestions to people under the shadow of COVID-19. Method: The Post-traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), was used to assess the PTSD symptoms extent of 338 healthy participants over the past month. Networks were analyzed using state-of-the-art regularized partial correlation models. In addition, the centrality of the symptoms and the robustness of the results were analyzed. Results: The network analysis revealed that the especially strong connections emerged between avoidance of thoughts and avoidance of reminders, hypervigilance and exaggerated startle response, intrusive thoughts and nightmares, flashbacks and emotional cue reactivity, and detachment and restricted affect. The most central symptoms were self-destructive/reckless behavior. Incorporation of covariates into the network revealed the strong connections path between self-destructive/reckless behavior and loss of interest and depression. Conclusion: Self-destructive/reckless behavior was the most central symptom in the network of PTSD symptoms related to the COVID-19 pandemic, which as an important target of interfere may have great benefits.

Dysfunctional posttraumatic cognitions, posttraumatic stress and depression in children and adolescents exposed to trauma: a network analysis

BACKGROUND

The latest version of the International Classification of Diseases (ICD-11) proposes a posttraumatic stress disorder (PTSD) diagnosis reduced to its core symptoms within the symptom clusters re-experiencing, avoidance and hyperarousal. Since children and adolescents often show a variety of internalizing and externalizing symptoms in the aftermath of traumatic events, the question arises whether such a conceptualization of the PTSD diagnosis is supported in children and adolescents. Furthermore, although dysfunctional posttraumatic cognitions (PTCs) appear to play an important role in the development and persistence of PTSD in children and adolescents, their function within diagnostic frameworks requires clarification.

METHODS

We compiled a large international data set of 2,313 children and adolescents aged 6 to 18 years exposed to trauma and calculated a network model including dysfunctional PTCs, PTSD core symptoms and depression symptoms. Central items and relations between constructs were investigated.

RESULTS

The PTSD re-experiencing symptoms strong or overwhelming emotions and strong physical sensations and the depression symptom difficulty concentrating emerged as most central. Items from the same construct were more strongly connected with each other than with items from the other constructs. Dysfunctional PTCs were not more strongly connected to core PTSD symptoms than to depression symptoms.

CONCLUSIONS

Our findings provide support that a PTSD diagnosis reduced to its core symptoms could help to disentangle PTSD, depression and dysfunctional PTCs. Using longitudinal data and complementing between-subject with within-subject analyses might provide further insight into the relationship between dysfunctional PTCs, PTSD and depression.

The symptom representation of posttraumatic stress disorder in a sample of unaccompanied and accompanied refugee minors in Germany: a network analysis

Background: Given the unprecedented number of traumatized refugee minors in Europe and the increased prevalence of mental disorders such as PTSD in this vulnerable population, new methodologies that help us to better understand their symptomatology are crucial. Network analysis might help clinicians to both understand which symptoms might trigger other symptoms, and to identify relevant targets for treatment. However, to date only two studies have applied the network analysis approach to an (adult) refugee population and only three studies examined this approach in children and adolescents. Objective: The aim of this study is to explore the network structure and centrality of DSM-5 PTSD symptoms in a cross-sectional sample of severely traumatized refugee minors. Method: A total of N = 419 (M age = 16.3; 90.7% male) unaccompanied (79.9%) and accompanied (20.1%) refugee minors were recruited in five studies in southern Germany. PTSD symptoms were assessed using the Child and Adolescent Trauma Screen (CATS). The network was estimated using state-of-the-art regularized partial correlation models using the R-package qgraph. Results: The most central symptoms were nightmares, physiological and psychological reactivity, and concentration problems. The strongest connections between symptoms were established for psychological and physiological reactivity, irritability/anger and self-destructive/reckless behaviour, intrusions and nightmares, nightmares and sleep disturbance, and between concentrations problems and sleep disturbance. Conclusion: This study furnishes information relevant to research and the clinical management of PTSD in refugee minors, and also in terms of comparisons with trauma-exposed children and adolescents without a migration background. Re-experiencing symptoms seem to be central in the refugee minor PTSD profile and thus merit special consideration in the diagnostic and treatment evaluation process. Investigating the PTSD network longitudinally and complementing between-subject analyses with within-subject ones might provide further insight into the symptomatology of refugee minors and how to treat them successfully.

Posttraumatic Stress Disorder and executive dysfunction among children and adolescents: A Latent Profile Analysis

Background/Objective

The current study aimed to examine the relationship between Posttraumatic Stress Disorder (PTSD) symptoms and executive dysfunction in children and adolescents after psychological trauma.

Method

Participants were 13,438 of children and adolescents aged 6 to 18 years exposed to the 2008 Wenchuan earthquake. PTSD and dysexecutive symptoms were assessed using the UCLA PTSD Reaction Index for Children and the Self-Report Dysexecutive Questionnaire. Latent Profile Analysis (LPA) was conducted using Mplus version 7.4. Subgroup differences in trauma exposure and quality of life were calculated using ANCOVA.

Results

A 4-class parallel model was found to best describe latent PTSD symptom profiles and executive dysfunction. Individuals in higher symptom groups showed more trauma exposure and lower quality of life.

Conclusions

This LPA study shed light on the relationship between PTSD and executive dysfunction symptoms in children and adolescents. The correlation between PTSD and executive dysfunction was maintained after individual differences were taken into consideration. Our findings provide a new view on how PTSD relates to executive dysfunction and several suggestions for treating child and adolescent PTSD patients.

Network Analysis and Precision Rehabilitation for the Post-concussion Syndrome

Some people experience persistent symptoms following a mild traumatic brain injury (MTBI), and the etiology of those symptoms has been debated for generations. Post-concussion-like symptoms are caused by many factors both before and after MTBI, and this non-specificity is the bedrock of the conundrum regarding the existence of the post-concussion syndrome. A latent model or common cause theory for the syndrome is inconsistent with the prevailing biopsychosocial conceptualization. It is the thesis of this paper that adopting a network perspective for persistent symptoms following MTBI, including the post-concussion syndrome, could lead to new insights and targeted treatment and rehabilitation strategies. The network perspective posits that symptoms co-occur because they are strongly inter-related, activating, amplifying, and mutually reinforcing, not because they arise from a common latent disease entity. This approach requires a conceptual shift away from thinking that symptoms reflect an underlying disease or disorder toward viewing inter-related symptoms as constituting the syndrome or disorder. The symptoms do not arise from an underlying syndrome—the symptoms are the syndrome. A network analysis approach allows us to embrace heterogeneity and comorbidity, and it might lead to the identification of new approaches to sequenced care. The promise of precision rehabilitation requires us to better understand the interconnections among symptoms and problems so that we can produce more individualized and effective treatment and rehabilitation.

Commentary: Paediatric post-traumatic stress disorder from a neurodevelopmental network perspective: reflections on Weems et al. (2019)

Paediatric post-traumatic stress disorder (PTSD) is an incredibly heterogeneous and syndromic disorder that likely has a myriad of underlying neurobiological mechanisms at play. The disorder is even more complicated in youth, given that the expression of illness interacts with ongoing developmental processes. In their review in this issue, Weems and colleagues call for broader network-based approaches for studying the development and expression of PTSD in youth. In this commentary, I highlight some of the important knowledge gaps raised by Weems et al. and propose ways in which future studies may leverage network-based approaches for eventual translation into clinical care. Key concepts include the use of network-based approaches for understanding the emergence and maintenance of PTSD symptom architecture over development, identification of resilient and vulnerable patterns of symptom and brain network architecture following trauma, and consideration of how divergence between biological (e.g. brain) and chronological may inform our understanding of resilient and vulnerable patterns over development. Importantly, advancing and translating this work to clinical care will require larger, prospective studies assessing youth as early in development as possible, and integrating information across multiple research groups and sites.

Investigating systematic bias in brain age estimation with application to post-traumatic stress disorders

Brain age prediction using machine-learning techniques has recently attracted growing attention, as it has the potential to serve as a biomarker for characterizing the typical brain development and neuropsychiatric disorders. Yet one long-standing problem is that the predicted brain age is overestimated in younger subjects and underestimated in older. There is a plethora of claims as to the bias origins, both methodologically and in data itself. With a large neuroanatomical dataset (N = 2,026; 6-89 years of age) from multiple shared datasets, we show this bias is neither data-dependent nor specific to particular method including deep neural network. We present an alternative account that offers a statistical explanation for the bias and describe a simple, yet efficient, method using general linear model to adjust the bias. We demonstrate the effectiveness of bias adjustment with a large multi-modal neuroimaging data (N = 804; 8-21 years of age) for both healthy controls and post-traumatic stress disorders patients obtained from the Philadelphia Neurodevelopmental Cohort.