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Xu B, Kim S, Blais RK, Nadel M, Cai Q, Tanev KS. Longitudinal changes in the PTSD symptom network following trauma-focused treatment in military populations: Identifying central symptoms and the role of military sexual trauma. J Anxiety Disord 2024; 104:102872. [PMID: 38703664 DOI: 10.1016/j.janxdis.2024.102872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/25/2024] [Accepted: 04/29/2024] [Indexed: 05/06/2024]
Abstract
Posttraumatic stress disorder (PTSD) is a debilitating condition affecting military populations, with a higher prevalence compared to the general population. Despite the development of first-line trauma-focused treatments such as Cognitive Processing Therapy (CPT) and Prolonged Exposure Therapy (PE), a significant proportion of patients continue to experience persistent PTSD symptoms following treatment. This study utilized network analysis to explore the PTSD symptom network's dynamics pre- and post- trauma-focused treatment and investigated the role of military sexual trauma (MST) history in shaping the network. Network analysis is a novel approach that can guide treatment target areas. The sample was comprised of 1648 service members and veterans who participated in a two-week intensive PTSD treatment program, which included completion of evidenced-based individual therapy as well as skill-building focused group therapy. PTSD severity was assessed using the PTSD Checklist for DSM-5 at baseline and post-treatment. Network analyses revealed strong connections within symptom clusters, with negative emotions emerging as one of the most central symptoms. Interestingly, the symptom network's overall structure remained stable following treatment, whereas global strength significantly increased. MST history did not significantly impact the network's structure or its change relative to treatment. Future research should further examine whether targeting negative emotions optimizes PTSD treatment outcomes for military populations.
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Affiliation(s)
- Bingyu Xu
- Psychology Department, Arizona State University, Tempe, AZ, USA.
| | - Soyeong Kim
- Home Base: Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Rebecca K Blais
- Psychology Department, Arizona State University, Tempe, AZ, USA
| | - Molly Nadel
- Home Base: Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, USA
| | - Qiyue Cai
- Psychology Department, Arizona State University, Tempe, AZ, USA
| | - Kaloyan S Tanev
- Home Base: Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Karnick A, Caulfield NM, Buerke M, Stanley I, Capron D, Vujanovic A. Clinical and psychological implications of post-traumatic stress in firefighters: a moderated network study. Cogn Behav Ther 2024; 53:171-189. [PMID: 37960947 DOI: 10.1080/16506073.2023.2282374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/06/2023] [Indexed: 11/15/2023]
Abstract
Firefighters are frequently exposed to trauma and may experience a unique symptom presentation of post-traumatic stress. Prior research has identified stronger associations between certain post-traumatic stress symptoms (e.g. detachment, intrusions, physiological reactivity) using network analysis. However, little is known about the effects of symptom severity and emergency work-related trauma on symptom networks. The present study probed the network structure of post-traumatic stress symptoms in trauma-exposed firefighters (N = 871) to model the dynamic interactions of psychological symptoms. We developed a network of post-traumatic stress symptoms and a network of post-traumatic stress with clinical covariates and used moderated network modelling to assess the effects of having PTSD and experiencing work-related trauma on the networks. We identified high edge correlations between several nodes (e.g. startle/hypervigilance, internal/external cue avoidance, detachment/lack of interest) and high centrality of detachment, external cue avoidance, and flashbacks. Additionally, having PTSD moderated positive network associations between risk-taking and suicidality and between distorted blame and post-traumatic cognitions. Work-related trauma moderated negative associations between appetite gain and loss and appetite loss and suicidality. Findings suggest that targeting specific symptoms of detachment, external cue avoidance, and flashbacks could allow for the development of effective trauma-informed interventions for these populations.
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Affiliation(s)
- Aleksandr Karnick
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | | | | | - Ian Stanley
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Center for COMBAT Research, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel Capron
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Anka Vujanovic
- Department of Psychology, University of Houston, Houston, TX, USA
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Shelef L, Bechor U, Ohayon O, Tatsa-Laur L, Antonovsky A. The Psychological Impact of Exposure to Battle on Medics: A Cross-Sectional Study of Ex-Soldiers Who Sought Help From the IDF Combat Reaction Unit. Mil Med 2024; 189:e781-e788. [PMID: 37721515 DOI: 10.1093/milmed/usad368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/31/2023] [Accepted: 09/11/2023] [Indexed: 09/19/2023] Open
Abstract
INTRODUCTION The present study's central aim was to examine two questions: (1) Will there be differences in mental health outcomes between medics and non-medics who sought help at the Israeli Combat Reaction Unit (CRU)? (2) Will there be differences in mental health outcomes between combatants and non-combatants? MATERIALS AND METHODS This cross-sectional study included files of 1,474 Israeli Defense Forces ex-service members (89% combatants, of whom 13% were medics; 11% non-combatants, of whom 6% were medics), who filled out questionnaires on admission for evaluation at the CRU.Dependent variables were mental health measures and included two PTSD measures (Clinician-Administered PTSD Scale and PTSD Checklist for DSM-5), Beck Depression Inventory, Dissociative Experience Scale, and Brief Symptom Inventory. Military profession (medics vs. non-medics) and status (combatant vs. non-combatant) were the independent variables. Background variables were also examined. RESULTS We found no substantial differences between medics and non-medics in the mental health measures. When looking at combat and non-combat separately, the non-combat medics (CMs), in general, were in better mental health conditions than the other three groups- CMs, non-medic combatants, and non-medic non-combatants-all of whom had similar scores in the mental health measures. However, compared to the rest, non-CMs took considerably longer years before approaching the CRU. CONCLUSIONS The elapsed time to seek help for non-MCs was explained by their reluctance to seek help, not being combatants, and being medics who are portrayed as resilient. Recommendations for encouraging this subgroup to seek help were given.
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Affiliation(s)
- Leah Shelef
- The School of Social Work, Sapir Academic College, D. N. Hof Ashkelon 79165, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Uzi Bechor
- Department of Health and Well-Being, IDF Medical Corps, Israel Defense Forces, Ramat Gan 5262000, Israel
| | - Ofir Ohayon
- Department of Health and Well-Being, IDF Medical Corps, Israel Defense Forces, Ramat Gan 5262000, Israel
| | - Lucian Tatsa-Laur
- Department of Health and Well-Being, IDF Medical Corps, Israel Defense Forces, Ramat Gan 5262000, Israel
| | - Avishai Antonovsky
- Department of Health and Well-Being, IDF Medical Corps, Israel Defense Forces, Ramat Gan 5262000, Israel
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Zhu Z, Eli B, Chen Y, Liu Z. Symptom structure of posttraumatic stress disorder in workplace trauma: A "distraction-avoidance" pattern. J Clin Psychol 2024; 80:490-502. [PMID: 38050467 DOI: 10.1002/jclp.23626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 11/02/2023] [Accepted: 11/10/2023] [Indexed: 12/06/2023]
Abstract
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.
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Affiliation(s)
- Zhengqing Zhu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Buzohre Eli
- Department of Psychology, Normal College, Shihezi University, Shihezi, Xinjiang, China
| | - Yaru Chen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Zhengkui Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Hinchey LME, Grasser LR, Saad B, Gorski K, Pernice F, Javanbakht A. The Predictive Utility of Trauma Subtypes in the Assessment of Mental Health Outcomes for Persons Resettled as Refugees. J Immigr Minor Health 2023; 25:274-281. [PMID: 36260186 PMCID: PMC9991939 DOI: 10.1007/s10903-022-01407-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/24/2022]
Abstract
Pre-migration trauma, a psychological risk factor for refugees, is often measured using cumulative indices. However, recent research suggests that trauma subtypes, rather than cumulative trauma, may better predict psychological outcomes. This study investigated the predictive utility of trauma subtypes in the assessment of refugee mental health. Multiple regression was used to determine whether cumulative trauma or trauma subtypes explained more variance in depression, anxiety, and post-traumatic stress disorder (PTSD) symptom scores in 70 Syrian and Iraqi refugees. Subtype models performed better than cumulative trauma models for PTSD (cumulative R2 = 0.138; subtype R2 = 0.32), anxiety (cumulative R2 = 0.061; subtype R2 = 0.246), and depression (cumulative R2 = 0.041; subtype R2 = 0.184). Victimization was the only subtype significantly associated with PTSD (p < 0.001; r2 = 0.210), anxiety (p < 0.001; r2 = 0.162), and depression (p = 0.002; r2 = 0.140). Cumulative trauma was predictive of PTSD symptoms only (p = 0.003; r2 = 0.125). Trauma subtypes were more informative than cumulative trauma, indicating their utility for improving predictive efforts in research and clinical contexts.
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Affiliation(s)
- Liza Marie-Emilie Hinchey
- Department of Theoretical and Behavioral Foundations, Wayne State University, 5425 Gullen Mall Education Building, Room 351, Detroit, MI, 48202, USA.
| | - Lana Ruvolo Grasser
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, 3901 Chrysler Service Dr., Detroit, MI, 48201, USA
| | - Bassem Saad
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, 3901 Chrysler Service Dr., Detroit, MI, 48201, USA
| | - Kathleen Gorski
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, 3901 Chrysler Service Dr., Detroit, MI, 48201, USA
| | - Francesca Pernice
- Department of Theoretical and Behavioral Foundations, Wayne State University, 5425 Gullen Mall Education Building, Room 351, Detroit, MI, 48202, USA
| | - Arash Javanbakht
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, 3901 Chrysler Service Dr., Detroit, MI, 48201, USA
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Weygandt J, Moody M, Sajjadi NB, Greiner B, Ford AI, Mazur A, Hartwell M. Discontinuation and nonpublication of clinical trials for the pharmacologic treatment of posttraumatic stress disorder among military veterans. J Trauma Stress 2023; 36:325-332. [PMID: 36787385 DOI: 10.1002/jts.22911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 02/16/2023]
Abstract
Failures by researchers and clinicians to overcome barriers in veteran health-related research may result in clinical trial (CT) discontinuation and nonpublication. Such outcomes are a waste of limited academic resources. To determine rates of discontinuation and nonpublication among CTs for posttraumatic stress disorder (PTSD) with pharmaceutical interventions specific to the veteran population, we performed a systematic search of registered trials in ClinicalTrials.gov for pharmaceutical interventions for the treatment of PTSD. Extracted study characteristics included sample size, study design, trial status, phase, and funding source. Studies were classified as completed or discontinued based on the status listed in ClinicalTrials.gov. Descriptive statistics of trials were reported, and associations of trial termination and nonpublication were assessed using logistic regression. The final sample included 54 CTs, 15 of which (27.8%) had not been published within the FDA's required timeframe, and 11 (20.4%) were discontinued. The total number of trial participants was 3,463, with a median of 37 (interquartile range: 15-92). Of the 54 trials, 12 (22.2%) were nonrandomized, and 42 (77.8%) were randomized. There were 25 (46.3%) trials that were in either Phase 3 or Phase 4, and 39 (72.2%) were government-funded. We found high rates of CT discontinuation and nonpublication among PTSD pharmaceutical intervention studies in veterans, as has been shown in other fields of research.
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Affiliation(s)
- Jonas Weygandt
- Oklahoma State University Center for Health Sciences, Office of Medical Student Research, Tulsa, Oklahoma, USA
| | - Morgan Moody
- Oklahoma State University Center for Health Sciences, Office of Medical Student Research, Tulsa, Oklahoma, USA
| | - Nicholas B Sajjadi
- Oklahoma State University Center for Health Sciences, Office of Medical Student Research, Tulsa, Oklahoma, USA
| | - Benjamin Greiner
- University of Texas Medical Branch, Department of Internal Medicine, Galveston, Texas, USA
| | - Alicia Ito Ford
- Oklahoma State University Center for Health Sciences, College of Osteopathic Medicine, Department of Psychiatry and Behavioral Sciences, Tulsa, Oklahoma, USA
| | - Anna Mazur
- Oklahoma State University Center for Health Sciences, College of Osteopathic Medicine, Department of Psychiatry and Behavioral Sciences, Tulsa, Oklahoma, USA
| | - Micah Hartwell
- Oklahoma State University Center for Health Sciences, Office of Medical Student Research, Tulsa, Oklahoma, USA.,Oklahoma State University Center for Health Sciences, College of Osteopathic Medicine, Department of Psychiatry and Behavioral Sciences, Tulsa, Oklahoma, USA
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An exploration of the antecedents and mechanisms causing athletes' stress and twisties symptom. Heliyon 2022; 8:e11040. [PMID: 36276731 PMCID: PMC9583172 DOI: 10.1016/j.heliyon.2022.e11040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 04/07/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
Research background Twisties symptoms have attracted the world's attention in the sports field since the 2020 Tokyo Olympics. Aim However, studies on the symptoms and causes, inducing mechanisms, and relationships between DP/DR (Depersonalization/Derealization Disorder) and anxiety and depression for athletes have been sparse for both the general population and athletes. The literature on the twisties issue of athletes is quite scarce in the past. Research method Adopting the criteria appealing to PRISMA Items to review the subject twisties in a broader mode and combing with the IPO (Input-Process-Output) model for triangulation testing purpose, this study categorized the literature to explore input variables causing athletes’ twisties and identified process variables in psychological mechanisms bridging suppression and finally discussed the existing possible ways in helping athletes to solve problems caused by twisties. Results The authors formed 6 propositions in summarizing twisties' influential factors and mechanisms and tried to propose solutions to reduce the stress and the relevant twisties symptom of athletes. (1) Promotion of Athletes' Mental Toughness to Resist Stressors. (2) Interventions that correct for cognitive misinterpretations and appropriate relaxation and mindfulness practice in correcting a range of attention might reduce DP/DR. (3) Monitoring the athlete's HRV test results to ensure the Athlete's ability to resist pressure. (4) Avoid organizational stressors. (5) Written Emotional Disclosure method. (6) Improve various support systems for athletes: dual career paths. (7) Athletes' Stressful Awareness about the impact of gender, seniority, and environment. Conclusion Through the theoretical dialogue on the symptom of twisties, this study helps promote the development of the research of “twisties” and depersonalization-derealization symptoms (DDS); both have been under-researched.
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Stefanovic M, Ehring T, Wittekind CE, Kleim B, Rohde J, Krüger-Gottschalk A, Knaevelsrud C, Rau H, Schäfer I, Schellong J, Dyer A, Takano K. Comparing PTSD symptom networks in type I vs. type II trauma survivors. Eur J Psychotraumatol 2022; 13:2114260. [PMID: 36186163 PMCID: PMC9518442 DOI: 10.1080/20008066.2022.2114260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: Network analysis has gained increasing attention as a new framework to study complex associations between symptoms of post-traumatic stress disorder (PTSD). A number of studies have been published to investigate symptom networks on different sets of symptoms in different populations, and the findings have been inconsistent. Objective: We aimed to extend previous research by testing whether differences in PTSD symptom networks can be found in survivors of type I (single event; sudden and unexpected, high levels of acute threat) vs. type II (repeated and/or protracted; anticipated) trauma (with regard to their index trauma). Method: Participants were trauma-exposed individuals with elevated levels of PTSD symptomatology, most of whom (94%) were undergoing assessment in preparation for PTSD treatment in several treatment centres in Germany and Switzerland (n = 286 with type I and n = 187 with type II trauma). We estimated Bayesian Gaussian graphical models for each trauma group and explored group differences in the symptom network. Results: First, for both trauma types, our analyses identified the edges that were repeatedly reported in previous network studies. Second, there was decisive evidence that the two networks were generated from different multivariate normal distributions, i.e. the networks differed on a global level. Third, explorative edge-wise comparisons showed moderate or strong evidence for specific 12 edges. Edges which emerged as especially important in distinguishing the networks were between intrusions and flashbacks, highlighting the stronger positive association in the group of type II trauma survivors compared to type I survivors. Flashbacks showed a similar pattern of results in the associations with detachment and sleep problems (type II > type I). Conclusion: Our findings suggest that trauma type contributes to the heterogeneity in the symptom network. Future research on PTSD symptom networks should include this variable in the analyses to reduce heterogeneity.
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Affiliation(s)
| | - Thomas Ehring
- Department of Psychology, LMU Munich, Munich, Germany
| | | | - Birgit Kleim
- Department of Psychology, University of Zurich, Zurich, Switzerland.,Outpatient Centre for Specific Psychotherapy, Psychiatric University Hospital, Zurich, Switzerland
| | - Judith Rohde
- Outpatient Centre for Specific Psychotherapy, Psychiatric University Hospital, Zurich, Switzerland
| | | | - Christine Knaevelsrud
- Department of Clinical Psychology and Psychotherapy, Free University Berlin, Berlin, Germany
| | - Heinrich Rau
- Psychotrauma Centre, German Armed Forces Hospital Berlin, Berlin, Germany
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Schellong
- Department of Psychotherapy and Psychosomatic Medicine, Technical University Dresden, Dresden, Germany
| | - Anne Dyer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
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Eli B, Liang Y, Chen Y, Huang X, Liu Z. Symptom structure of posttraumatic stress disorder after parental bereavement - a network analysis of Chinese parents who have lost their only child. J Affect Disord 2021; 295:673-680. [PMID: 34509783 DOI: 10.1016/j.jad.2021.08.123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/24/2021] [Accepted: 08/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The death of a child is a highly traumatic event and often leads to mental health problems, including posttraumatic stress disorder (PTSD). Previous studies have focused on overall PTSD after the loss of an only child; however, little attention has been given to PTSD at the symptom level. This study aims to identify the network structure of PTSD symptoms in bereaved parents who have lost their only child, known as Shidu parents in Chinese society. METHODS A cross-sectional study enrolled 385 bereaved individuals who had lost an only child across 10 cities in China from November 2016 to July 2017. PTSD symptoms were measured by the PTSD Checklist for DSM-5 (PCL-5). Network analysis was implemented by using the R packages qgraph and bootnet. RESULTS The PTSD network revealed that diminished interest, exaggerated startle, irritability/anger, and nightmares were the most central symptoms. The strongest connections emerged between the symptoms of recurrent thoughts and nightmares, irritability/anger and reckless/self-destructive behavior, and hypervigilance and exaggerated startle. LIMITATIONS We utilized cross-sectional data, and it is therefore not possible to infer the evolution of the symptom network over time. In addition, participants were limited to parents who had lost an only child, and the findings of this study must be interpreted with caution. CONCLUSIONS The current study provides further clarity regarding how PTSD symptoms relate to each other in bereaved parents who have lost an only child. Symptoms with high centrality and connectedness may be viable targets for intervention in bereaved parents who have lost an only child.
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Affiliation(s)
- Buzohre Eli
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yiming Liang
- School of Psychology and Cognitive Science, East China Normal University, Shanghai 200062, China
| | - Yaru Chen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Xin Huang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Zhengkui Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China.
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