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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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Pollmann Y, Clancy KJ, Devignes Q, Ren B, Kaufman M, Rosso IM. Ecological Momentary Assessments of Trauma-Related Intrusive Memories: Potential Clinical Utility. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.15.24307377. [PMID: 38798682 PMCID: PMC11118638 DOI: 10.1101/2024.05.15.24307377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
As the global prevalence of trauma rises, there is a growing need for accessible and scalable treatments for trauma-related disorders like posttraumatic stress disorder (PTSD). Trauma-related intrusive memories (TR-IMs) are a central PTSD symptom and a target of exposure-based therapies, gold-standard treatments that are effective but resource-intensive. This study examined whether a brief ecological momentary assessment (EMA) protocol assessing the phenomenology of TR-IMs could reduce intrusion symptoms in trauma-exposed adults. Participants (N=131) experiencing at least 2 TR-IMs per week related to a DSM-5 criterion A trauma completed a 2-week EMA protocol during which they reported on TR-IM properties three times per day, and on posttraumatic stress symptoms at the end of each day. Longitudinal symptom measurements were entered into linear mixed-effects models to test the effect of Time on TR-IMs. Over the 2-week EMA protocol, intrusion symptom severity (cluster B scores) significantly declined (t = -2.78, p = 0.006), while other symptom cluster scores did not significantly change. Follow-up analyses demonstrated that this effect was specific to TR-IMs (t = -4.02, p < 0.001), and was not moderated by survey completion rate, total PTSD symptom severity, or ongoing treatment. Our findings indicate that implementing an EMA protocol assessing intrusive memories could be an effective trauma intervention. Despite study limitations like its quasi-experimental design and absence of a control group, the specificity of findings to intrusive memories argues against a mere regression to the mean. Overall, an EMA approach could provide a cost-effective and scalable treatment option targeting intrusive memory symptoms.
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Schumacher L, Echterhoff J, Zindler A, Barthel D. Depression among refugee youth in an outpatient healthcare center-prevalence and associated factors. Front Psychiatry 2024; 15:1367799. [PMID: 38707619 PMCID: PMC11067052 DOI: 10.3389/fpsyt.2024.1367799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/26/2024] [Indexed: 05/07/2024] Open
Abstract
Background Due to armed conflict and other crises, many children worldwide have to flee their home country and are, consequently, at a high risk for mental health problems. Objective As the majority of previous research on refugee minors focused on post-traumatic stress disorder (PTSD), we aimed to assess the prevalence and risk factors for depression in a clinical sample of refugee youth. Methods Data were collected during the standard diagnostic process in an outpatient refugee clinic in Germany. We assessed the prevalence of depression based on a diagnostic interview and investigated the association between age, gender, duration of flight, accompanying status, number of interpersonal traumatic experiences, residence status, and PTSD diagnosis with a depression diagnosis. More specifically, we conducted a Bayesian logistic regression with these associated factors as predictors and the presence of depression as the outcome. Additionally, we conducted a Bayesian network analysis including all these variables. Results The majority of the 575 included refugee children were male (n = 423, 73.6%) and, on average, 15.1 years old (SD = 2.69). Nearly half of the children (n = 243, 42.3%) met the diagnostic criteria for depression, of which most also showed a comorbid PTSD diagnosis. We found strong evidence that age, gender, number of traumatic experiences, and a diagnosis of PTSD were related to depression. The network analysis indicated that only age, gender, and PTSD were directly associated to depression. Flight-related factors were only indirectly associated with depression due to their associations with number of traumatic experiences and PTSD diagnosis. Conclusion The high prevalence of depression and its strong associations with PTSD suggest that refugee minors are likely to experience depressive symptoms which might develop from PTSD symptoms. This implies a need for monitoring depressive symptoms in refugee minors, especially when these have a PTSD diagnosis.
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Affiliation(s)
- Lea Schumacher
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jette Echterhoff
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Areej Zindler
- Outpatient Center GmbH, Refugee Outpatient Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dana Barthel
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Clancy KJ, Devignes Q, Ren B, Pollmann Y, Nielsen SR, Howell K, Kumar P, Belleau EL, Rosso IM. Spatiotemporal dynamics of hippocampal-cortical networks underlying the unique phenomenological properties of trauma-related intrusive memories. Mol Psychiatry 2024:10.1038/s41380-024-02486-9. [PMID: 38454081 DOI: 10.1038/s41380-024-02486-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 03/09/2024]
Abstract
Trauma-related intrusive memories (TR-IMs) possess unique phenomenological properties that contribute to adverse post-traumatic outcomes, positioning them as critical intervention targets. However, transdiagnostic treatments for TR-IMs are scarce, as their underlying mechanisms have been investigated separate from their unique phenomenological properties. Extant models of more general episodic memory highlight dynamic hippocampal-cortical interactions that vary along the anterior-posterior axis of the hippocampus (HPC) to support different cognitive-affective and sensory-perceptual features of memory. Extending this work into the unique properties of TR-IMs, we conducted a study of eighty-four trauma-exposed adults who completed daily ecological momentary assessments of TR-IM properties followed by resting-state functional magnetic resonance imaging (rs-fMRI). Spatiotemporal dynamics of anterior and posterior hippocampal (a/pHPC)-cortical networks were assessed using co-activation pattern analysis to investigate their associations with different properties of TR-IMs. Emotional intensity of TR-IMs was inversely associated with the frequency and persistence of an aHPC-default mode network co-activation pattern. Conversely, sensory features of TR-IMs were associated with more frequent co-activation of the HPC with sensory cortices and the ventral attention network, and the reliving of TR-IMs in the "here-and-now" was associated with more persistent co-activation of the pHPC and the visual cortex. Notably, no associations were found between HPC-cortical network dynamics and conventional symptom measures, including TR-IM frequency or retrospective recall, underscoring the utility of ecological assessments of memory properties in identifying their neural substrates. These findings provide novel insights into the neural correlates of the unique features of TR-IMs that are critical for the development of individualized, transdiagnostic treatments for this pervasive, difficult-to-treat symptom.
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Affiliation(s)
- Kevin J Clancy
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Quentin Devignes
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Boyu Ren
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, MA, USA
| | - Yara Pollmann
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, USA
| | - Sienna R Nielsen
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, USA
| | - Kristin Howell
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, USA
| | - Poornima Kumar
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Emily L Belleau
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Isabelle M Rosso
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, 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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Devignes Q, Ren B, Clancy KJ, Howell K, Pollmann Y, Martinez-Sanchez L, Beard C, Kumar P, Rosso IM. Trauma-related intrusive memories and anterior hippocampus structural covariance: an ecological momentary assessment study in posttraumatic stress disorder. Transl Psychiatry 2024; 14:74. [PMID: 38307849 PMCID: PMC10837434 DOI: 10.1038/s41398-024-02795-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 02/04/2024] Open
Abstract
Trauma-related intrusive memories (TR-IMs) are hallmark symptoms of posttraumatic stress disorder (PTSD), but their neural correlates remain partly unknown. Given its role in autobiographical memory, the hippocampus may play a critical role in TR-IM neurophysiology. The anterior and posterior hippocampi are known to have partially distinct functions, including during retrieval of autobiographical memories. This study aimed to investigate the relationship between TR-IM frequency and the anterior and posterior hippocampi morphology in PTSD. Ninety-three trauma-exposed adults completed daily ecological momentary assessments for fourteen days to capture their TR-IM frequency. Participants then underwent anatomical magnetic resonance imaging to obtain measures of anterior and posterior hippocampal volumes. Partial least squares analysis was applied to identify a structural covariance network that differentiated the anterior and posterior hippocampi. Poisson regression models examined the relationship of TR-IM frequency with anterior and posterior hippocampal volumes and the resulting structural covariance network. Results revealed no significant relationship of TR-IM frequency with hippocampal volumes. However, TR-IM frequency was significantly negatively correlated with the expression of a structural covariance pattern specifically associated with the anterior hippocampus volume. This association remained significant after accounting for the severity of PTSD symptoms other than intrusion symptoms. The network included the bilateral inferior temporal gyri, superior frontal gyri, precuneus, and fusiform gyri. These novel findings indicate that higher TR-IM frequency in individuals with PTSD is associated with lower structural covariance between the anterior hippocampus and other brain regions involved in autobiographical memory, shedding light on the neural correlates underlying this core symptom of PTSD.
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Affiliation(s)
- Quentin Devignes
- Center for Depression, Anxiety and Stress Disorders, McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Boyu Ren
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Psychiatric Biostatistics Laboratory, McLean Hospital, Belmont, MA, USA
| | - Kevin J Clancy
- Center for Depression, Anxiety and Stress Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kristin Howell
- Center for Depression, Anxiety and Stress Disorders, McLean Hospital, Belmont, MA, USA
| | - Yara Pollmann
- Center for Depression, Anxiety and Stress Disorders, McLean Hospital, Belmont, MA, USA
| | | | - Courtney Beard
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Poornima Kumar
- Center for Depression, Anxiety and Stress Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Isabelle M Rosso
- Center for Depression, Anxiety and Stress Disorders, McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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7
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Yuan GF, Liu C, Li X, Fung HW, Wong MYC, Lam SKK, An Y, Feng X. Hurting myself to cope: Using network analysis to understand the association between perceived stigma and non-suicidal self-injury functions among men who have sex with men in China. Arch Psychiatr Nurs 2024; 48:43-50. [PMID: 38453281 DOI: 10.1016/j.apnu.2024.01.005] [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: 02/14/2023] [Revised: 05/04/2023] [Accepted: 01/05/2024] [Indexed: 03/09/2024]
Abstract
Prior studies have demonstrated that perceived stigma is robustly associated with risky and life-threatening behaviors, including non-suicidal self-injury (NSSI), among men who have sex with men (MSM). However, studies regarding the relationship between perceived stigma and NSSI are limited. The present study aimed to investigate the network structure of perceived stigma and NSSI functions, along with bridge nodes, to elucidate how they co-exist. A sample of 2610 Chinese MSM (mean age = 23.99, age range: 18-68 years) was recruited from an online survey platform. All participants completed a web-based survey with measures of perceived stigma and NSSI functions. Results indicated that 'negative attitudes towards homosexuality' and 'disappointment in gay son' were identified as the most central nodes in the perceived stigma network, whereas 'seeking attention' and 'influencing others to change' ranked highest on centrality in the NSSI network. Two bridge connections were exhibited within the combined perceived stigma and NSSI network model: 'unwelcoming in public' and 'avoiding unpleasant tasks' from perceived stigma and NSSI communities, respectively. This is among the first studies investigating the co-occurrence between perceived stigma and NSSI from the network approach. Our findings provide an empirically-based perspective on the importance of family- and community-based interventions, with potential clinical implications for reducing NSSI among sexual and gender minority groups.
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Affiliation(s)
- Guangzhe Frank Yuan
- School of Education Science, Leshan Normal University, Leshan, China; Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Caimeng Liu
- School of Education Science, Leshan Normal University, Leshan, China.
| | - Xiaoming Li
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Hong Wang Fung
- Department of Social Work, Faculty of Social Sciences, The Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Ming Yu Claudia Wong
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong
| | - Stanley Kam Ki Lam
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong
| | - Yuanyuan An
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.
| | - Xueyou Feng
- Center for Mental Health Education and Counseling, Guangzhou College of Commerce, Guangzhou, China
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Stiltner B, Fischer IC, Duek O, Polimanti R, Harpaz-Rotem I, Pietrzak RH. Evaluating a novel 8-factor dimensional model of PTSD in U.S. military veterans: Results from the National Health and Resilience in Veterans Study. J Affect Disord 2024; 346:303-307. [PMID: 37979626 DOI: 10.1016/j.jad.2023.11.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/16/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Accumulating data suggest that the structure of posttraumatic stress disorder (PTSD) symptoms may be more nuanced than proposed by prevailing nosological models. Emerging theory further suggests that an 8-factor model with separate internally- (e.g., flashbacks) and externally- (e.g., trauma cue-related emotional reactivity) generated intrusive symptoms may best represent PTSD symptoms. To date, however, scarce research has evaluated the fit of this model and whether index traumas are differentially associated with it in populations at high risk for trauma exposure, such as military veterans. METHODS Data were analyzed from a nationally representative sample of 3847 trauma-exposed U.S. veterans who participated in the National Health and Resilience in Veterans Study. Confirmatory factor analyses were conducted to evaluate the fit of a novel 8-factor model of PTSD symptoms relative to 4-factor DSM-5 and empirically-supported 7-factor hybrid models. RESULTS The 8-factor model fit the data significantly better than the 7-factor hybrid and 4-factor DSM-5 models. Combat exposure and harming others were more strongly associated with internally-generated intrusions, while interpersonal violence and disaster/accident showed stronger significant associations with externally-generated intrusions. LIMITATIONS The 8-factor model requires validation in non-veteran and more diverse trauma-exposed populations, as well as with clinician-administered interviews. CONCLUSIONS Results of this study provide support for a novel 8-factor model of PTSD symptoms that is characterized by separate internally- and externally-generated intrusions. They also suggest that certain index traumas may lead to differential expression of these symptoms.
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Affiliation(s)
- Brendan Stiltner
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ian C Fischer
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Or Duek
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Epidemiology, Biostatistics and Community Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Israel
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ilan Harpaz-Rotem
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.
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Rosencrans PL, Zoellner LA, Feeny NC. A network approach to posttraumatic stress disorder: Comparing interview and self-report networks. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2024; 16:340-346. [PMID: 34672659 PMCID: PMC10225153 DOI: 10.1037/tra0001151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Trauma-related fear (e.g., reexperiencing), impaired reward (e.g., anhedonia), and interpersonal (e.g., detachment) processes may be functionally intertwined, giving rise to chronic psychopathology after a trauma. Network analyses can help pinpoint symptom drivers and treatment targets, but studies examining posttraumatic stress disorder (PTSD) treatment-seeking individuals are lacking. METHOD Treatment-seeking adults with primary PTSD (N = 350) completed interview and self-report measures of PTSD severity (PSS-I; PSS-SR). Self-report and interview-based networks were estimated and compared. RESULTS Both networks suggested distinct but interconnected communities of reexperiencing and dysphoric symptoms (e.g., interpersonal detachment, numbing). Centrality profiles were strongly associated across networks (rs = .71), with cued reexperiencing and interpersonal detachment showing strong centrality. Self-reported symptoms were more interconnected, suggesting lower specificity. CONCLUSIONS For those seeking treatment, interrelated fear and interpersonal processes may drive functional impairment in PTSD, and interview-based networks may help better delineate influential symptoms. Therapeutically, targeting cued reexperiencing and interpersonal detachment may facilitate broader symptom decreases. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | | | - Norah C Feeny
- Department of Psychological Sciences, Case Western Reserve University
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10
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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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Jin J, Yuan GF, An Y, Li X. Longitudinal Association Between Posttraumatic Stress Symptoms and Depression Symptoms Among Chinese Adolescents During COVID-19: Evidence from Network Perspective. Child Psychiatry Hum Dev 2024:10.1007/s10578-023-01650-6. [PMID: 38219268 DOI: 10.1007/s10578-023-01650-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/16/2024]
Abstract
Although there are an increasing number of studies that have explored the mental health consequences of COVID-19 focusing on revealing risk factors, the longitudinal research examining the potential mechanism of the co-occurrence of posttraumatic stress symptoms (PTSS) and depression symptoms among adolescents were scarce. The present study identified the important comorbidity symptoms and explored longitudinal relationship of PTSS and depression symptoms from the network perspective. A two-wave investigation (4 months interval; T1 and T2) was conducted with a sample of 1225 Chinese adolescents. Cross-sectional network and cross-lagged panel network (CLPN) analyses were adopted. Results showed that comorbidity symptoms consisted of both overlapping and non-overlapping symptoms, including "Future foreshortening" at T1 and T2 from PTSS, and "Hard to get started" at T1 and "Not sleep well" at T2 from depression symptoms. Strong longitudinal pathways appeared from all PTSS to depression symptoms, among which the pathway from "Difficulty concentrating" to "Hard to get started" was the strongest. These findings suggest that the possible comorbidity between PTSS and depression symptoms is caused by their independent and related structures, and their longitudinal association. Clinical intervention for these symptoms may alleviate adolescents' psychological problems in the aftermath of traumatic events.
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Affiliation(s)
- Jialu Jin
- School of Psychology, Nanjing Normal University, No. 122 Ninghai Road, Gulou District, Nanjing, 210097, People's Republic of China
| | - Guangzhe Frank Yuan
- School of Education Science, Leshan Normal University, No. 778 Binhe Road, Shizhong District, Leshan, 614000, People's Republic of China
| | - Yuanyuan An
- School of Psychology, Nanjing Normal University, No. 122 Ninghai Road, Gulou District, Nanjing, 210097, People's Republic of China.
| | - Xiaohui Li
- School of Family and Consumer Sciences, Northern Illinois University, DeKalb, USA
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Yuan GF, Qiao S, Li X. Bridging internalized HIV stigma and depressive symptoms among people living with HIV in China during the COVID-19 pandemic: a network analysis. Front Public Health 2024; 11:1306414. [PMID: 38249397 PMCID: PMC10796684 DOI: 10.3389/fpubh.2023.1306414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024] Open
Abstract
Previous research has documented that HIV-related stigma may be a significant trigger of mental health problems among people living with HIV (PLWH). However, less is known about how internalized HIV stigma is linked to depressive symptoms among PLWH during the COVID-19 pandemic. The current study sought to explore the network structure of internalized HIV stigma and depressive symptoms, along with bridge nodes, to elucidate how they co-exist. Participants were 1,197 Chinese PLWH (64.3% male, Mage = 41.52, SD = 9.20) who completed the measurements of internalized HIV stigma and depressive symptoms during the early phase of the COVID-19 outbreak (May 2020). Results revealed that "ashamed of having HIV" was identified as the most central nodes in the internalized HIV stigma network, whereas "mind wandered during tasks" ranked highest on centrality in the depressive symptoms network. Two bridge connections were exhibited within the combined internalized HIV stigma and depressive symptoms network model: "inferiority due to HIV" and "gloomy feelings" from internalized HIV stigma and depressive symptoms communities, respectively. This study is one of the first to examine the co-occurrence of internalized HIV stigma and depressive symptoms in the context of the COVID-19 pandemic using a network approach. These findings have potential clinical implications for mitigating depressive symptoms in populations facing socioeconomic disadvantage and vulnerability.
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Affiliation(s)
- Guangzhe F. Yuan
- School of Education Science, Leshan Normal University, Leshan, Sichuan, China
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Shan Qiao
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Xiaoming Li
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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13
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He Y, Wu C, LeMoult J, Huang J, Zhao Y, Liang K, Chen S, Wang E, Huang L, Chi X. Exploring symptom-level associations between anxiety and depression across developmental stages of adolescence: a network analysis approach. BMC Psychiatry 2023; 23:941. [PMID: 38093232 PMCID: PMC10720222 DOI: 10.1186/s12888-023-05449-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Anxiety and depression often co-occur during adolescence, but the associations between symptoms of these two disorders in this developmental period are not yet fully understood. Network analysis provides a valuable approach to uncover meaningful associations among symptoms and offers insights for prevention and intervention strategies. This study aimed to investigate symptom-level associations between anxiety and depression using network analysis and to identify core symptoms, bridge symptoms, and differences in network structure across different stages of adolescence. METHODS The cross-sectional study was conducted in March 2022 in Shenzhen, China. Participants completed the Generalized Anxiety Disorder Scale-7 and Patient Health Questionnaire Depression Scale, along with demographic questionnaires assessing age and gender. Chinese adolescents aged 10 to 17 who were in Grades 5 or 6 of elementary school, Grades 1 or 2 of middle school, or Grades 1 or 2 of high school, and who could comprehensively understand and read Chinese were recruited as participants. Students in Grade 3 of middle and high schools were excluded due to their upcoming high school or college entrance examinations. Based on age, participants were categorized into early, middle, and late developmental stages of adolescence. RESULTS "Loss of control" was among the most central symptoms in the comorbidity network throughout all three developmental stages; "excessive worry" and "anhedonia" emerged as the core symptoms in early adolescence, and "restlessness" as the core symptom in late adolescence. "Anhedonia," "sad mood," and "fatigue" were identified as bridge symptoms between anxiety and depression across all three developmental stages of adolescence. The global strength of the network in middle adolescence was significantly higher compared to the other two stages. CONCLUSION These findings highlight the core and bridge symptoms that require special attention and intervention at each stage of adolescence. Moreover, significantly higher network connectivity in middle adolescence suggests this is a critical period for intervention to prevent the development of comorbid mental disorders.
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Affiliation(s)
- Yunhan He
- School of psychology, Shenzhen University, No. 3688, Nanhai Avenue, Nanshan District, Shenzhen, Guangdong, 518060, China
- The Shenzhen Humanities & Social Sciences Key Research Bases of the Center for Mental Health, Shenzhen, China
| | - Chengrui Wu
- Graduate School of Education, University of Pennsylvania, Philadelphia, PA, USA
- Department of Applied Social Science, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Joelle LeMoult
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Jiasheng Huang
- Department of Psychology, Sun Yat-sen University, Guangzhou, China
| | - Yue Zhao
- School of psychology, Shenzhen University, No. 3688, Nanhai Avenue, Nanshan District, Shenzhen, Guangdong, 518060, China
- The Shenzhen Humanities & Social Sciences Key Research Bases of the Center for Mental Health, Shenzhen, China
| | - Kaixin Liang
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macau, China
| | - Shiyun Chen
- Department of Applied Social Science, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Enna Wang
- School of Psychology, Northwest Normal University, Lanzhou, China
| | - Liuyue Huang
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macau, China
| | - Xinli Chi
- School of psychology, Shenzhen University, No. 3688, Nanhai Avenue, Nanshan District, Shenzhen, Guangdong, 518060, China.
- The Shenzhen Humanities & Social Sciences Key Research Bases of the Center for Mental Health, Shenzhen, China.
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14
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Baker LD, Ponder WN, Carbajal J, Galusha JM, Hidalgo JE, Price M. Mapping PTSD, depression, and anxiety: A network analysis of co-occurring symptoms in treatment-seeking first responders. J Psychiatr Res 2023; 168:176-183. [PMID: 37913744 DOI: 10.1016/j.jpsychires.2023.10.038] [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: 04/17/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023]
Abstract
First responders are at high risk for a range of co-occurring mental health conditions due to their repeated exposure to traumatic events. When first responders present for treatment, their complex presentation of symptoms including posttraumatic stress disorder (PTSD), depression, and generalized anxiety disorder (GAD) can prove challenging to differentiate for clinical purposes. Network analysis provides a means to identify the nuanced associations between the symptoms of these conditions and to identify groups of related symptoms. In this study, a treatment-seeking sample of first responders (N = 432) completed self-report measures of PTSD, depression, and GAD. Network analysis was used to identify symptom clusters within the sample. Our cross-sectional data yielded six empirically distinct communities: depression symptoms, GAD symptoms, and four communities comprising PTSD symptoms - intrusion and avoidance; irritability and aggression; negative affect; and arousal and sleep. Network associations underscore the heterogeneity of PTSD and also highlight overlapping and diverging symptoms of depression and GAD. These findings are discussed within the context of existing research on first responders, and recommendations for further study and treatment interventions are provided.
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Affiliation(s)
- Lucas D Baker
- Department of Mental Health Service, George E. Wahlen VA Medical Center, Salt Lake City, Utah, United States
| | | | - Jose Carbajal
- Stephen F. Austin State University, Nacogdoches, Texas, United States
| | | | - Johanna E Hidalgo
- Department of Psychological Science, University of Vermont, Burlington, Vermont, United States
| | - Matthew Price
- Department of Psychological Science, University of Vermont, Burlington, Vermont, United States
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15
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Liu A, Liu M, Ren Y, Lin W, Wu X. Exploring gender differences in the relationships among childhood maltreatment, PTSD, and depression in young adults through network analysis. CHILD ABUSE & NEGLECT 2023; 146:106503. [PMID: 37922615 DOI: 10.1016/j.chiabu.2023.106503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/16/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND AND OBJECTIVES College students who have experienced childhood maltreatment commonly exhibit adverse psychological consequences such as post-traumatic stress disorder (PTSD) and depression. The aim of this study is to use network analysis to investigate the gender differences in complex connections among various types of childhood maltreatment, PTSD, and depression. METHODS This study involved 481 participants (M = 19.25 years, 54.5 % female) who were selected from a larger sample of 5231 college students. These participants had experienced childhood maltreatment and exhibited significant clinical symptoms of PTSD and depression. The participants completed validated measures that assessed childhood trauma, PTSD, and depression. RESULTS The network analysis performed on the entire sample revealed robust connections among various types of childhood maltreatment, symptom clusters of PTSD, and depression. The most central symptom that emerged was negative alterations in cognitions and mood (NACM), with emotional abuse displaying the highest centrality measure among the various types of childhood maltreatment. Upon comparing the subnetworks, the centrality analysis identified significant gender differences in nodes such as sexual abuse, physical neglect, emotional neglect, and avoidance. CONCLUSIONS The study's findings confirm that various forms of childhood abuse have intricate and multifaceted connections with depression and PTSD symptoms in adulthood. The study suggests that NACM could be the most significant symptom, and emotional abuse may play a vital role in adverse psychological outcomes. Furthermore, notable gender discrepancies were identified in the relationship between various forms of maltreatment and psychopathological symptoms.
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Affiliation(s)
- Aiyi Liu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Mingxiao Liu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Yizhen Ren
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Wenzhou Lin
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Xinchun Wu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing 100875, China.
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16
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Roland A, Windal M, Briganti G, Kornreich C, Mairesse O. Intensity and Network Structure of Insomnia Symptoms and the Role of Mental Health During the First Two Waves of the COVID-19 Pandemic. Nat Sci Sleep 2023; 15:1003-1017. [PMID: 38059205 PMCID: PMC10697149 DOI: 10.2147/nss.s432944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/07/2023] [Indexed: 12/08/2023] Open
Abstract
Purpose Insomnia, being a mental disorder, is best conceived as a network of symptoms. With the important increase in insomnia prevalence during the COVID-19 pandemic, our aim was to investigate how the structure of insomnia symptoms in the general population has changed due to the pandemic. We also looked at the directional dependencies of nightmares and of covid- and lockdown-related stress/anxiety and depression in insomnia. Patients and Methods 5986 persons replied to our online questionnaire for the first wave and 2843 persons to our second wave questionnaire. Both questionnaires included the Insomnia Severity Index (ISI). Regularized Gaussian Graphical Models (GGM) and Bayesian Directed Acyclic Graphs (DAG) were estimated. Results The pre- and peri-lockdown networks were equally strongly connected (first wave: S = 0.13, p = 0.39; second wave: S = 0.03, p = 0.67), but differed for the first lockdown regarding only six edges (M = 0.13, p < 0.001) and for the second lockdown only five edges (M = 0.16, p < 0.001). These symptoms all worsened during the lockdowns in comparison to before the pandemic (p < 0.001). The diurnal items of the ISI had the highest predictability and centrality values in the GGMs. Lockdown-related stress/anxiety influenced indirectly nightmares through covid-related stress/anxiety, lockdown-related depressive affect and mental fatigue. These reported feelings of stress/anxiety and depression showed an indirect impact on insomnia symptoms through mental and physical fatigue. Conclusion Though the lockdown slightly intensified insomnia symptoms, it did not alter their network structure. Despite their differences, both GGMs and DAGs agree that the diurnal symptoms of the ISI, play an essential role in the network structure. Both methods confirm the need for emphasizing the cognitive/affective component in the treatment of insomnia (ie cognitive behavioral therapy).
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Affiliation(s)
- Aurore Roland
- Brain, Body and Cognition, Department of Psychology, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels University Consultation Center, Department of Psychology, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Maxime Windal
- Brain, Body and Cognition, Department of Psychology, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Faculty of Psychology, Université Libre de Bruxelles, Brussels, Belgium
| | - Giovanni Briganti
- Laboratoire de Psychologie Médicale et Addictologie, CHU/UVC Brugmann, Brussels, Belgium
- Faculty of Medicine, Université libre de Bruxelles, Brussels, Belgium
- Faculty of Medicine, Université de Mons, Mons, Belgium
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Charles Kornreich
- Laboratoire de Psychologie Médicale et Addictologie, CHU/UVC Brugmann, Brussels, Belgium
- Faculty of Medicine, Université libre de Bruxelles, Brussels, Belgium
| | - Olivier Mairesse
- Brain, Body and Cognition, Department of Psychology, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels University Consultation Center, Department of Psychology, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Laboratoire de Psychologie Médicale et Addictologie, CHU/UVC Brugmann, Brussels, Belgium
- Vital Signs and PERformance Monitoring (VIPER), LIFE Department, Royal Military Academy, Brussels, Belgium
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Yun JY, Myung SJ, Kim KS. Associations among the workplace violence, burnout, depressive symptoms, suicidality, and turnover intention in training physicians: a network analysis of nationwide survey. Sci Rep 2023; 13:16804. [PMID: 37798353 PMCID: PMC10556140 DOI: 10.1038/s41598-023-44119-1] [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: 12/16/2022] [Accepted: 10/04/2023] [Indexed: 10/07/2023] Open
Abstract
Depression and anxiety are the most common mental disorders among physicians, who have a greater risk of suicide than those in other professional occupations. Relationships among a demanding workload, workplace violence, burnout, and intention to turnover have also been reported. The current study examined the principal components and propagating patterns of mental health and working environment interactions in training physicians. A total of 1981 training physicians completed online self-report questionnaires during September-October (midpoint of the training year) 2020. Regularized partial correlations in a mixed graphical model (MGM) and joint probability distributions (directed acyclic graph; DAG) were estimated for four subtypes of workplace violence (verbal abuse/physical violence perpetrated by clients/hospital staff), three burnout subdomains (Maslach Burnout Inventory), thoughts about quitting, and nine depressive symptoms, including suicidality, comprising the DSM-5 diagnostic criteria for major depressive disorder (assessed using the Patient Health Questionnaire-9). Thoughts of death/self-harm showed directional dependencies on the joint probability distributions of psychomotor agitation/retardation, concentration difficulty, self-reproach, and sadness in the DAG. In the MGM, a partial correlation with psychomotor agitation/retardation (r = 0.196) accounted for 56.5% of the variance in thoughts of death/self-harm. Partial correlations with concentration difficulties (r = 0.294), self-reproach (r = 0.257), changes in appetite (r = 0.184), and worker-on-worker physical violence (r = 0.240) in the MGM accounted for 54.4% of the variance in psychomotor agitation/retardation. Thoughts about quitting were partially correlated with and dependent upon the joint probability distributions of emotional exhaustion (r = 0.222), fatigue (r = 0.142), anhedonia (r = 0.178), and sadness (r = 0.237). In contrast, worker-on-worker (r = 0.417) and client-on-physician (r = 0.167) verbal abuse had regularized partial correlations with directional dependencies on thoughts about quitting. Organization-level interventions aiming to reduce the worker-on-worker violence and individual-level approaches of clinical screening program and psychiatric counseling clinic are required. Follow-up studies to verify the effectiveness of these interventions for training physicians are needed.
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Affiliation(s)
- Je-Yeon Yun
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Yeongeon Student Support Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun Jung Myung
- Office of Medical Education, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Kyung Sik Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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18
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Makale MT, Abbasi S, Nybo C, Keifer J, Christman L, Fairchild JK, Yesavage J, Blum K, Gold MS, Baron D, Cadet JL, Elman I, Dennen CA, Murphy KT. Personalized repetitive transcranial magnetic stimulation (prtms®) for post-traumatic stress disorder (ptsd) in military combat veterans. Heliyon 2023; 9:e18943. [PMID: 37609394 PMCID: PMC10440537 DOI: 10.1016/j.heliyon.2023.e18943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023] Open
Abstract
Emerging data suggest that post-traumatic stress disorder (PTSD) arises from disrupted brain default mode network (DMN) activity manifested by dysregulated encephalogram (EEG) alpha oscillations. Hence, we pursued the treatment of combat veterans with PTSD (n = 185) using an expanded form of repetitive transcranial magnetic stimulation (rTMS) termed personalized-rTMS (PrTMS). In this treatment methodology spectral EEG based guidance is used to iteratively optimize symptom resolution via (1) stimulation of multiple motor sensory and frontal cortical sites at reduced power, and (2) adjustments of cortical treatment loci and stimulus frequency during treatment progression based on a proprietary frequency algorithm (PeakLogic, Inc. San Diego) identifying stimulation frequency in the DMN elements of the alpha oscillatory band. Following 4 - 6 weeks of PrTMS® therapy in addition to routine PTSD therapy, veterans exhibited significant clinical improvement accompanied by increased cortical alpha center frequency and alpha oscillatory synchronization. Full resolution of PTSD symptoms was attained in over 50% of patients. These data support DMN involvement in PTSD pathophysiology and suggest a role in therapeutic outcomes. Prospective, sham controlled PrTMS® trials may be warranted to validate our clinical findings and to examine the contribution of DMN targeting for novel preventive, diagnostic, and therapeutic strategies tailored to the unique needs of individual patients with both combat and non-combat PTSD.
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Affiliation(s)
- Milan T. Makale
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA
| | - Shaghayegh Abbasi
- Department of Electrical Engineering, University of Portland, Portland, OR, 97203, USA
| | - Chad Nybo
- CrossTx Inc., Bozeman, MT, 59715, USA
| | | | | | - J. Kaci Fairchild
- Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
- Sierra Pacific Mental Illness Research, Education, and Clinical Center, VA Medical Center, Palo Alto, CA, 94304, USA
| | - Jerome Yesavage
- Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Kenneth Blum
- Division of Addiction Research & Education, Center for Sports, Exercise & Global Mental Health, Western University Health Sciences, Pomona, USA
- Department of Clinical Psychology and Addiction, Institute of Psychology, Faculty of Education and Psychology, Eötvös Loránd University, Hungary
- Department of Psychiatry, Wright University, Boonshoft School of Medicine, Dayton, OH, USA
- Department of Molecular Biology and Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Mark S. Gold
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - David Baron
- Division of Addiction Research & Education, Center for Sports, Exercise & Global Mental Health, Western University Health Sciences, Pomona, USA
| | - Jean Lud Cadet
- Molecular Neuropsychiatry Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | - Igor Elman
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Catherine A. Dennen
- Department of Family Medicine, Jefferson Health Northeast, Philadelphia, PA, USA
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Haws JK, Laifer LM, Acosta LM, Ralston AL, Ruggiero KJ, Davidson TM, Andrews AR. A Distinction Without a Difference? A Multi-Method Approach to Understanding PTSD and Depression Symptom Overlap Among Disaster-Exposed Adolescents. Res Child Adolesc Psychopathol 2023; 51:1021-1035. [PMID: 36881210 DOI: 10.1007/s10802-023-01042-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 03/08/2023]
Abstract
Among adolescents exposed to trauma, posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) commonly co-occur. Despite the prevalence of comorbidity, the question of how PTSD and MDD are related and appropriate conceptual models for understanding their linkage in adolescence remains unclear. This study applies a multi-methodological approach to advance conceptual and theoretical understanding of the overlap between PTSD and MDD diagnoses/symptoms. We tested three methodological approaches with three distinct theoretical underpinnings on the structure of each disorder proposed in the literature: confirmatory factor analysis (CFA) with dimensional constructs, latent class analysis (LCA) with person-based categorical constructs, and network analysis with symptom-to-symptom associations. Across the three different analytical approaches, there was a significant overlap between PTSD and MDD. Overall, there was no compelling evidence for distinct boundaries between disorders among trauma-exposed adolescents. Instead, we found considerable evidence that the typical latent-construct-based conceptualizations, whether categorical or dimensional, may need revision.
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Affiliation(s)
- James Kyle Haws
- Department of Family Medicine, and the Adult and Child Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, 13199 E. Montview Blvd, Suite 300, Aurora, CO, 80045, USA.
| | - Lauren M Laifer
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Laura M Acosta
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Allura L Ralston
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Kenneth J Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Tatiana M Davidson
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Arthur R Andrews
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
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20
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Suomi A, Bolton A, Pasalich D. The Prevalence of Post-Traumatic Stress Disorder in Birth Parents in Child Protection Services: Systematic Review and Meta-analysis. TRAUMA, VIOLENCE & ABUSE 2023; 24:1032-1046. [PMID: 34736361 DOI: 10.1177/15248380211048444] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Birth parents of children in the statutory child protection system have disproportionally high rates of trauma exposure and mental health problems, however, little is known about the extent to which this population display symptoms of Post-Traumatic Stress Disorder (PTSD) or Complex PTSD. This study provides a systematic review and meta-analysis of the PTSD rates in parent samples involved in the child protection services. METHOD Articles were identified by searching PSYCINFO, Medline, CINAHL, and PILOTS. The search included terminology pertaining to parents, trauma, and child protective services and we included all peer-reviewed articles that reported a valid measure of PTSD and child protection service involvement. RESULTS Fifteen studies were included in the review with a combined prevalence estimate for PTSD based on 11 studies (n = 4871) was 26.0% (95% CI 20.0-32.0%) for mothers, and estimate based on three studies (n = 2606) was 13.0% (95% CI 7.0%-18.0%) for fathers and 23.0% (95% CI 17.0-29.0) for all parents based on 7848 responses. Four studies that did not report prevalence rates, reported sample mean scores for PTSD that were consistently higher than in general population. Factors associated with parents' PTSD symptoms included mental health co-morbidities, victimization of physical and sexual violence, and perpetration of child abuse. CONCLUSION There are high rates of PTSD in parents involved in the protective system, thus more targeted efforts are needed to identify and adequately address trauma symptoms of parents as part of child protection interventions.
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Affiliation(s)
- Aino Suomi
- Institute of Child Protection Studies, 95359Australian Catholic University, Canberra, VIC, Australia
- Research School of Population Health, 2219Australian National University, Canberra, ACT, Australia
| | - Annalese Bolton
- Matilda Centre, University of Sydney, Sydney, NSW, Australia
- Forensic Psychology Clinic, 7800University of New South Wales, Sydney, NSW, Australia
| | - Dave Pasalich
- Research School of Psychology, 2219Australian National University, Canberra, ACT, Australia
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Yun JY, Yun YH. Health-promoting behavior to enhance perceived meaning and control of life in chronic disease patients with role limitations and depressive symptoms: a network approach. Sci Rep 2023; 13:4848. [PMID: 36964273 PMCID: PMC10039031 DOI: 10.1038/s41598-023-31867-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 03/20/2023] [Indexed: 03/26/2023] Open
Abstract
The association between health-related role limitations in the mental and physical subdomains and clinical status (i.e., chronic disease and comorbid depressive symptoms) is mediated by health-promoting behaviors. To enhance health-promoting behaviors in adults with chronic disease, it is necessary to identify item-level associations among targets of health-related monitoring and management. Therefore, the current study used a network approach to examine associations among health-related role limitations, depressive symptoms, existential well-being, socioeconomic position, and health-promoting behavior in adults with chronic disease. A total of 535 adults (mean ± SD age = 62.9 ± 11.9 years; males, n = 231, females, n = 304) who were regularly visiting an outpatient clinic for chronic disease treatment participated in this cross-sectional study. Data on participant demographics, chronic disease diagnoses, socioeconomic status, health-related role limitations (12-item short form survey scores), depressive symptoms (patient health questionnaire-9 scores), existential well-being (scores for four items of the McGill quality of life questionnaire-Revised), and health-promoting behavior (Healthy Habits Questionnaire scores) were acquired. "Undirected regularized partial correlations" and "directional joint probability distributions" among these variables were calculated using a mixed graphical model (MGM) and directed acyclic graph (DAG). In the MGM, the most influential nodes were emotional well-being, feelings of failure, and health-related limitations affecting usual role and physical activities. According to both the MGM and DAG, the relationship between emotional well-being and feelings of failure mediated the relationships of health-related role limitations with concentration difficulty and suicidal ideation. A positive mindset was dependent on the probability distributions of suicidal ideation, controllability of life, and positive self-image. Both the meaning of life and a positive mindset had direct associations with proactive living. Specifically, proactive living was associated with a balanced diet, regular exercise, volunteering in the community, and nurturing intimacy in social interactions. The meaning and controllability of life in individuals with chronic diseases could mediate the relationships of health-promoting behavior with health-related limitations related to usual role activities, physical activities, and depressive symptoms. Thus, interventions targeting health-promoting behaviors should aim to enhance the meaning and controllability of life (as it pertains to limitations in usual role and physical activities), as well as promote proactive screening and timely psychiatric treatment of depressive symptoms including feelings of failure, concentration difficulties, and suicidal ideation.
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Affiliation(s)
- Je-Yeon Yun
- Seoul National University Hospital, Seoul, Republic of Korea
- Yeongeon Student Support Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Ho Yun
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Family Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
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Sun Y, Zhang Y, Lu Z, Yan H, Guo L, Liao Y, Lu T, Wang L, Li J, Li W, Yang Y, Yu H, Lv L, Zhang D, Bi W, Yue W. Longitudinal Network Analysis Reveals Interactive Change of Schizophrenia Symptoms During Acute Antipsychotic Treatment. Schizophr Bull 2023; 49:208-217. [PMID: 36179110 PMCID: PMC9810008 DOI: 10.1093/schbul/sbac131] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND HYPOTHESIS Complex schizophrenia symptoms were recently conceptualized as interactive symptoms within a network system. However, it remains unknown how a schizophrenia network changed during acute antipsychotic treatment. The present study aimed to evaluate the interactive change of schizophrenia symptoms under seven antipsychotics from individual time series. STUDY DESIGN Data on 3030 schizophrenia patients were taken from a multicenter randomized clinical trial and used to estimate the partial correlation cross-sectional networks and longitudinal random slope networks based on multivariate multilevel model. Thirty symptoms assessed by The Positive and Negative Syndrome Scale clustered the networks. STUDY RESULTS Five stable communities were detected in cross-sectional networks and random slope networks that describe symptoms change over time. Delusions, emotional withdrawal, and lack of spontaneity and flow of conversation featured as central symptoms, and conceptual disorganization, hostility, uncooperativeness, and difficulty in abstract thinking featured as bridge symptoms, all showing high centrality in the random slope network. Acute antipsychotic treatment changed the network structure (M-test = 0.116, P < .001) compared to baseline, and responsive subjects showed lower global strength after treatment (11.68 vs 14.18, S-test = 2.503, P < .001) compared to resistant subjects. Central symptoms and bridge symptoms kept higher centrality across random slope networks of different antipsychotics. Quetiapine treatment network showed improvement in excitement symptoms, the one featured as both central and bridge symptom. CONCLUSION Our findings revealed the central symptoms, bridge symptoms, cochanging features, and individualized features under different antipsychotics of schizophrenia. This brings implications for future targeted drug development and search for pathophysiological mechanisms.
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Affiliation(s)
- Yaoyao Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, P. R. China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, P. R. China
| | - Yuyanan Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, P. R. China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, P. R. China
| | - Zhe Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, P. R. China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, P. R. China
| | - Hao Yan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, P. R. China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, P. R. China
| | - Liangkun Guo
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, P. R. China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, P. R. China
| | - Yundan Liao
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, P. R. China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, P. R. China
| | - Tianlan Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, P. R. China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, P. R. China
| | - Lifang Wang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, P. R. China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, P. R. China
| | - Jun Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, P. R. China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, P. R. China
| | - Wenqiang Li
- Henan Key Lab of Biological Psychiatry, Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, P. R. China
| | - Yongfeng Yang
- Henan Key Lab of Biological Psychiatry, Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, P. R. China
| | - Hao Yu
- Department of Psychiatry, Jining Medical University, Jining, Shandong, P. R. China
| | - Luxian Lv
- Henan Key Lab of Biological Psychiatry, Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, P. R. China
| | - Dai Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, P. R. China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, P. R. China
- PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
- Chinese Institute for Brain Research, Beijing, P. R. China
| | - Wenjian Bi
- Department of Medical Genetics, School of Basic Medical Sciences, Peking University, Beijing, P. R. China
| | - Weihua Yue
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, P. R. China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, P. R. China
- Henan Key Lab of Biological Psychiatry, Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, P. R. China
- PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
- Chinese Institute for Brain Research, Beijing, P. R. China
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Network analysis of distress, suicidality, and resilience in a treatment seeking sample of first responders. J Affect Disord 2023; 320:742-750. [PMID: 36179781 DOI: 10.1016/j.jad.2022.09.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 08/30/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION First responders are routinely and regularly exposed to traumatic events that can clinically manifest with a symptom constellation of posttraumatic stress disorder (PTSD), generalized anxiety, depression, and suicidality. METHODS We used network analysis to examine baseline data from treatment seeking first responders (n = 308) to examine the interrelatedness of those constructs, including a measure of resilience. We estimated two models: a regularized partial correlation network and a Bayesian Directed Acyclic Graph (DAG). RESULTS The models reveal converging evidence highlighting the central role of negative alterations in cognitions and mood PTSD cluster along with affective depression. These nodes did not significantly differ, though they were among the strongest in the partial correlation network and shared the most variance with the other nodes. The DAG results suggested that the negative alterations in cognitions and mood PTSD cluster predicted downstream constructs of affective depression; intrusion, hyperarousal, and avoidance PTSD clusters; and resilience. Only resilience and affective depression exhibited direct effects on suicidality. Both somatic depression and suicidality were endogenous endpoints in the DAG. Resilience exhibited an inverse path to suicide. However, resilience was relatively independent of the other constructs in the models and the DAG suggested that it was a consequence of PTSD related distress. LIMITATIONS The data is cross-sectional in nature that should be followed up in longitudinal studies. CONCLUSION Findings are discussed in respect to the role of distress and emotional dysregulation as common factors underlying a broad range of internalizing problems.
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Cheng P, Wang L, Zhou Y, Ma W, Zhao G, Zhang L, Li W. Post-traumatic stress disorder and depressive symptoms among firefighters: a network analysis. Front Public Health 2023; 11:1096771. [PMID: 37213609 PMCID: PMC10193951 DOI: 10.3389/fpubh.2023.1096771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 04/04/2023] [Indexed: 05/23/2023] Open
Abstract
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.
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Affiliation(s)
- Peng Cheng
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Lirong Wang
- Xiangya School of Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Ying Zhou
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Wenjing Ma
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Guangju Zhao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Li Zhang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Weihui Li
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- *Correspondence: Weihui Li,
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25
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Shi S, Almklov E, Afari N, Pittman JOE. Symptoms of major depressive disorder and post-traumatic stress disorder in veterans with mild traumatic brain injury: A network analysis. PLoS One 2023; 18:e0283101. [PMID: 37141223 PMCID: PMC10159137 DOI: 10.1371/journal.pone.0283101] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/01/2023] [Indexed: 05/05/2023] Open
Abstract
Mild Traumatic Brain Injury (mTBI, or concussion) is a debilitating condition that often leads to persistent cognitive and mental health problems post-injury. Post-traumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) are two most commonly occurring mental health problems following mTBI and are suggested to be strong contributors to the persistent post-concussion symptoms. Thus, it is important to understand the symptomatology of PTSD and MDD post-mTBI, to better inform targets for behavioral health interventions. Therefore, the current study examined the symptom structure of post-mTBI co-morbid PTSD and MDD through network approaches; we compared the network structure of participants with a positive mTBI screen (N = 753) to the network structure of participants with a negative mTBI screen (N = 2044); lastly, we examined a network of PTSD and MDD symptoms with clinical covariates in a positive mTBI sample. We found that feeling distant/cutoff (P10) and difficulty concentrating (P15) were the most central symptoms in the positive mTBI network and sleep problems were the most prominent bridge nodes across the disorders. No significant difference between the positive and negative mTBI network were found through network comparison tests. Moreover, anxiety and insomnia were strongly associated with sleep symptoms and irritability symptoms, and emotional support and resilience were potential buffers against most of the PTSD and MDD symptoms. The results of this study might be particularly useful for identifying targets (i.e., feeling distant, concentration and sleep problems) for screening, monitoring and treatment after concussion to better inform post-mTBI mental health care and to improve treatment outcomes.
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Affiliation(s)
- Shuyuan Shi
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Erin Almklov
- VA Center of Excellence for Stress and Mental Health, San Diego, CA, United States of America
- VA San Diego Healthcare System, San Diego, CA, United States of America
| | - Niloofar Afari
- VA Center of Excellence for Stress and Mental Health, San Diego, CA, United States of America
- VA San Diego Healthcare System, San Diego, CA, United States of America
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States of America
| | - James O E Pittman
- VA Center of Excellence for Stress and Mental Health, San Diego, CA, United States of America
- VA San Diego Healthcare System, San Diego, CA, United States of America
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States of America
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26
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Li W, Zhao YJ, Zhang SF, Yang B, Cheung T, Jackson T, Sha S, Xiang YT. Mapping post-traumatic stress disorder symptoms and quality of life among residents of Wuhan, China after the COVID-19 outbreak: A network perspective. J Affect Disord 2022; 318:80-87. [PMID: 36030998 PMCID: PMC9420032 DOI: 10.1016/j.jad.2022.08.074] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/06/2022] [Accepted: 08/22/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVES The Coronavirus Disease 2019 (COVID-19) outbreak may have a long-term impact on mental health in the general population. This study examined inter-relationships between post-traumatic stress disorder symptoms (PTSS) and quality of life (QOL) in Wuhan residents after the COVID-19 outbreak using network approach. METHODS A cross-sectional survey was conducted between May 25 and June 18, 2020. PTSS and QOL were measured using Chinese versions of the Post -Traumatic Stress Disorder Checklist - Civilian Version and the World Health Organization Quality of Life Questionnaire - brief version, respectively. RESULTS A total of 2598 participants were included. A network analysis revealed "Avoiding reminders", "Feeling emotionally numb", "Avoiding thoughts", "Hypervigilance", and "Reliving experiences" as the most central (influential) nodes in PTSS network models both before and after controlling for covariates. The connection between "Avoiding thoughts" and "Avoiding reminders" had the strongest edge. Three symptom communities were detected and can be summarized as "re-experiencing and avoidance", "negative changes in thinking and mood", and "hyperarousal". The bridge symptoms connecting PTSS and QOL were "Sleep disturbances", "Irritability", and "Loss of interest". LIMITATIONS Limitations included the cross-sectional study design, self-report measures in data collection, and lack of follow-ups beyond the initial phase of the pandemic. CONCLUSIONS PTSS were common among Wuhan residents even after the initial COVID-19 outbreak had passed. Attention should be paid to lingering symptoms of avoiding reminders, emotional numbness, avoiding thoughts, hypervigilance, and reliving experiences in treating PTSS related to the COVID-19 outbreak.
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Affiliation(s)
- Wen Li
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice China, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Yan-Jie Zhao
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao; Centre for Cognitive and Brain Sciences, University of Macau, Macao; Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao
| | - Shu-Fang Zhang
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, Hubei, China,; Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei province, China
| | - Bingxiang Yang
- School of Nursing, Wuhan University, Wuhan, Hubei, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong kong
| | - Todd Jackson
- Department of Psychology, University of Macau, Macao
| | - Sha Sha
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao; Centre for Cognitive and Brain Sciences, University of Macau, Macao; Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao.
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27
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Zhou J, Fan A, Zhou X, Pao C, Xiao L, Feng Y, Xi R, Chen Y, Huang Q, Dong B, Zhou J. Interrelationships between childhood maltreatment, depressive symptoms, functional impairment, and quality of life in patients with major depressive disorder: A network analysis approach. CHILD ABUSE & NEGLECT 2022; 132:105787. [PMID: 35917751 DOI: 10.1016/j.chiabu.2022.105787] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/22/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Childhood maltreatment continues to pose a great challenge to psychiatry. Although there is growing evidence demonstrating that childhood maltreatment is an important risk factor for depressive disorders, it remains to be elucidated which specific symptoms occur after exposure to different kinds of childhood maltreatment, and whether certain pathways may account for these associations. PARTICIPANTS AND SETTINGS A total of 203 adult patients (18-53 years old) with MDD, diagnosed by Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria, were recruited from the outpatient clinic of Beijing Anding Hospital, Capital Medical University. METHODS Childhood maltreatment, depressive symptoms, functional impairment, and quality of life were evaluated by the Childhood Trauma Questionnaire - Short Form (CTQ-SF), 17-item Hamilton Depression Rating Scale (HAMD-17), Sheehan Disability Scale (SDS), and Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF). Undirected network analysis was used to explore the most relevant connections between them. Bayesian network analysis was used to estimate a directed acyclic graph (DAG) while investigating the most likely direction of the putative causal association. RESULTS In network analysis, the strongest edges were a positive correlation between emotional abuse and suicidal behavior as well as a negative association between emotional neglect and age of onset. In DAG analysis, emotional abuse emerged as the most pivotal network node, triggering both suicidal behaviors and depression symptoms. CONCLUSIONS Emotional abuse appears to be an extremely harmful form of childhood maltreatment in the clinical presentation of depression. This study has promise in informing the clinical intervention of depression.
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Affiliation(s)
- Jia Zhou
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Anyuyang Fan
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xinyi Zhou
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Christine Pao
- Mental Health and Behavioral Science Service, Bruce W. Carter VA Medical Center, Miami, FL, United States
| | - Le Xiao
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yuan Feng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Rui Xi
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China; Beijing Institute of Mental Health, Beijing, China
| | - Yun Chen
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China; Beijing Institute of Mental Health, Beijing, China
| | - Qingzhi Huang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China; Beijing Institute of Mental Health, Beijing, China
| | - Bin Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China.
| | - Jingjing Zhou
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
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28
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Chen S, Bi K, Lyu S, Sun P, Bonanno GA. Depression and PTSD in the aftermath of strict COVID-19 lockdowns: a cross-sectional and longitudinal network analysis. Eur J Psychotraumatol 2022; 13:2115635. [PMID: 36186164 PMCID: PMC9518634 DOI: 10.1080/20008066.2022.2115635] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) are two highly comorbid psychological outcomes commonly studied in the context of stress and potential trauma. In Hubei, China, of which Wuhan is the capital, residents experienced unprecedented stringent lockdowns in the early months of 2020 when COVID-19 was first reported. The comorbidity between PTSD and MDD has been previously studied using network models, but often limited to cross-sectional data and analysis. Objectives: This study aims to examine the cross-sectional and longitudinal network structures of MDD and PTSD symptoms using both undirected and directed methods. Methods: Using three types of network analysis - cross-sectional undirected network, longitudinal undirected network, and directed acyclic graph (DAG) - we examined the interrelationships between MDD and PTSD symptoms in a sample of Hubei residents assessed in April, June, August, and October 2020. We identified the most central symptoms, the most influential bridge symptoms, and causal links among symptoms. Results: In both cross-sessional and longitudinal networks, the most central depressive symptoms included sadness and depressed mood, whereas the most central PTSD symptoms changed from irritability and hypervigilance at the first wave to difficulty concentrating and avoidance of potential reminders at later waves. Bridge symptoms showed similarities and differences between cross-sessional and longitudinal networks with irritability/anger as the most influential bridge longitudinally. The DAG found feeling blue and intrusive thoughts the gateways to the emergence of other symptoms. Conclusions: Combining cross-sectional and longitudinal analysis, this study elucidated central and bridge symptoms and potential causal pathways among PTSD and depression symptoms. Clinical implications and limitations are discussed.
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Affiliation(s)
- Shuquan Chen
- Department of Clinical and Counseling Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Kaiwen Bi
- Department of Psychology, School of Social Sciences, Tsinghua University, Beijing, People’s Republic of China
| | - Shibo Lyu
- Department of Clinical and Counseling Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Pei Sun
- Department of Psychology, School of Social Sciences, Tsinghua University, Beijing, People’s Republic of China
| | - George A. Bonanno
- Department of Clinical and Counseling Psychology, Teachers College, Columbia University, New York, NY, USA
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29
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Dunsmoor JE, Cisler JM, Fonzo GA, Creech SK, Nemeroff CB. Laboratory models of post-traumatic stress disorder: The elusive bridge to translation. Neuron 2022; 110:1754-1776. [PMID: 35325617 PMCID: PMC9167267 DOI: 10.1016/j.neuron.2022.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/18/2022] [Accepted: 02/28/2022] [Indexed: 12/14/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a debilitating mental illness composed of a heterogeneous collection of symptom clusters. The unique nature of PTSD as arising from a precipitating traumatic event helps simplify cross-species translational research modeling the neurobehavioral effects of stress and fear. However, the neurobiological progress on these complex neural circuits informed by animal models has yet to produce novel, evidence-based clinical treatment for PTSD. Here, we provide a comprehensive overview of popular laboratory models of PTSD and provide concrete ideas for improving the validity and clinical translational value of basic research efforts in humans. We detail modifications to simplified animal paradigms to account for myriad cognitive factors affected in PTSD, which may contribute to abnormalities in regulating fear. We further describe new avenues for integrating different areas of psychological research underserved by animal models of PTSD. This includes incorporating emerging trends in the cognitive neuroscience of episodic memory, emotion regulation, social-emotional processes, and PTSD subtyping to provide a more comprehensive recapitulation of the human experience to trauma in laboratory research.
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Affiliation(s)
- Joseph E Dunsmoor
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin, TX, USA; Center for Psychedelic Research and Therapy, University of Texas at Austin Dell Medical School, Austin, TX, USA.
| | - Josh M Cisler
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin, TX, USA; Institute for Early Life Adversity Research, University of Texas at Austin, Austin, TX, USA; Center for Psychedelic Research and Therapy, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Gregory A Fonzo
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin, TX, USA; Institute for Early Life Adversity Research, University of Texas at Austin, Austin, TX, USA; Center for Psychedelic Research and Therapy, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Suzannah K Creech
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin, TX, USA; Institute for Early Life Adversity Research, University of Texas at Austin, Austin, TX, USA
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin, TX, USA; Institute for Early Life Adversity Research, University of Texas at Austin, Austin, TX, USA; Center for Psychedelic Research and Therapy, University of Texas at Austin Dell Medical School, Austin, TX, USA.
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30
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Yun JY, Lee YI, Park S, Choi JM, Choi SH, Jang JH. Functional activation of insula and dorsal anterior cingulate for conflict control against larger monetary loss in young adults with subthreshold depression: a preliminary study. Sci Rep 2022; 12:6956. [PMID: 35484391 PMCID: PMC9050651 DOI: 10.1038/s41598-022-10989-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 04/15/2022] [Indexed: 11/08/2022] Open
Abstract
Subthreshold depression (StD) is associated with higher risk of later developing major depressive disorder (MDD). Deficits of goal-directed behaviors regarding the motional, motivational, and conflict control are found in MDD. The current study examined neural underpinning of conflict control against monetary punishment in StD compared to MDD and healthy controls (HC). Seventy-one participants (HC, n = 27; StD, n = 21; MDD, n = 23) in their mid-20's completed self-reports. Preprocessing of functional magnetic resonance imaging acquired for the Simon task against larger or smaller monetary punishment was conducted using ENIGMA HALFpipe version 1.2.1. Neural correlates of conflict control against monetary punishment that could vary with either diagnosis or PHQ-9 total score were examined using a general linear model of FSL. Simon effect was effective for reaction time and accuracy in every subgroup of diagnosis and regardless of the size of monetary punishment. Conflict control against larger monetary loss was associated with higher functional activation of left insula in StD than HC and MDD. StD showed lower functional activation of left dorsal anterior cingulate (dACC) than MDD for conflict control against larger monetary loss. For conflict control against smaller monetary loss, StD demonstrated higher functional activation of left paracentral lobule and right putamen compared to HC. Directed acyclic graphs showed directional associations from suicidal ideation, sadness, and concentration difficulty to functional activation of paracentral lobule, ventromedial prefrontal cortex (vmPFC), and thalamus for conflict control against monetary loss. Differential functional activation of insula and dACC for conflict control against larger monetary loss could be a brain phenotype of StD. Item-level depressive symptoms of suicidal ideation, sadness, and concentration difficulty could be reflected in the conflict control-related functional activation of paracentral lobule (against smaller monetary loss), vmPFC and thalamus (against larger monetary loss), respectively.
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Affiliation(s)
- Je-Yeon Yun
- Seoul National University Hospital, Seoul, Republic of Korea
- Yeongeon Student Support Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoonji Irene Lee
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Susan Park
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jong Moon Choi
- Department of Psychology, Louisiana State University, Baton Rouge, USA
| | - Soo-Hee Choi
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joon Hwan Jang
- Department of Psychiatry, Seoul National University Health Service Center, Gwanak-ro 1, Gwanak-gu, Seoul, 08826, Republic of Korea.
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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31
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Croizier C, Bouillon-Minois JB, Bay JO, Dutheil F. COVID-19 lockdown and mental health: why we must look into oncology units. Psychol Med 2022; 52:787-788. [PMID: 32616099 PMCID: PMC7369335 DOI: 10.1017/s0033291720002500] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Carolyne Croizier
- Service thérapie cellulaire et hématologie clinique, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Jean-Baptiste Bouillon-Minois
- CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, Emergency Medicine, Clermont Auvergne University, Clermont-Ferrand, France
| | - Jacques-Olivier Bay
- Service thérapie cellulaire et hématologie clinique, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Frédéric Dutheil
- CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, Occupational and Environmental Medicine, WittyFit, Clermont Auvergne University, Clermont-Ferrand, Auvergne-Rhône-Alpes, France
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32
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Zhen R, Zhou X. Latent Patterns of Posttraumatic Stress Symptoms, Depression, and Posttraumatic Growth Among Adolescents During the COVID-19 Pandemic. J Trauma Stress 2022; 35:197-209. [PMID: 34339577 PMCID: PMC8426724 DOI: 10.1002/jts.22720] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/24/2021] [Accepted: 05/28/2021] [Indexed: 12/23/2022]
Abstract
Researchhas shown that posttraumatic reactions can co-occur in trauma-exposed individuals. Many studies have assessed the co-occurring patterns of two types of reactions, but few have assessed the patterns of multiple reactions. To build on existing knowledge, the present study examined co-occurring patterns of posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, and posttraumatic growth (PTG) among adolescents during the COVID-19 pandemic. Participants (N = 683) were adolescents selected from an area in China severely affected by COVID-19 who completed the PTSD Checklist, a measure of depression, a PTG inventory, and a cognitive emotional regulation questionnaire. Latent profile analysis and multinomial logistic regression were used for the data analyses. The results showed three heterogeneous patterns characterized by growth (n = 248, 36.3%), distress (n = 101, 14.8%), and struggle (n = 334, 48.9%). Positive refocusing and reappraisal were associated with membership in the growth group compared with distress group, OR = 0.83, 95% CI [0.75, 0.93] and OR = 0.78, 95% CI [0.68, 0.90], whereas rumination, catastrophizing, and "putting into perspective" were associated with membership in the distress group compared with growth group, ORs = 1.15-1.44. These findings suggest that posttraumatic reactions show heterogeneous characteristics: struggle, rather than growth or distress, is common among adolescents during COVID-19; and distinct cognitive emotional regulation strategies have distinguishing roles in the three patterns of posttraumatic reactions.
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Affiliation(s)
- Rui Zhen
- School of EducationHangzhou Normal UniversityHangzhouChina
| | - Xiao Zhou
- Department of Psychology and Behavioral SciencesZhejiang UniversityHangzhouChina
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33
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Coussement C, De Longueville X, Heeren A. Attentional networks in co-occurring generalized anxiety disorder and major depression disorder: Towards a staging approach to the executive control deficits. Compr Psychiatry 2022; 113:152294. [PMID: 34942482 DOI: 10.1016/j.comppsych.2021.152294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/29/2021] [Accepted: 12/17/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Major Depression Disorder (MDD) and Generalized Anxiety Disorder (GAD) often co-occur, but the neurocognitive mechanisms of this co-occurrence remain unknown. Prominent views have pointed to attentional processes as potent mechanisms at play in MDD and GAD, respectively. Yet uncertainty remains regarding the very nature of attentional impairments in patients with co-occurring MDD and GAD. METHODS Inspired by contemporary models of attentional networks, we compared the three main attentional networks, namely the orienting, alerting, and executive networks of the Attention Network Task's model, in four groups of patients with, respectively, co-occurring DSM-5 MDD and GAD (n = 30), DSM-5 MDD only (n = 30), DSM-5 GAD only (n = 30), or free from any DSM-5 diagnosis (n = 30). To capture the multivariate nature of our data, we examined between-group differences in the attentional networks through a multivariate analysis of variance. RESULTS Patients with co-occurring MDD and GAD exhibited more severe impairments in the executive control network than those with only one of the disorders. Although patients with MDD or GAD solely did not differ in terms of attentional impairments, both groups showed significantly more impairments in the executive control network than those free from any DSM-5 diagnosis (all Bonferonni-corrected post-hoc ps < 0.05). CONCLUSIONS Our findings align with a longstanding staging approach to comorbidity whereby, via synergistic effects, co-occurring disorders produce more damages than the sum of each disorder. Here, for the first time, we extended this approach to the executive network of attention in the context of the co-occurrence between MDD and GAD.
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Affiliation(s)
- Charlotte Coussement
- Psychological Sciences Research Institute, UCLouvain, Belgium; Le Beau Vallon - Psychiatric Hospital, Belgium
| | - Xavier De Longueville
- Department of Adult Psychiatry, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Alexandre Heeren
- Psychological Sciences Research Institute, UCLouvain, Belgium; Institute of Neuroscience, UCLouvain, Belgium.
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34
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Spohrs J, Ulrich M, Grön G, Plener PL, Abler B. FAAH polymorphism (rs324420) modulates extinction recall in healthy humans: an fMRI study. Eur Arch Psychiatry Clin Neurosci 2022; 272:1495-1504. [PMID: 34893921 PMCID: PMC9653364 DOI: 10.1007/s00406-021-01367-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/24/2021] [Indexed: 01/03/2023]
Abstract
Gold standard treatments for anxiety- and trauma-related disorders focus on exposure therapy promoting extinction learning and extinction retention. However, its efficacy is limited. Preclinical and particularly animal research has been able to demonstrate that homozygosity for the fatty acid amide hydrolase (FAAH) C385A allele, similar to FAAH inhibition, is associated with elevated concentrations of anandamide (AEA) and facilitates extinction learning and extinction recall. However, in humans, the underlying neurobiological processes are less well understood, and further knowledge might enhance the development of more effective therapies. In this functional magnetic resonance imaging (fMRI) study, a fear conditioning, fear extinction and extinction recall paradigm was conducted with 55 healthy male adults. They were genotyped for the FAAH single-nucleotide polymorphism (SNP) rs324420 to investigate differences related to extinction recall in neural activation and State-Trait Anxiety Inventory (STAI) ratings between AC heterozygotes and CC homozygotes (FAAH C385A SNP). Differential brain activation upon an unextinguished relative to an extinguished stimulus, was greater in AC heterozygotes as compared to CC homozygotes in core neural structures previously related to extinction recall, such as the medial superior frontal gyrus, the dorsal anterior cingulate and the anterior and middle insular cortex. Furthermore, AC heterozygotes displayed higher AEA levels and lower STAI-state ratings. Our data can be interpreted in line with previous suggestions of more successful extinction recall in A-allele carriers with elevated AEA levels. Data corroborate the hypothesis that the endocannabinoid system, particularly AEA, plays a modulatory role in the extinction of aversive memory.
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Affiliation(s)
- Jennifer Spohrs
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Martin Ulrich
- Clinic for Psychiatry and Psychotherapy III, Ulm University, Ulm, Germany
| | - Georg Grön
- Clinic for Psychiatry and Psychotherapy III, Ulm University, Ulm, Germany
| | - Paul L. Plener
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany ,Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - Birgit Abler
- Clinic for Psychiatry and Psychotherapy III, Ulm University, Ulm, Germany.
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35
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Kratzer L, Heinz P, Schennach R, Knefel M, Schiepek G, Biedermann SV, Büttner M. Sexual symptoms in post-traumatic stress disorder following childhood sexual abuse: a network analysis. Psychol Med 2022; 52:90-101. [PMID: 32517829 DOI: 10.1017/s0033291720001750] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Even though recent research indicates that sexual symptoms are highly prevalent in post-traumatic stress disorder following childhood sexual abuse and cause severe distress, current treatments neither address them nor are they effective in reducing them. This might be due to a lack of understanding of sexual symptoms' specific role in the often complex and comorbid psychopathology of post-traumatic stress disorder following childhood abuse. METHODS Post-traumatic, dissociative, depressive, and sexual symptoms were assessed in 445 inpatients with post-traumatic stress disorder following childhood sexual abuse. Comorbidity structure was analyzed using a partial correlation network with regularization. RESULTS A total of 360 patients (81%) reported difficulties engaging in sexual activities and 102 patients (23%) reported to suffer from their sexual preferences. Difficulties engaging in sexual activities were linked to depressive and hyperarousal symptoms, whereas sexual preferences causing distress were linked to anger and dissociation. Dissociative amnesia, visual intrusions, and physical reactions to trauma reminders were of central importance for the network. Dissociative amnesia, depressed mood, lack of energy, and difficulties engaging in sexual activities were identified as bridge symptoms. Local clustering analysis indicated the non-redundancy of sexual symptoms. CONCLUSIONS Sexual symptoms are highly prevalent in survivors of childhood sexual abuse with post-traumatic stress disorder. Further research is needed regarding the link of difficulties engaging in sexual activities, depression, and post-traumatic stress disorder, as well as regarding the association of dissociation and sexual preferences causing distress. Sexual symptoms require consideration in the treatment of post-traumatic stress disorder following childhood sexual abuse.
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Affiliation(s)
- Leonhard Kratzer
- Department of Psychotraumatology, Clinic St. Irmingard, Prien am Chiemsee, Germany
| | - Peter Heinz
- Department of Psychotraumatology, Clinic St. Irmingard, Prien am Chiemsee, Germany
| | - Rebecca Schennach
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Matthias Knefel
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Günter Schiepek
- Institute for Synergetics and Psychotherapy Research, Paracelsus Medical University, Salzburg, Austria
- Department of Psychiatry and Psychotherapy, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
- Department of Psychology, Ludwig-Maximilians-University, Munich, Germany
| | - Sarah V Biedermann
- Department of Psychiatry and Psychotherapy, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Melanie Büttner
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, Technische Universität München, Munich, Germany
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36
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Yuan GF, Shi W, Elhai JD, Montag C, Chang K, Jackson T, Hall BJ. Gaming to cope: Applying network analysis to understand the relationship between posttraumatic stress symptoms and internet gaming disorder symptoms among disaster-exposed Chinese young adults. Addict Behav 2022; 124:107096. [PMID: 34469784 DOI: 10.1016/j.addbeh.2021.107096] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/21/2021] [Accepted: 08/22/2021] [Indexed: 12/17/2022]
Abstract
Research has demonstrated that posttraumatic stress disorder (PTSD) is associated with internet-related problematic behaviors. However, studies have not explored the linkage between PTSD symptoms and internet gaming disorder (IGD) symptoms. The current study aimed to investigate the relationship between posttraumatic stress symptoms (PTSS) and IGD symptoms via network analysis. We conducted a cross-sectional study with 341 Chinese young adults directly exposed to a typhoon and examined the network structure of PTSS and IGD symptoms, along with bridge symptoms, to elucidate how they co-occur. Results indicated that 'avoiding external reminders' and 'anhedonia' were identified as the most central symptoms in the PTSD network, whereas 'preoccupation,' 'gaming despite harms', and 'loss of control' ranked highest on centrality in the IGD network. Two bridge symptoms emerged within the combined PTSD and IGD network model: 'concentration difficulties' and 'conflict due to gaming' from among the PTSS and IGD symptoms, respectively. These findings reveal novel associations between PTSS and IGD symptoms and provide an empirically-based hypothesis for how these two disorders may co-occur among individuals exposed to natural disasters.
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Affiliation(s)
- Guangzhe Frank Yuan
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao (SAR), People's Republic of China
| | - Wei Shi
- Institute for Disaster Management and Reconstruction, Sichuan University, People's Republic of China.
| | - Jon D Elhai
- Department of Psychology, University of Toledo, 2801 W. Bancroft Street, Toledo, OH 43606, USA; Department of Psychiatry, University of Toledo, 3000 Arlington Ave., Toledo, OH 43614, USA
| | - Christian Montag
- Department of Molecular Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Kay Chang
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao (SAR), People's Republic of China
| | - Todd Jackson
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao (SAR), People's Republic of China
| | - Brian J Hall
- New York University (Shanghai), Shanghai, People's Republic of China.
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37
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Qi J, Sun R, Zhou X. Network analysis of comorbid posttraumatic stress disorder and depression in adolescents across COVID-19 epidemic and Typhoon Lekima. J Affect Disord 2021; 295:594-603. [PMID: 34509075 DOI: 10.1016/j.jad.2021.08.080] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 07/30/2021] [Accepted: 08/25/2021] [Indexed: 01/10/2023]
Abstract
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.
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Affiliation(s)
- Junjun Qi
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou 310028, China
| | - Rui Sun
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou 310028, China
| | - Xiao Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou 310028, China.
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38
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Klyce DW, West SJ, Perrin PB, Agtarap SD, Finn JA, Juengst S, Dams-O'Connor K, Eagye CB, Vargas TA, Chung JS, Bombardier CH. Network Analysis of Neurobehavioral and Posttraumatic Stress Disorder Symptoms One Year after Traumatic Brain Injury: A Veterans Affairs TBI Model Systems Study. J Neurotrauma 2021; 38:3332-3340. [PMID: 34652955 DOI: 10.1089/neu.2021.0200] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Traumatic brain injury (TBI) is often experienced under stressful circumstances that can lead to both symptoms of posttraumatic stress disorder (PTSD) and neurobehavioral symptoms of brain injury. There is considerable symptom overlap in the behavioral expression of these conditions. Psychometric network analysis is a useful approach to investigate the role of specific symptoms in connecting these two disorders and is thus well-suited to explore their interrelatedness. This study applied network analysis to examine the associations among PTSD and TBI symptoms in a sample of Service Members and Veterans (SM/Vs) with a history of TBI one year after injury. Responses to the Neurobehavioral Symptom Inventory (NSI) and PTSC Checklist-Civilian version (PCL-C) were obtained from participants who completed comprehensive inpatient rehabilitation services at five VA polytrauma rehabilitation centers. Participants (N = 612) were 93.1% male with an average age of 36.98 years at injury. The analysis produced a stable network. Within the NSI symptom groups, the frustration symptom was an important bridge between the affective and cognitive TBI symptoms. The PCL-C nodes formed their own small cluster with hyperarousal yielding connections with the affective, cognitive, and somatic symptom groups. Consistent with this observation, the hyperarousal node had the second strongest bridge centrality in the network. Hyperarousal appears to play a key role in holding together this network of distress and thus represents a prime target for intervention among individuals with elevated symptoms of PTSD and a history of TBI. Network analysis offers an empirical approach to visualizing and quantifying the associations among symptoms. The identification of symptoms that are central to connecting multiple conditions can inform diagnostic precision and treatment selection.
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Affiliation(s)
- Daniel Wesley Klyce
- Richmond VAMC, 20125, 1201 Broad Rock Blvd, Richmond, Virginia, United States, 23249.,Sheltering Arms Institute, 559078, Richmond, United States, 23233-7632;
| | - Samuel J West
- Virginia Commonwealth University, 6889, Department of Psychology, Richmond, Virginia, United States;
| | - Paul B Perrin
- Virginia Commonwealth University, Department of Psychology, Richmond, United States;
| | | | - Jacob A Finn
- Minneapolis VA Health Care System, 20040, Minneapolis, Minnesota, United States.,University of Minnesota Department of Psychiatry, 172737, Minneapolis, Minnesota, United States;
| | - Shannon Juengst
- University of Texas Southwestern, Physical Medicine & Rehabilitation; Rehabilitation Counseling, 5323 Harry Hines Blvd, Dallas, Texas, United States, 75390-9055;
| | - Kristen Dams-O'Connor
- Icahn School of Medicine at Mount Sinai, 5925, Rehabilitation Medicine, One Gustave Levy Place, Box 1163, New York, New York, United States, 10029; kristen.dams-o'
| | - C B Eagye
- Craig Hospital, 20588, Research Department, Englewood, Colorado, United States;
| | | | - Joyce S Chung
- Veterans Affairs Palo Alto Health Care System, Polytrauma, Palo Alto, California, United States;
| | - Charles H Bombardier
- University of Washington, Rehabilitation Medicine, Box 359612, Harborview Medical Center, 325 9th Avenue, Seattle, Washington, United States, 98104;
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39
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Suh WY, Lee J, Yun JY, Sim JA, Yun YH. A network analysis of suicidal ideation, depressive symptoms, and subjective well-being in a community population. J Psychiatr Res 2021; 142:263-271. [PMID: 34392053 DOI: 10.1016/j.jpsychires.2021.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 01/18/2023]
Abstract
Although the relationship between subjective well-being (SWB) and suicidal ideation (SI) has been illustrated in previous research, few studies have conceptualized SWB as a comprehensive measure of life satisfaction in multiple domains, nor have they considered possible mediators such as depressive symptoms. Therefore, the present study aimed to identify dimensions of SWB correlated with SI, and to analyze associations among SWB sub-domains, depressive symptoms, and SI in a community population. A total of 1200 community adults in South Korea, aged 20-86 years, completed self-report questionnaires on demographics, depressive mood (Patient Health Questionnaire-9 [PHQ-9]), SI (item 9 of the PHQ-9), and 14 SWB sub-domains (Subjective Well-Being Inventory). Factors associated with SI, and interactions among SI, depressive mood, and SWB, were identified by logistic regression and phenotype network analyses, respectively. The five main factors influencing the regularized partial correlation network were life satisfaction, self-blame, job, hopelessness, and fatigue. Pathways were observed from work-life balance and life satisfaction to hopelessness; from self-blame and fatigue to safety and health; and from sleep disturbance, concentration difficulties, self-blame, and hopelessness to SI. Making job activities more emotionally rewarding, the potential for career progression and regular work hours could address anhedonia, hopelessness and sleep disturbance, respectively, thus enhancing SWB and reducing SI in the community population.
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Affiliation(s)
- Won Young Suh
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Jongjun Lee
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Je-Yeon Yun
- Seoul National University Hospital, Seoul, Republic of Korea; Yeongeon Student Support Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Jin-Ah Sim
- School of AI Convergence, Hallym University, Chuncheon, Republic of Korea
| | - Young Ho Yun
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Biomedical Informatics, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Family Medicine, Seoul Nation University Hospital, Seoul, Republic of Korea
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40
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Wang S, Sit HF, Garabiles MR, Blum D, Hannam K, Chérie Armour, Hall BJ. A network analysis investigation of the comorbidity between sleep dysfunction and PTSD symptomatology among Filipino domestic workers in Macao (SAR) China. J Psychiatr Res 2021; 140:337-345. [PMID: 34134057 DOI: 10.1016/j.jpsychires.2021.05.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/01/2021] [Accepted: 05/18/2021] [Indexed: 12/28/2022]
Abstract
Posttraumatic stress disorder (PTSD) is highly comorbid with sleep dysfunction. This association was previously explained based on cognitive and emotional dysfunction. The current study extends this literature by investigating the symptom level comorbidity of sleep dysfunction and DSM-5 PTSD utilizing a network approach. Participants were trauma-exposed female Filipino domestic workers (N = 1241). Network analysis was applied to 23 items: 18 items from PCL-5 measuring PTSD (Community 1) and 5 items from PSQI assessing sleep dysfunction (Community 2). The results showed that the symptoms within each community had the strongest correlations. Bridge connections were identified between the sleep dysfunction and PTSD symptom communities. Symptoms with the highest bridge strength were concentration difficulties, recklessness, irritability, and sleep disturbance. This is among the first studies investigating the comorbidity between PTSD and sleep dysfunction from the network approach. Future interventions may be developed that emphasize the bridge symptoms to address comorbidity among trauma exposed migrants.
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Affiliation(s)
- Siyuan Wang
- New York University (Shanghai), People's Republic of China
| | - Hao Fong Sit
- New York University (Shanghai), People's Republic of China
| | | | - Daniel Blum
- New York University (Shanghai), People's Republic of China
| | - Kevin Hannam
- University of St. Joseph, Macao (SAR), People's Republic of China
| | - Chérie Armour
- Research Centre for Stress Trauma and Related Conditions (STARC), School of Psychology, Queen's University Belfast, Belfast, Northern Ireland, UK; New York University (Shanghai), Shanghai, China
| | - Brian J Hall
- New York University (Shanghai), People's Republic of China; School of Global Public Health, New York University, New York, NY, USA.
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41
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Yuan G, Park CL, Birkeland SR, Yip PSY, Hall BJ. A Network Analysis of the Associations Between Posttraumatic Stress Symptoms and Posttraumatic Growth Among Disaster-Exposed Chinese Young Adults. J Trauma Stress 2021; 34:786-798. [PMID: 33843120 DOI: 10.1002/jts.22673] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/16/2021] [Accepted: 01/25/2021] [Indexed: 12/13/2022]
Abstract
Posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) have been shown to coexist following exposure to a traumatic event, but consensus about what accounts for this association is lacking. Network analysis is a novel analytic method that can explain this linkage. In a sample of 1,809 Chinese college students (66.1% female, age range: 16-35 years) who were directly exposed to a typhoon, we investigated the network structure of PTSS and PTG, along with bridge symptoms and elements, to elucidate how distress and growth coexist. The seven strongest edges found in the model included two between elements in the PTSS cluster, one between elements of PTG, and four between elements of PTSS and PTG. Eight bridge symptoms and elements emerged: intrusive thoughts, emotional cue reactivity, hypervigilance, self-destructive or reckless behavior, nightmares, and physiological cue reactivity among PTSS, and changed priorities and stronger religious faith among PTG elements. These findings reveal connections between PTSS and PTG that explain how these constructs may coexist in individuals exposed to natural disasters. The network perspective provides a novel way to conceptualize the association between PTSS and PTG and contributes to the field's understanding of recovery after traumatic events.
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Affiliation(s)
- Guangzhe Yuan
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macao (SAR), People's Republic of China
| | - Crystal L Park
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Samuel R Birkeland
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macao (SAR), People's Republic of China
| | - Paul S Y Yip
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macao (SAR), People's Republic of China
| | - Brian J Hall
- New York University Shanghai, Shanghai, People's Republic of China.,School of Global Public Health, New York University, New York, USA
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42
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Liebman RE, Becker KR, Smith KE, Cao L, Keshishian AC, Crosby RD, Eddy KT, Thomas JJ. Network Analysis of Posttraumatic Stress and Eating Disorder Symptoms in a Community Sample of Adults Exposed to Childhood Abuse. J Trauma Stress 2021; 34:665-674. [PMID: 33370465 DOI: 10.1002/jts.22644] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 11/08/2022]
Abstract
Posttraumatic stress disorder (PTSD) and eating disorders (EDs) are individually debilitating and highly comorbid conditions. Childhood abuse is a prominent risk factor for PTSD and ED symptoms both individually and as a comorbid syndrome (PTSD-ED). There may be a functional association between comorbid PTSD-ED symptoms whereby disordered eating behaviors are used to avoid trauma-related thoughts and feelings. The current study used a network analytic approach to examine key associations between PTSD and ED symptom subscales (i.e., PCL-5 and EPSI, respectively) in a community sample of 120 adults who endorsed at least one experience of childhood abuse (i.e., physical, sexual, or emotional abuse; witnessing domestic violence). Participants completed an anonymous online survey using Amazon's Mechanical Turk Prime. We used three network analysis indices (i.e., strength centrality, key players, and bridge symptoms) to identify symptoms that may maintain the comorbid PTSD-ED network. The results indicated that reexperiencing symptoms had the highest strength centrality in the PTSD-ED network and bridged the PTSD and ED clusters. For ED, cognitive restraint was a bridge to all PTSD symptoms. Hyperarousal, negative alterations in cognitions and mood (NACM), and purging were key players, indicating they are integral to the network structure. If replicated in prospective studies, these results may indicate that reexperiencing and cognitive restraint are core drivers of PTSD-ED comorbidity, whereas hyperarousal, NACM, and purging may be downstream consequences maintaining the comorbid condition. Concurrent treatments that address PTSD and ED symptoms simultaneously may result in the best outcomes.
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Affiliation(s)
- Rachel E Liebman
- Faculty of Health, York University, Toronto, Canada.,Department of Psychology, Ryerson University, Toronto, Canada
| | - Kendra R Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathryn E Smith
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, Los Angeles, California, USA
| | - Li Cao
- Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA
| | - Ani C Keshishian
- Department of Psychology, University of Louisville, Louisville, Kentucky, USA
| | - Ross D Crosby
- Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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43
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Sun R, Qi J, Huang J, Zhou X. Network analysis of PTSD in college students across different areas after the COVID-19 epidemic. Eur J Psychotraumatol 2021; 12:1920203. [PMID: 34104353 PMCID: PMC8158277 DOI: 10.1080/20008198.2021.1920203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Various studies have examined the psychological 'typhoon eye' and 'ripple' effects in mental disorders following COVID-19. However, these studies only considered the disorders as entities and assessed severity, and overlooked the differences in specific symptoms of disorders. Objectives: This aim of the study is to assess the psychological typhoon eye and ripple effects at the symptom-level in posttraumatic stress disorder (PTSD), which is considered as a common psychopathology following the COVID-19 epidemic. Method: In total, 1150 undergraduates, including 271 students from the Hubei province (e.g. epidemic centre) and 879 students from other provinces, completed the self-report questionnaire. The networks were estimated and compared using the R packages. Results: Although the PTSD networks of Hubei and non-Hubei undergraduates were similarly connected and shared some symptoms with high centrality (e.g. flashbacks, irritability and anger), there were differences across the networks. Distorted cognition and no positive emotion only exhibited high centrality in the Hubei network. Physiological responses and exaggerated startle only exhibited high centrality in the non-Hubei network. Conclusion: These findings suggested that the psychological typhoon eye and ripple effects may co-exist at the symptom level. Targeted and distinct psychological services for college students in Hubei and non-Hubei provinces should be emphasized following COVID-19.
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Affiliation(s)
- Rui Sun
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, P.R. China
| | - Junjun Qi
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, P.R. China
| | - Jiali Huang
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, P.R. China
| | - Xiao Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, P.R. China
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44
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Thakur A, Choudhary D, Kumar B, Chaudhary A. A review on post-traumatic stress disorder (PTSD): "Symptoms, Therapies and Recent Case Studies". Curr Mol Pharmacol 2021; 15:502-516. [PMID: 34036925 DOI: 10.2174/1874467214666210525160944] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 11/22/2022]
Abstract
Post-traumatic stress disorder (PTSD), previously known as battle fatigue syndrome or shell shock, is a severe mental disturbance condition that is normally triggered by the experience of some frightening/scary events or trauma where a person undergoes some serious physical or mental harm or threatened. PTSD is a long-life effect of the continuous occurrence of traumatic conditions which, leading the production of feelings of helplessness, intense fear, and horror in the person. There are various examples of events that can cause PTSD, such as physical, mental, or sexual assault at home or working place by others, unexpected death of a loved one, an accidental event, war, or some kind of natural disaster. Treatment of PTSD includes the removal or reduction of these emotional feelings or symptoms with the aim to improve the daily life functioning of a person. Problems which are needed to be considered in case of PTSD like ongoing trauma, abusive or bad relationships. Various drugs which are used for the treatment of PTSD include selective serotonin reuptake inhibitors (SSRIs) (citalopram, fluvoxamine, fluoxetine, etc.); tricyclic antidepressants (amitriptyline and isocarboxazid); mood stabilizers (Divalproex and lamotrigine); atypical antipsychotics (aripiprazole and quetiapine), etc. In this review, we have covered the different risk factors, case studies related to various treatment options with different age group peoples in PTSD and their effects on them. We have also covered the symptoms and associated disorders which can play a key role in the development of PTSD.
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Affiliation(s)
- Amandeep Thakur
- School of Pharmacy, College of Pharmacy, Taipei Medical University, 250 Wuxing Street, Taipei 11031. Taiwan
| | - Diksha Choudhary
- Department of School of Pharmacy, Abhilashi University, Chail Chowk, tehsil Chachyot, Mandi, Himachal Pradesh 175028, India
| | - Bhupinder Kumar
- Department of Pharmaceutical Chemistry, ISF College of Pharmacy, Ghal Kalan, G.T Road, Moga, Punjab, India
| | - Amit Chaudhary
- Department of School of Pharmacy, Abhilashi University, Chail Chowk, tehsil Chachyot, Mandi, Himachal Pradesh 175028, India
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45
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Ge F, Jiang J, Wang Y, Wan M, Zhang W. Mapping the Presence of Anxiety Symptoms in Adults With Major Depressive Disorder. Front Psychiatry 2021; 12:595418. [PMID: 34093253 PMCID: PMC8169985 DOI: 10.3389/fpsyt.2021.595418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 04/07/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Patients with major depressive disorder (MDD) often present with co-occurring anxiety symptoms. The network method provides a novel view on understanding the co-occurrence of depressive and anxiety symptoms. Thus, the purpose of our study was to explore it by applying network analysis methods. Methods: We used electronic medical records from West China Hospital in China. In total, 3,424 patients who met the criteria for MDD were included. R-studio 3.6 was used to estimate the network structure. First, we estimated the network structure of depression and anxiety symptoms using the graphic LASSO algorithm. Then, we estimated the centrality indices of nodes to determine which symptoms are more central in the network. We then estimated the bridge centrality indices using the bridge function via the R package networktools. Results: Some strong connections were found like "easy to wake up," "wake up early," and "difficulty falling asleep," "suicidal thoughts," and "hopelessness." "Depressed mood," "somatic anxiety," "hopelessness," "anxiety mood," and "tension" have the higher centrality indices. Results revealed eight bridge symptoms (e.g., concentration/memory difficulty, gastrointestinal symptoms) in the co-occurrence network structure. Conclusions: This research suggests that the described approach in mapping the presence of anxiety symptoms in individuals with major depression might potentially increase diagnostic precision and help choose more targeted interventions and potentially reduce the occurrence of treatment resistance.
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Affiliation(s)
- Fenfen Ge
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jingwen Jiang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yue Wang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Mentong Wan
- Wuyuzhang Honors College, Sichuan University, Chengdu, China
| | - Wei Zhang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
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46
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Hong JC, Hauser ER, Redding TS, Sims KJ, Gellad ZF, O'Leary MC, Hyslop T, Madison AN, Qin X, Weiss D, Bullard AJ, Williams CD, Sullivan BA, Lieberman D, Provenzale D. Characterizing chronological accumulation of comorbidities in healthy veterans: a computational approach. Sci Rep 2021; 11:8104. [PMID: 33854078 PMCID: PMC8046765 DOI: 10.1038/s41598-021-85546-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 12/14/2020] [Indexed: 12/13/2022] Open
Abstract
Understanding patient accumulation of comorbidities can facilitate healthcare strategy and personalized preventative care. We applied a directed network graph to electronic health record (EHR) data and characterized comorbidities in a cohort of healthy veterans undergoing screening colonoscopy. The Veterans Affairs Cooperative Studies Program #380 was a prospective longitudinal study of screening and surveillance colonoscopy. We identified initial instances of three-digit ICD-9 diagnoses for participants with at least 5 years of linked EHR history (October 1999 to December 2015). For diagnoses affecting at least 10% of patients, we calculated pairwise chronological relative risk (RR). iGraph was used to produce directed graphs of comorbidities with RR > 1, as well as summary statistics, key diseases, and communities. A directed graph based on 2210 patients visualized longitudinal development of comorbidities. Top hub (preceding) diseases included ischemic heart disease, inflammatory and toxic neuropathy, and diabetes. Top authority (subsequent) diagnoses were acute kidney failure and hypertensive chronic kidney failure. Four communities of correlated comorbidities were identified. Close analysis of top hub and authority diagnoses demonstrated known relationships, correlated sequelae, and novel hypotheses. Directed network graphs portray chronologic comorbidity relationships. We identified relationships between comorbid diagnoses in this aging veteran cohort. This may direct healthcare prioritization and personalized care.
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Affiliation(s)
- Julian C Hong
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA. .,Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA. .,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA.
| | - Elizabeth R Hauser
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Thomas S Redding
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA
| | - Kellie J Sims
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA
| | - Ziad F Gellad
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA.,Department of Medicine, Duke University, Durham, NC, USA
| | - Meghan C O'Leary
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA
| | - Terry Hyslop
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Ashton N Madison
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA
| | - Xuejun Qin
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - David Weiss
- Cooperative Studies Program Coordinating Center, Perry Point VA Medical Center, Perry Point, MD, USA
| | - A Jasmine Bullard
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA
| | - Christina D Williams
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA.,Department of Medicine, Duke University, Durham, NC, USA
| | - Brian A Sullivan
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA.,Department of Medicine, Duke University, Durham, NC, USA
| | - David Lieberman
- VA Portland Health Care System, Portland, OR, USA.,Oregon Health and Science University, Portland, OR, USA
| | - Dawn Provenzale
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA. .,Department of Medicine, Duke University, Durham, NC, USA.
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47
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D'Elia ATD, Juruena MF, Coimbra BM, Mello MF, Mello AF. Posttraumatic stress disorder (PTSD) and depression severity in sexually assaulted women: hypothalamic-pituitary-adrenal (HPA) axis alterations. BMC Psychiatry 2021; 21:174. [PMID: 33789596 PMCID: PMC8010966 DOI: 10.1186/s12888-021-03170-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 03/17/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Sexual assault is implicated in several adverse psychological and physical health outcomes, including posttraumatic stress disorder (PTSD) and depression. Neurobiological research has shown variations related to the hypothalamic-pituitary-adrenal (HPA) axis, immune alterations, metabolic function, and brain circuitry. Although these mechanisms have been extensively studied, the results have demonstrated different outcomes in PTSD. METHODS We compared the plasma adrenocorticotropin (ACTH) and salivary cortisol levels of fifty-eight women with PTSD developed after sexual assault to those of forty-four female controls with no history of trauma. We also evaluated the psychiatric diagnosis and symptom severity of PTSD and depression. The participants' clinical conditions were associated with their hormonal levels to assess whether symptom severity was related to hormonal imbalance. RESULTS A large percentage of sexually assaulted women had PTSD and comorbid depression. The ACTH levels were higher in the PTSD group than the control group and increased as PTSD severity increased, considering depressive symptoms, measured by the Beck Depression Inventory (BDI) (p < 0.0001), as well as PTSD symptoms, measured by subscale D of the Clinician-Administered PTSD Scale (CAPS-5) (p = 0.045) and the CAPS-5 total scale (p = 0.026). Cortisol levels measured at 10 pm were higher for the PTSD group than the control group (p = 0.045, p = 0.037, respectively), and the cortisol awakening response showed elevated cortisol levels for the PTSD group. CONCLUSIONS These results show a correlation between symptom severity and HPA axis imbalance in patients with PTSD. Elevated ACTH and an elevated cortisol response in patients with comorbid depressive symptoms were the opposite of the expected response for patients with PTSD only. This association leads to the hypothesis that the neurobiological alterations of PTSD are related to the type of symptoms presented and their severity. These manifestations likely influence the disease course, prognosis and response to treatment. These outcomes highlight the need to discuss particular neurobiological alterations in patients with PTSD developed after sexual assault, mainly those with severe depressive symptoms.
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Affiliation(s)
- Ana Teresa D D'Elia
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), Rua Major Maragliano, 241, Vila Mariana, São Paulo, SP, CEP 04017-030, Brazil.
| | - Mario F Juruena
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), Rua Major Maragliano, 241, Vila Mariana, São Paulo, SP, CEP 04017-030, Brazil
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, Kings College London, London, UK
| | - Bruno M Coimbra
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), Rua Major Maragliano, 241, Vila Mariana, São Paulo, SP, CEP 04017-030, Brazil
| | - Marcelo F Mello
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), Rua Major Maragliano, 241, Vila Mariana, São Paulo, SP, CEP 04017-030, Brazil
| | - Andrea F Mello
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), Rua Major Maragliano, 241, Vila Mariana, São Paulo, SP, CEP 04017-030, Brazil
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48
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Shi J, Chen Y, Li X, An Y. Predicting Posttraumatic Stress and Depression Symptoms Among Frontline Firefighters in China. J Nerv Ment Dis 2021; 209:23-27. [PMID: 33075018 DOI: 10.1097/nmd.0000000000001250] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To investigate the prevalence and comorbidity rate of potential posttraumatic stress disorder (PTSD) and depression in frontline firefighters in China, as well as to analyze the related predictive factors for PTSD and depression, our study included 261 firefighters who completed assessments including the Demographic Data Forum, PTSD Checklist for DSM-5, Center for Epidemiological Studies Depression Scale, Chinese version of Perceived Stress Scale, and Perceived Social Support Scale. Among the participants, 1.9% and 11.9% were identified as having potential PTSD and depression, respectively. There was a 9.1% chance of comorbid PTSD among the depressed firefighters and a 60% chance of comorbid depression among the firefighters with PTSD. Perceived stress positively predicted both PTSD and depression; perceived social support negatively predicted both PTSD and depression. Whereas family exogenous support predicted both PTSD and depression, family endogenous support only predicted depression. In addition, PTSD was predicted by rank. Soldiers and sergeants demonstrated higher level of PTSD than officers. Future studies on mental health of firefighters should take factors like perceived stress, social support, and rank into consideration.
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Affiliation(s)
- Junyi Shi
- School of Psychology, Nanjing Normal University, Nanjing, PR China
| | - Yaru Chen
- School of Psychology, Nanjing Normal University, Nanjing, PR China
| | - Xiaohui Li
- School of Family and Consumer Sciences, Northern Illinois University, DeKalb, Illinois
| | - Yuanyuan An
- School of Psychology, Nanjing Normal University, Nanjing, PR China
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49
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Wichers M, Riese H, Hodges TM, Snippe E, Bos FM. A Narrative Review of Network Studies in Depression: What Different Methodological Approaches Tell Us About Depression. Front Psychiatry 2021; 12:719490. [PMID: 34777038 PMCID: PMC8581034 DOI: 10.3389/fpsyt.2021.719490] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
The network theory of psychopathology proposes that mental disorders arise from direct interactions between symptoms. This theory provides a promising framework to understand the development and maintenance of mental disorders such as depression. In this narrative review, we summarize the literature on network studies in the field of depression. Four methodological network approaches are distinguished: (i) studies focusing on symptoms at the macro-level vs. (ii) on momentary states at the micro-level, and (iii) studies based on cross-sectional vs. (iv) time-series (dynamic) data. Fifty-six studies were identified. We found that different methodological approaches to network theory yielded largely inconsistent findings on depression. Centrality is a notable exception: the majority of studies identified either positive affect or anhedonia as central nodes. To aid future research in this field, we outline a novel complementary network theory, the momentary affect dynamics (MAD) network theory, to understand the development of depression. Furthermore, we provide directions for future research and discuss if and how networks might be used in clinical practice. We conclude that more empirical network studies are needed to determine whether the network theory of psychopathology can indeed enhance our understanding of the underlying structure of depression and advance clinical treatment.
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Affiliation(s)
- Marieke Wichers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, Netherlands
| | - Harriëtte Riese
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, Netherlands
| | - Taylor M Hodges
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, Netherlands
| | - Evelien Snippe
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, Netherlands
| | - Fionneke M Bos
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, Netherlands.,University of Groningen, University Medical Center Groningen, Department of Psychiatry, Rob Giel Research Center, Groningen, Netherlands
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50
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Spiller TR, Levi O, Neria Y, Suarez-Jimenez B, Bar-Haim Y, Lazarov A. On the validity of the centrality hypothesis in cross-sectional between-subject networks of psychopathology. BMC Med 2020; 18:297. [PMID: 33040734 PMCID: PMC7549218 DOI: 10.1186/s12916-020-01740-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the network approach to psychopathology, psychiatric disorders are considered networks of causally active symptoms (nodes), with node centrality hypothesized to reflect symptoms' causal influence within a network. Accordingly, centrality measures have been used in numerous network-based cross-sectional studies to identify specific treatment targets, based on the assumption that deactivating highly central nodes would proliferate to other nodes in the network, thereby collapsing the network structure and alleviating the overall psychopathology (i.e., the centrality hypothesis). METHODS Here, we summarize three types of evidence pertaining to the centrality hypothesis in psychopathology. First, we discuss the validity of the theoretical assumptions underlying the centrality hypothesis in psychopathology. We then summarize the methodological aspects of extant studies using centrality measures as predictors of symptom change following treatment, while delineating their main findings and several of their limitations. Finally, using a specific dataset of 710 treatment-seeking patients with posttraumatic stress disorder (PTSD) as an example, we empirically examine node centrality as a predictor of therapeutic change, replicating the approach taken by previous studies, while addressing some of their limitations. Specifically, we investigated whether three pre-treatment centrality indices (strength, predictability, and expected influence) were significantly correlated with the strength of the association between a symptom's change and the change in the severity of all other symptoms in the network from pre- to post-treatment (Δnode-Δnetwork association). Using similar analyses, we also examine the predictive validity of two simple non-causal node properties (mean symptom severity and infrequency of symptom endorsement). RESULTS Of the three centrality measures, only expected influence successfully predicted how strongly changes in nodes/symptoms were associated with change in the remainder of the nodes/symptoms. Importantly, when excluding the amnesia node, a well-documented outlier in the phenomenology of PTSD, none of the tested centrality measures predicted symptom change. Conversely, both mean symptom severity and infrequency of symptom endorsement, two standard non-network-derived indices, were found to be more predictive than expected influence and remained significantly predictive also after excluding amnesia from the network analyses. CONCLUSIONS The centrality hypothesis in its current form is ill-defined, showing no consistent supporting evidence in the context of cross-sectional, between-subject networks.
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Affiliation(s)
- Tobias R Spiller
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Ofir Levi
- Division of Mental Health, Medical Corps, Israel Defense Forces, Tel Aviv, Israel
- Social Work Department, Ruppin Academic Center, Emek Hefer, Israel
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Neria
- Departments of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Benjamin Suarez-Jimenez
- Departments of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Amit Lazarov
- Departments of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
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