Hostname: page-component-848d4c4894-wg55d Total loading time: 0 Render date: 2024-05-30T20:07:24.885Z Has data issue: false hasContentIssue false
  • English
  • Français

Symptom structure of PTSD and co-morbid depressive symptoms – a network analysis of combat veteran patients

Published online by Cambridge University Press:  27 August 2019

Amit Lazarov Open the ORCID record for Amit Lazarov [Opens in a new window] ,
Benjamin Suarez-Jimenez ,
Ofir Levi ,
Daniel D. L. Coppersmith ,
Gadi Lubin ,
Daniel S. Pine ,
Yair Bar-Haim ,
Rany Abend  and
Yuval Neria
Amit Lazarov*
Affiliation:
Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
Benjamin Suarez-Jimenez
Affiliation:
Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
Ofir Levi
Affiliation:
Division of Mental Health, Medical Corps, Israel Defense Forces, Israel Social Work Department, Ruppin Academic Center, Emek Hefer, Israel Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
Daniel D. L. Coppersmith
Affiliation:
Department of Psychology, Harvard University, Cambridge, MA, USA Section on Developmental Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, USA
Gadi Lubin
Affiliation:
Division of Mental Health, Medical Corps, Israel Defense Forces, Israel The Jerusalem Mental Health Center, Eitanim-Kfar Shaul, Israel
Daniel S. Pine
Affiliation:
Section on Developmental Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, USA
Yair Bar-Haim
Affiliation:
School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
Rany Abend
Affiliation:
Section on Developmental Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, USA
Yuval Neria
Affiliation:
Departments of Psychiatry and Epidemiology, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
*
Author for correspondence: Amit Lazarov, E-mail: al3676@cumc.columbia.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Despite extensive research, symptom structure of posttraumatic stress disorder (PTSD) is highly debated. The network approach to psychopathology offers a novel method for understanding and conceptualizing PTSD. However, extant studies have mainly used small samples and self-report measures among sub-clinical populations, while also overlooking co-morbid depressive symptoms.

Methods

PTSD symptom network topology was estimated in a sample of 1489 treatment-seeking veteran patients based on a clinician-rated PTSD measure. Next, clinician-rated depressive symptoms were incorporated into the network to assess their influence on PTSD network structure. The PTSD-symptom network was then contrasted with the network of 306 trauma-exposed (TE) treatment-seeking patients not meeting full criteria for PTSD to assess corresponding network differences. Finally, a directed acyclic graph (DAG) was computed to estimate potential directionality among symptoms, including depressive symptoms and daily functioning.

Results

The PTSD symptom network evidenced robust reliability. Flashbacks and getting emotionally upset by trauma reminders emerged as the most central nodes in the PTSD network, regardless of the inclusion of depressive symptoms. Distinct clustering emerged for PTSD and depressive symptoms within the comorbidity network. DAG analysis suggested a key triggering role for re-experiencing symptoms. Network topology in the PTSD sample was significantly distinct from that of the TE sample.

Conclusions

Flashbacks and psychological reactions to trauma reminders, along with their strong connections to other re-experiencing symptoms, have a pivotal role in the clinical presentation of combat-related PTSD among veterans. Depressive and posttraumatic symptoms constitute two separate diagnostic entities, but with meaningful between-disorder connections, suggesting two mutually-influential systems.

Keywords

combat-related traumadepressive symptomsnetwork analysisPost-traumatic stress disorderveterans.
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 13 , October 2020 , pp. 2154 - 2170
Check for updates
Copyright
Copyright © Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

‡

The online version of this article has been updated since original publication. A notice detailing the changes has also been published.

*

This work reflects equal contribution of the first three authors

**

This work reflects equal contribution of the two senior authors

References

Afzali, MH, Sunderland, M, Batterham, PJ, Carragher, N, Calear, A and Slade, T (2017 a) Network approach to the symptom-level association between alcohol use disorder and posttraumatic stress disorder. Social Psychiatry and Psychiatric Epidemiology 52, 329–339.CrossRefGoogle Scholar
Afzali, MH, Sunderland, M, Teesson, M, Carragher, N, Mills, K and Slade, T (2017 b) A network approach to the comorbidity between posttraumatic stress disorder and major depressive disorder: the role of overlapping symptoms. Journal of Affective Disorders 208, 490–496.CrossRefGoogle Scholar
American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders, 4th Edn. text revised. Washington, DC: American Psychiatric Publishing.Google Scholar
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th Edn. Washington, DC: American Psychiatric Publishing.Google Scholar
Angelakis, S and Nixon, RDV (2015) The comorbidity of PTSD and MDD: implications for clinical practice and future research. Behaviour Change 32, 1–25.CrossRefGoogle Scholar
Armour, C and Shevlin, M (2010) Testing the dimensionality of PTSD and the specificity of the dysphoria factor. Journal of Loss & Trauma 15, 11–27.CrossRefGoogle Scholar
Armour, C, Tsai, J, Durham, TA, Charak, R, Biehn, TL, Elhai, JD and Pietrzak, RH (2015) Dimensional structure of DSM-5 posttraumatic stress symptoms: support for a hybrid anhedonia and externalizing behaviors model. Journal of Psychiatric Research 61, 106–113.CrossRefGoogle Scholar
Armour, C, Fried, EI, Deserno, MK, Tsai, J and Pietrzak, RH (2017) A network analysis of DSM-5 posttraumatic stress disorder symptoms and correlates in US military veterans. Journal of Anxiety Disorders 45, 49–59.CrossRefGoogle Scholar
Au, TM, Dickstein, BD, Comer, JS, Salters-Pedneault, K and Litz, BT (2013) Co-occurring posttraumatic stress and depression symptoms after sexual assault: a latent profile analysis. Journal of Affective Disorders 149, 209–216.CrossRefGoogle Scholar
Benfer, N, Bardeen, JR, Cero, I, Kramer, LB, Whiteman, SE, Rogers, TA, Silverstein, MW and Weathers, FW (2018) Network models of posttraumatic stress symptoms across trauma types. Journal of Anxiety Disorders 58, 70–77.CrossRefGoogle Scholar
Berkson, J (2014) Limitations of the application of fourfold table analysis to hospital data. International Journal of Epidemiology 43, 511–515.CrossRefGoogle Scholar
Bernardy, NC and Friedman, MJ (2015) Psychopharmacological strategies in the management of posttraumatic stress disorder (PTSD): what have we learned? Current Psychiatry Reports 17, 20.CrossRefGoogle Scholar
Birkeland, MS and Heir, T (2017) Making connections: exploring the centrality of posttraumatic stress symptoms and covariates after a terrorist attack. European Journal of Psychotraumatology 8, 75–90.CrossRefGoogle Scholar
Blake, DD, Weathers, FW, Nagy, LM, Kaloupek, DG, Gusman, FD, Charney, DS and Keane, TM (1995) The development of a clinician-administered PTSD scale. Journal of Traumatic Stress 8, 75–90.CrossRefGoogle Scholar
Blanchard, EB, Buckley, TC, Hickling, EJ and Taylor, AE (1998) Posttraumatic stress disorder and comorbid major depression: is the correlation an illusion? Journal of Anxiety Disorders 12, 21–37.CrossRefGoogle Scholar
Borsboom, D and Cramer, AOJ (2013) Network analysis: an integrative approach to the structure of psychopathology. Annual Review of Clinical Psychology 9, 91–121.CrossRefGoogle Scholar
Borsboom, D, Mellenbergh, GJ and van Heerden, J (2003) The theoretical status of latent variables. Psychological Review 110, 203–219.CrossRefGoogle Scholar
Borsboom, D, Epskamp, S, Kievit, RA, Cramer, AOJ and Schmittmann, VD (2011) Transdiagnostic networks: commentary on Nolen-Hoeksema and Watkins (2011). Perspectives on Psychological Science 6, 610–614.CrossRefGoogle Scholar
Boschloo, L, van Borkulo, CD, Rhemtulla, M, Keyes, KM, Borsboom, D and Schoevers, RA (2015) The network structure of symptoms of the diagnostic and statistical manual of mental disorders. Plos One 10, e0137621.CrossRefGoogle Scholar
Bradley, R, Greene, J, Russ, E, Dutra, L and Westen, D (2005) A multidimensional meta-analysis of psychotherapy for PTSD. The American Journal of Psychiatry 162, 214–227.CrossRefGoogle Scholar
Brewin, CR (2001) A cognitive neuroscience account of posttraumatic stress disorder and its treatment. Behaviour Research and Therapy 39, 373–393.CrossRefGoogle Scholar
Brewin, CR and Holmes, EA (2003) Psychological theories of posttraumatic stress disorder. Clinical Psychology Review 23, 339–376.CrossRefGoogle Scholar
Brewin, CR, Dalgleish, T and Joseph, S (1996) A dual representation theory of posttraumatic stress disorder. Psychological Review 103, 670–686.CrossRefGoogle Scholar
Brewin, CR, Gregory, JD, Lipton, M and Burgess, N (2010) Intrusive images in psychological disorders: characteristics, neural mechanisms, and treatment implications. Psychological Review 117, 210–232.CrossRefGoogle Scholar
Bringmann, LF, Vissers, N, Wichers, M, Geschwind, N, Kuppens, P, Peeters, F, Borsboom, D and Tuerlinckx, F (2013) A network approach to psychopathology: new insights into clinical longitudinal data. Plos One 8, e60188.CrossRefGoogle Scholar
Bringmann, LF, Elmer, T, Epskamp, S, Krause, RW, Schoch, D, Wichers, M, Wigman, J and Snippe, E (2018) What do centrality measures measure in psychological networks? Preprint downloaded from ResearchGate. doi: 10.13140/RG.2.2.25024.58884.CrossRefGoogle Scholar
Bryant, RA, Moulds, ML, Guthrie, RM, Dang, ST and Nixon, RDV (2003) Imaginal exposure alone and imaginal exposure with cognitive restructuring in treatment of posttraumatic stress disorder. Journal of Consulting and Clinical Psychology 71, 706–712.CrossRefGoogle Scholar
Bryant, RA, Creamer, M, O'Donnell, M, Forbes, D, McFarlane, AC, Silove, D and Hadzi-Pavlovic, D (2017) Acute and chronic posttraumatic stress symptoms in the emergence of posttraumatic stress disorder: a network analysis. JAMA Psychiatry 74, 135–142.CrossRefGoogle Scholar
Chawla, N and Ostafin, B (2007) Experiential avoidance as a functional dimensional approach to psychopathology: an empirical review. Journal of Clinical Psychology 63, 871–890.CrossRefGoogle Scholar
Chemtob, CM, Roitblat, HL, Hamada, RS, Carlson, JG and Twentyman, CT (1988) A cognitive action theory of post-traumatic stress disorder. Journal of Anxiety Disorders 2, 253–275.CrossRefGoogle Scholar
Chung, H and Breslau, N (2008) The latent structure of post-traumatic stress disorder: tests of invariance by gender and trauma type. Psychological Medicine 38, 563–573.CrossRefGoogle Scholar
Cloitre, M, Garvert, DW, Brewin, CR, Bryant, RA and Maercker, A (2013) Evidence for proposed ICD-11 PTSD and complex PTSD: a latent profile analysis. European Journal of Psychotraumatology 4, 20706.CrossRefGoogle Scholar
Cole, SR, Platt, RW, Schisterman, EF, Chu, HT, Westreich, D, Richardson, D and Poole, C (2010) Illustrating bias due to conditioning on a collider. International Journal of Epidemiology 39, 417–420.CrossRefGoogle Scholar
Contractor, AA, Elhai, JD, Fine, TH, Tamburrino, MB, Cohen, G, Shirley, E, Chan, PK, Liberzon, I, Galea, S and Calabrese, JR (2015) Latent profile analyses of posttraumatic stress disorder, depression and generalized anxiety disorder symptoms in trauma-exposed soldiers. Journal of Psychiatric Research 68, 19–26.CrossRefGoogle Scholar
Costantini, G and Epskamp, S (2017) EstimateGroupNetwork: Perform the joint graphical lasso and selects tuning parameters. R package version 0.1.2. https://cran.r-project.org/web/packages/EstimateGroupNetwork/index.html.Google Scholar
Costenbader, E and Valente, TW (2003) The stability of centrality measures when networks are sampled. Social Networks 25, 283–307.CrossRefGoogle Scholar
Cramer, AOJ, Waldorp, LJ, van der Maas, HLJ and Borsboom, D (2010 a) Comorbidity: a network perspective. Behavioral and Brain Sciences 33, 137–150.CrossRefGoogle Scholar
Cramer, AOJ, Waldorp, LJ, van der Maas, HLJ and Borsboom, D (2010 b) Complex realities require complex theories: refining and extending the network approach to mental disorders. Behavioral and Brain Sciences 33, 178–193.CrossRefGoogle Scholar
Dablander, F and Hinne, M (2018) Centrality measures as a proxy for causal influence? A cautionary tale. Preprint downloaded from PsyArXiv. https://doi.org/10.31234/osf.io/nue4z.CrossRefGoogle Scholar
Danaher, P, Wang, P and Witten, DM (2014) The joint graphical lasso for inverse covariance estimation across multiple classes. Journal of the Royal Statistical Society Series B-Statistical Methodology 76, 373–397.CrossRefGoogle Scholar
de Ron, J, Fried, EI and Epskamp, S (2019) Psychological Networks in Clinical Populations: A tutorial on the consequences of Berkson's Bias. Preprint downloaded from PsyArXiv. https://doi.org/10.31234/osf.io/5t8zw.CrossRefGoogle Scholar
DeViva, JC, Zayfert, C and Mellman, TA (2004) Factors associated with insomnia among civilians seeking treatment for PTSD: an exploratory study. Behavioral Sleep Medicine 2, 162–176.CrossRefGoogle Scholar
Deykin, EY, Keane, TM, Kaloupek, D, Fincke, G, Rothendler, J, Siegfried, M and Creamer, K (2001) Posttraumatic stress disorder and the use of health services. Psychosomatic Medicine 63, 835–841.CrossRefGoogle Scholar
Difede, J, Olden, M and Cukor, J (2014) Evidence-based treatment of post-traumatic stress disorder. Annual Review of Medicine 65, 319–332.CrossRefGoogle Scholar
Ehlers, A (2015) Intrusive reexperiencing in posttraumatic stress disorder: memory processes and their implications for therapy. Clinical Perspectives on Autobiographical Memory 12, 109–132.CrossRefGoogle Scholar
Ehlers, A and Clark, DM (2000) A cognitive model of posttraumatic stress disorder. Psychiatria Hungarica 15, 319–345.Google Scholar
Elhai, JD, Grubaugh, AL, Kashdan, TB and Frueh, BC (2008) Empirical examination of a proposed refinement to DSM-IV posttraumatic stress disorder symptom criteria using the National Comorbidity Survey Replication data. Journal of Clinical Psychiatry 69, 597–602.CrossRefGoogle Scholar
Elhai, JD, Carvalho, LDF, Miguel, FK, Palmieri, PA, Primi, R and Frueh, BC (2011) Testing whether posttraumatic stress disorder and major depressive disorder are similar or unique constructs. Journal of Anxiety Disorders 25, 404–410.CrossRefGoogle Scholar
Epskamp, S and Fried, EI (2016) A primer on estimating regularized psychological networks. Retrieved from http://arxiv.org/abs/1607.01367.Google Scholar
Epskamp, S and Fried, EI (2018) A tutorial on regularized partial correlation networks. Psychological Methods 23, 617–634.CrossRefGoogle Scholar
Epskamp, S, Cramer, AOJ, Waldorp, LJ, Schmittmann, VD and Borsboom, D (2012) Qgraph: network visualizations of relationships in psychometric data. Journal of Statistical Software 48, 1–18.CrossRefGoogle Scholar
Epskamp, S, Borsboom, D and Fried, EI (2018) Estimating psychological networks and their accuracy: a tutorial paper. Behavior Research Methods 50, 195–212.CrossRefGoogle Scholar
Flory, JD and Yehuda, R (2015) Comorbidity between post-traumatic stress disorder and major depressive disorder: alternative explanations and treatment considerations. Dialogues in Clinical Neuroscience 17, 141–150.Google Scholar
Forbes, D, Lockwood, E, Elhai, JD, Creamer, M, Bryant, R, McFarlane, A, Silove, D, Miller, MW, Nickerson, A and O'Donnell, M (2015) An evaluation of the DSM-5 factor structure for posttraumatic stress disorder in survivors of traumatic injury. Journal of Anxiety Disorders 29, 43–51.CrossRefGoogle Scholar
Fried, EI and Cramer, AOJ (2017) Moving forward: challenges and directions for psychopathological network theory and methodology. Perspectives on Psychological Science 12, 999–1020.CrossRefGoogle Scholar
Fried, EI, van Borkulo, CD, Cramer, AOJ, Boschloo, L, Schoevers, RA and Borsboom, D (2017) Mental disorders as networks of problems: a review of recent insights. Social Psychiatry and Psychiatric Epidemiology 52, 1–10.CrossRefGoogle Scholar
Fried, EI, Eidhof, MB, Palic, S, Costantini, G, Huisman-van Dijk, HM, Bockting, CLH, Engelhard, I, Armour, C, Nielsen, ABS and Karstoft, KI (2018) Replicability and generalizability of posttraumatic stress disorder (PTSD) networks: a cross-cultural multisite study of PTSD symptoms in four trauma patient samples. Clinical Psychological Science 6, 335–351.CrossRefGoogle Scholar
Friedman, MJ, Kilpatrick, DG, Schnurr, PP and Weathers, FW (2016) Correcting misconceptions about the diagnostic criteria for posttraumatic stress disorder in DSM-5. JAMA Psychiatry 73, 753–754.CrossRefGoogle Scholar
Fulton, JJ, Calhoun, PS, Wagner, HR, Schry, AR, Hair, LP, Feeling, N, Elbogen, E and Beckham, JC (2015) The prevalence of posttraumatic stress disorder in operation enduring freedom/operation Iraqi freedom (OEF/OIF) veterans: a meta-analysis. Journal of Anxiety Disorders 31, 98–107.CrossRefGoogle Scholar
Galatzer-Levy, IR and Bryant, RA (2013) 636120 ways to have posttraumatic stress disorder. Perspectives on Psychological Science 8, 651–662.CrossRefGoogle Scholar
Germain, A, Buysse, DJ and Nofzinger, E (2008) Sleep-specific mechanisms underlying posttraumatic stress disorder: integrative review and neurobiological hypotheses. Sleep Medicine Reviews 12, 185–195.CrossRefGoogle Scholar
Gillespie, K, Duffy, M, Hackmann, A and Clark, DM (2002) Community-based cognitive therapy in the treatment of post-traumatic stress disorder following the omagh bomb. Behavior Research and Therapy 40, 345–357.CrossRefGoogle Scholar
Goldstein, RB, Smith, SM, Chou, SP, Saha, TD, Jung, J, Zhang, HT, Pickering, RP, Ruan, WJ, Huang, BJ and Grant, BF (2016) The epidemiology of DSM-5 posttraumatic stress disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Social Psychiatry and Psychiatric Epidemiology 51, 1137–1148.CrossRefGoogle Scholar
Grant, DM, Beck, JG, Marques, L, Palyo, SA and Clapp, JD (2008) The structure of distress following trauma: posttraumatic stress disorder, major depressive disorder, and generalized anxiety disorder. Journal of Abnormal Psychology 117, 662–672.CrossRefGoogle Scholar
Green, JL, Lowry, JL and Kopta, SM (2003) College students versus counseling center clients: what are the differences? Journal of College Student Psychotherapy 17, 25–37.CrossRefGoogle Scholar
Green, BL, Krupnick, JL, Chung, J, Siddique, J, Krause, ED, Revicki, D, Frank, L and Miranda, J (2006) Impact of PTSD comorbidity on one-year outcomes in a depression trial. Journal of Clinical Psychology 62, 815–835.CrossRefGoogle Scholar
Greene, T, Gelkopf, M, Epskamp, S and Fried, E (2018) Dynamic networks of PTSD symptoms during conflict. Psychological Medicine 48, 2409–2417.CrossRefGoogle Scholar
Gros, DF, Simms, LJ and Acierno, R (2010) Specificity of posttraumatic stress disorder symptoms an investigation of comorbidity between posttraumatic stress disorder symptoms and depression in treatment-seeking veterans. Journal of Nervous and Mental Disease 198, 885–890.CrossRefGoogle Scholar
Guina, J (2016) Changes to the definition of posttraumatic stress disorder in the DSM-5. JAMA Psychiatry 73, 1201–1202.CrossRefGoogle Scholar
Haag, C, Robinaugh, DJ, Ehlers, A and Kleim, B (2017) Understanding the emergence of chronic posttraumatic stress disorder through acute stress symptom networks. JAMA Psychiatry 74, 649–650.CrossRefGoogle Scholar
Hallquist, M, Wright, AG and Molenaar, PCM (2019) Problems with centrality measures in psychopathology symptom networks: Why network psychometrics cannot escape psychometric theory. Preprint downloaded from PsyArXiv. https://doi.org/10.31234/osf.io/pg4mf.CrossRefGoogle Scholar
Hansen, M, Hyland, P, Armour, C, Shevlin, M and Elklit, A (2015) Less is more? Assessing the validity of the ICD-11 model of PTSD across multiple trauma samples. European Journal of Psychotraumatology 6, 28766.CrossRefGoogle Scholar
Heeren, A, Jones, PJ and McNally, RJ (2018) Mapping network connectivity among symptoms of social anxiety and comorbid depression in people with social anxiety disorder. Journal of Affective Disorders 228, 75–82.CrossRefGoogle Scholar
Hofmann, SG, Curtiss, J and McNally, RJ (2016) A complex network perspective on clinical science. Perspectives on Psychological Science 11, 597–605.CrossRefGoogle Scholar
Hoge, CW, Riviere, LA, Wilk, JE, Herrell, RK and Weathers, FW (2014) The prevalence of post-traumatic stress disorder (PTSD) in US combat soldiers: a head-to-head comparison of DSM-5 versus DSM-IV-TR symptom criteria with the PTSD checklist. The Lancet. Psychiatry 1, 269–277.CrossRefGoogle Scholar
Hoge, CW, Yehuda, R, Castro, CA, McFarlane, AC, Vermetten, E, Jetly, R, Koenen, KC, Greenberg, N, Shalev, AY, Rauch, SAM, Marmar, CR and Rothbaum, BO (2016) Unintended consequences of changing the definition of posttraumatic stress disorder in DSM-5 critique and call for action. JAMA Psychiatry 73, 750–752.CrossRefGoogle Scholar
Horowitz, MJ (1976) Stress Response Syndromes. New York: Aronson.Google Scholar
Horowitz, MJ (1986) Stress Response Syndromes. Northvale, NJ: Jason Aronson.Google Scholar
Jakupcak, M, Conybeare, D, Phelps, L, Hunt, S, Holmes, HA, Felker, B, Klevens, M and McFall, ME (2007) Anger, hostility, and aggression among Iraq and Afghanistan war veterans reporting PTSD and subthreshold PTSD. Journal of Traumatic Stress 20, 945–954.CrossRefGoogle Scholar
Joiner, TE, Steer, RA, Beck, AT, Schmidt, NB, Rudd, MD and Catanzaro, SJ (1999) Physiological hyperarousal: construct validity of a central aspect of the tripartite model of depression and anxiety. Journal of Abnormal Psychology 108, 290–298.CrossRefGoogle Scholar
Jones, PJ, Heeren, A and McNally, RJ (2017) Commentary: a network theory of mental disorders. Frontiers in Psychology 8, 1305.CrossRefGoogle Scholar
Jones, PJ, Mair, P, Riemann, BC, Mugno, BL and McNally, RJ (2018) A network perspective on comorbid depression in adolescents with obsessive-compulsive disorder. Journal of Anxiety Disorders 53, 1–8.CrossRefGoogle Scholar
Jones, PJ, Ma, R and McNally, RJ (2019) Bridge centrality: a network approach to understanding comorbidity. Multivariate Behavioral Research 1–15.CrossRefGoogle Scholar
Jung, WH, Chang, KJ and Kim, NH (2016) Disrupted topological organization in the whole-brain functional network of trauma-exposed firefighters: a preliminary study. Psychiatry Research-Neuroimaging 250, 15–23.CrossRefGoogle Scholar
Kashdan, TB, Elhai, JD and Frueh, BC (2006) Anhedonia and emotional numbing in combat veterans with PTSD. Behaviour Research and Therapy 44, 457–467.CrossRefGoogle Scholar
Kashdan, TB, Elhai, JD and Frueh, BC (2007) Anhedonia, emotional numbing, and symptom overreporting in male veterans with PTSD. Personality and Individual Differences 43, 725–735.CrossRefGoogle Scholar
Keane, TM and Barlow, DH (2002) Posttraumatic stress disorder. In Barlow, DH (ed.), Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic. New York, NY: Guilford Press, pp. 418–453.Google Scholar
Kelley, LP, Weathers, FW, McDevitt-Murphy, ME, Eakin, DE and Flood, AM (2009) A comparison of PTSD symptom patterns in three types of civilian trauma. Journal of Traumatic Stress 22, 227–235.CrossRefGoogle Scholar
Kessler, RC (2000) Posttraumatic stress disorder: the burden to the individual and to society. The Journal of Clinical Psychiatry 61, 4–12.Google Scholar
Kessler, RC, Sonnega, A, Bromet, E, Hughes, M and Nelson, CB (1995) Posttraumatic-Stress-Disorder in the national comorbidity survey. Archives of General Psychiatry 52, 1048–1060.CrossRefGoogle Scholar
Khan, A, Khan, SR, Shankles, EB and Polissar, NL (2002) Relative sensitivity of the Montgomery-Asberg Depression Rating Scale, the Hamilton Depression rating scale and the Clinical Global Impressions rating scale in antidepressant clinical trials. International Clinical Psychopharmacology 17, 281–285.CrossRefGoogle Scholar
Khan, A, Brodhead, AE and Kolts, RL (2004) Relative sensitivity of the Montgomery-Asberg depression rating scale, the Hamilton depression rating scale and the Clinical Global Impressions rating scale in antidepressant clinical trials: a replication analysis. International Clinical Psychopharmacology 19, 157–160.CrossRefGoogle Scholar
Kilpatrick, DG, Resnick, HS, Milanak, ME, Miller, MW, Keyes, KM and Friedman, MJ (2013) National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-5 criteria. Journal of Traumatic Stress 26, 537–547.CrossRefGoogle Scholar
Knefel, M, Tran, US and Lueger-Schuster, B (2016) The association of posttraumatic stress disorder, complex posttraumatic stress disorder, and borderline personality disorder from a network analytical perspective. Journal of Anxiety Disorders 43, 70–78.CrossRefGoogle Scholar
Koch, SBJ, van Zuiden, M, Nawijn, L, Frijling, JL, Veltman, DJ and Olff, M (2016) Aberrant resting-state brain activity in posttraumatic stress disorder: a meta-analysis and systematic review. Depression and Anxiety 33, 592–605.CrossRefGoogle Scholar
Konnert, C and Wong, M (2015) Age differences in PTSD among Canadian veterans: age and health as predictors of PTSD severity. International Psychogeriatrics 27, 297–304.CrossRefGoogle Scholar
Kuismin, M and Sillanpaa, MJ (2016) Use of Wishart prior and simple extensions for sparse precision matrix estimation. Plos One 11, e0148171.CrossRefGoogle Scholar
Lapierre, CB, Schwegler, AE and LaBauve, BJ (2007) Posttraumatic stress and depression symptoms in soldiers returning from combat operations in Iraq and Afghanistan. Journal of Traumatic Stress 20, 933–943.CrossRefGoogle Scholar
Lazarov, A, Suarez-Jimenez, B, Abend, R, Naim, R, Shvil, E, Helpman, L, Zhu, X, Papini, S, Duroski, A, Rom, R, Schneier, FR, Pine, DS, Bar-Haim, Y and Neria, Y (2018) Bias-contingent attention bias modification and attention control training in treatment of PTSD: a randomized control trial. Psychological Medicine 1–9.Google Scholar
Lazarov, A, Suarez-Jimenez, B, Tamman, A, Falzon, L, Zhu, X, Edmondson, DE and Neria, Y (2019) Attention to threat in posttraumatic stress disorder as indexed by eye-tracking indices: a systematic review. Psychological Medicine 49, 705–726.CrossRefGoogle Scholar
Lehavot, K, Katon, JG, Chen, JA, Fortney, JC and Simpson, TL (2018) Post-traumatic stress disorder by gender and veteran Status. American Journal of Preventive Medicine 54, e1–e9.CrossRefGoogle Scholar
Levi, O, Bar-Haim, Y, Kreiss, Y and Fruchter, E (2016) Cognitive-Behavioural therapy and psychodynamic psychotherapy in the treatment of combat-related post-traumatic stress disorder: a comparative effectiveness study. Clinical Psychology & Psychotherapy 23, 298–307.CrossRefGoogle Scholar
Levi, O, Shoval-Zuckerman, Y, Fruchter, E, Bibi, A, Bar-Haim, Y and Wald, I (2017) Benefits of a Psychodynamic Group Therapy (PGT) model for treating veterans With PTSD. Journal of Clinical Psychology 73, 1247–1258.CrossRefGoogle Scholar
Maercker, A, Brewin, CR, Bryant, RA, Cloitre, M, Reed, GM, van Ommeren, M, Humayun, A, Jones, LM, Kagee, A, Llosa, AE, Rousseau, C, Somasundaram, DJ, Souza, R, Suzuki, Y, Weissbecker, I, Wessely, SC, First, MB and Saxena, S (2013) Proposals for mental disorders specifically associated with stress in the International Classification of Diseases-11. Lancet 381, 1683–1685.CrossRefGoogle Scholar
McDonagh, A, Friedman, M, McHugo, G, Ford, J, Sengupta, A, Mueser, K, Carney-Demment, C, Fournier, D, Schnurr, PP and Descamps, M (2005) Randomized trial of cognitive-behavioral therapy for posttraumatic stress disorder in adult female survivors of childhood abuse. Journal of Consulting and Clinical Psychology 73, 515–524.CrossRefGoogle Scholar
McNally, RJ (2009) Can we fix PTSD in DSM-V? Depression and Anxiety 26, 597–600.CrossRefGoogle Scholar
McNally, RJ (2016) Can network analysis transform psychopathology? Behaviour Research and Therapy 86, 95–104.CrossRefGoogle Scholar
McNally, RJ (2017) Networks and nosology in posttraumatic stress disorder. JAMA Psychiatry 74, 124–125.CrossRefGoogle Scholar
McNally, RJ, Robinaugh, DJ, Wu, GWY, Wang, L, Deserno, MK and Borsboom, D (2015) Mental disorders as causal systems: a network approach to posttraumatic stress disorder. Clinical Psychological Science 3, 836–849.CrossRefGoogle Scholar
McNally, RJ, Heeren, A and Robinaugh, DJ (2017 a) A Bayesian network analysis of posttraumatic stress disorder symptoms in adults reporting childhood sexual abuse. European Journal of Psychotraumatology 8, 341276.CrossRefGoogle Scholar
McNally, RJ, Mair, P, Mugno, BL and Riemann, BC (2017 b) Co-morbid obsessive-compulsive disorder and depression: a Bayesian network approach. Psychological Medicine 47, 1204–1214.CrossRefGoogle Scholar
Megias, JL, Ryan, E, Vaquero, JMM and Frese, B (2007) Comparisons of traumatic and positive memories in people with and without PTSD profile. Applied Cognitive Psychology 21, 117–130.CrossRefGoogle Scholar
Miller, MW, Wolf, EJ, Martin, E, Kaloupek, DG and Keane, TM (2008) Structural equation modeling of associations among combat exposure, PTSD symptom factors, and global assessment of functioning. Journal of Rehabilitation Research and Development 45, 359–369.CrossRefGoogle Scholar
Miller, MW, Wolf, EJ, Harrington, KM, Brown, TA, Kaloupek, DG and Keane, TM (2010) An evaluation of competing models for the structure of PTSD symptoms using external measures of comorbidity. Journal of Traumatic Stress 23, 631–638.CrossRefGoogle Scholar
Mitchell, KS, Mazzeo, SE, Schlesinger, MR, Brewerton, TD and Smith, BN (2012) Comorbidity of partial and subthreshold ptsd among men and women with eating disorders in the national comorbidity survey-replication study. International Journal of Eating Disorders 45, 307–315.CrossRefGoogle Scholar
Mitchell, KS, Wolf, EJ, Bovin, MJ, Lee, LO, Green, JD, Rosen, RC, Keane, TM and Marx, BP (2017) Network models of DSM-5 posttraumatic stress disorder: implications for ICD-11. Journal of Abnormal Psychology 126, 355–366.CrossRefGoogle Scholar
Montgomery, SA and Asberg, M (1979) A new depression scale designed to be sensitive to change. The British Journal of Psychiatry 134, 382–389.CrossRefGoogle Scholar
Morin, CM and Ware, JC (1996) Sleep and psychopathology. Applied & Preventive Psychology 5, 211–224.CrossRefGoogle Scholar
Moshier, SJ, Bovin, MJ, Gay, NG, Wisco, BE, Mitchell, KS, Lee, DJ, Sloan, DM, Weathers, FW, Schnurr, PP, Keane, TM and Marx, BP (2018) Examination of posttraumatic stress disorder symptom networks using clinician-rated and patient-rated data. Journal of Abnormal Psychology 127, 541–547.CrossRefGoogle Scholar
Moskowitz, DS (1986) Comparison of self-reports, reports by knowledgeable informants, and behavioral observation data. Journal of Personality 54, 294–317.CrossRefGoogle Scholar
Mylle, J and Maes, M (2004) Partial posttraumatic stress disorder revisited. Journal of Affective Disorders 78, 37–48.CrossRefGoogle Scholar
National Institute for Clinical Excellence (2005) Post-traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care. London, UK: National Institute for Clinical Excellence (NICE).Google Scholar
Neria, Y and Bromet, EJ (2000) Comorbidity of PTSD and depression: linked or separate incidence. Biological Psychiatry 48, 878–880.CrossRefGoogle Scholar
Norris, FH, Friedman, MJ and Watson, PJ (2002 a) 60000 disaster victims speak: part II. Summary and implications of the disaster mental health research. Psychiatry-Interpersonal and Biological Processes 65, 240–260.CrossRefGoogle Scholar
Norris, FH, Friedman, MJ, Watson, PJ, Byrne, CM, Diaz, E and Kaniasty, K (2002 b) 60000 disaster victims speak: part I. An empirical review of the empirical literature, 1981–2001. Psychiatry 65, 207–239.CrossRefGoogle Scholar
O'Doherty, DCM, Chitty, KM, Saddiqui, S, Bennett, MR and Lagopoulos, J (2015) A systematic review and meta-analysis of magnetic resonance imaging measurement of structural volumes in posttraumatic stress disorder. Psychiatry Research-Neuroimaging 232, 1–33.CrossRefGoogle Scholar
O'Donnell, ML, Alkemade, N, Nickerson, A, Creamer, M, McFarlane, AC, Silove, D, Bryant, RA and Forbes, D (2014) Impact of the diagnostic changes to post-traumatic stress disorder for DSM-5 and the proposed changes to ICD-11. British Journal of Psychiatry 205, 230–235.CrossRefGoogle Scholar
Oquendo, MA, Friend, JM, Halberstam, B, Brodsky, BS, Burke, AK, Grunebaum, MF, Malone, KM and Mann, JJ (2003) Association of comorbid posttraumatic stress disorder and major depression with greater risk for suicidal behavior. American Journal of Psychiatry 160, 580–582.CrossRefGoogle Scholar
Papini, S, Rubin, M, Telch, MJ, Smits, JAJ and Hien, DA (2018) Pretreatment PTSD symptom network metrics predict the strength of the relationship between node change and network change during treatment. Preprint downloaded from ResearchGate. doi: 10.1002/jts.22379.CrossRefGoogle Scholar
Phillips, RD, Wilson, SM, Sun, DL, VA Mid-Atlantic MIRECC Workgroup and Morey, R (2018) Posttraumatic stress disorder symptom network analysis in U.S. Military veterans: examining the impact of combat exposure. Frontiers in Psychiatry 9, 608.CrossRefGoogle Scholar
Pietrzak, RH, Goldstein, RB, Southwick, SM and Grant, BF (2011) Prevalence and axis I comorbidity of full and partial posttraumatic stress disorder in the United States: results from wave 2 of the national epidemiologic survey on alcohol and related conditions. Journal of Anxiety Disorders 25, 456–465.CrossRefGoogle Scholar
Porter, S and Birt, AR (2001) Is traumatic memory special? A comparison of traumatic memory characteristics with memory for other emotional life experiences. Applied Cognitive Psychology 15, S101–S117.CrossRefGoogle Scholar
Post, LM, Zoellner, LA, Youngstrom, E and Feeny, NC (2011) Understanding the relationship between co-occurring PTSD and MDD: symptom severity and affect. Journal of Anxiety Disorders 25, 1123–1130.CrossRefGoogle Scholar
Price, M and van Stolk-Cooke, K (2015) Examination of the interrelations between the factors of PTSD, major depression, and generalized anxiety disorder in a heterogeneous trauma-exposed sample using DSM 5 criteria. Journal of Affective Disorders 186, 149–155.CrossRefGoogle Scholar
Price, M, Legrand, AC, Brier, ZMF and Hebert-Dufresne, L (2019) The symptoms at the center: examining the comorbidity of posttraumatic stress disorder, generalized anxiety disorder, and depression with network analysis. Journal of Psychiatric Research 109, 52–58.CrossRefGoogle Scholar
Pupo, MC, Jorge, MR, Schoedl, AF, Bressan, RA, Andreoli, SB, Mello, MF and Mari, JD (2011) The accuracy of the clinician-administered PTSD scale (CAPS) to identify PTSD cases in victims of urban violence. Psychiatry Research 185, 157–160.CrossRefGoogle Scholar
Ramsawh, HJ, Fullerton, CS, Mash, HB, Ng, TH, Kessler, RC, Stein, MB and Ursano, RJ (2014) Risk for suicidal behaviors associated with PTSD, depression, and their comorbidity in the U.S. Army. Journal of Affective Disorders 161, 116–122.CrossRefGoogle Scholar
Robinaugh, DJ, Millner, AJ and McNally, RJ (2016) Identifying highly influential nodes in the complicated grief network. Journal of Abnormal Psychology 125, 747–757.CrossRefGoogle Scholar
Ross, J, Murphy, D and Armour, C (2018) A network analysis of DSM-5 posttraumatic stress disorder and functional impairment in UK treatment-seeking veterans. Journal of Anxiety Disorders 57, 7–15.CrossRefGoogle Scholar
Rytwinski, NK, Avena, JS, Echiverri-Cohen, AM, Zoellner, LA and Feeny, NC (2014) The relationships between posttraumatic stress disorder severity, depression severity and physical health. Journal of Health Psychology 19, 509–520.CrossRefGoogle Scholar
Schmittmann, VD, Cramer, AOJ, Waldorp, LJ, Epskamp, S, Kievit, RA and Borsboom, D (2013) Deconstructing the construct: a network perspective on psychological phenomena. New Ideas in Psychology 31, 43–53.CrossRefGoogle Scholar
Schnurr, PP (2014) A guide to the literature on partial PTSD. PTSD Research Quarterly 25, 1–3.Google Scholar
Schwarz, N (1999) Self-reports – How the questions shape the answers. American Psychologist 54, 93–105.CrossRefGoogle Scholar
Scutari, M (2010) Learning Bayesian networks with the bnlearn R package. Journal of Statistical Software 35, 1–22.CrossRefGoogle Scholar
Scutari, M and Denis, JB (2014) Bayesian Networks: With Examples in R. New York: Chapman and Hall/CRC.CrossRefGoogle Scholar
Simms, LJ, Watson, D and Doebbeling, BN (2002) Confirmatory factor analyses of posttraumatic stress symptoms in deployed and nondeployed veterans of the gulf War. Journal of Abnormal Psychology 111, 637–647.CrossRefGoogle Scholar
Spiller, TR, Schick, M, Schnyder, U, Bryant, RA, Nickerson, A and Morina, N (2017) Symptoms of posttraumatic stress disorder in a clinical sample of refugees: a network analysis. European Journal of Psychotraumatology 8, 1318032.CrossRefGoogle Scholar
Spitzer, RL, First, MB and Wakefield, JC (2007) Saving PTSD from itself in DSM-V. Journal of Anxiety Disorders 21, 233–241.CrossRefGoogle Scholar
Spoont, MR, Williams, JW, Kehle-Forbes, S, Nieuwsma, JA, Mann-Wrobel, MC and Gross, R (2015) Does this patient have posttraumatic stress disorder? Rational clinical examination systematic review. JAMA 314, 501–510.CrossRefGoogle Scholar
Stander, VA, Thomsen, CJ and Highfill-McRoy, RM (2014) Etiology of depression comorbidity in combat-related PTSD: a review of the literature. Clinical Psychology Review 34, 87–98.CrossRefGoogle Scholar
Steckler, T and Risbrough, V (2012) Pharmacological treatment of PTSD-established and new approaches. Neuropharmacology 62, 617–627.CrossRefGoogle Scholar
Stein, MB, Walker, JR, Hazen, AL and Forde, DR (1997) Full and partial posttraumatic stress disorder: findings from a community survey. American Journal of Psychiatry 154, 1114–1119.Google Scholar
Stein, NR, Dickstein, BD, Schuster, J, Litz, BT and Resick, PA (2012) Trajectories of response to treatment for posttraumatic stress disorder. Behavior Therapy 43, 790–800.CrossRefGoogle Scholar
Stein, DJ, McLaughlin, KA, Koenen, KC, Atwoli, L, Friedman, MJ, Hill, ED, Maercker, A, Petukhova, M, Shahly, V, van Ommeren, M, Alonso, J, Borges, G, de Girolamo, G, de Jonge, P, Demyttenaere, K, Florescu, S, Karam, EG, Kawakami, N, Matschinger, H, Okoliyski, M, Posada-Villa, J, Scott, KM, Viana, MC and Kessler, RC (2014) DSM-5 and ICD-11 definitions of posttraumatic stress disorder: investigating “narrow” and “broad” approaches. Depression and Anxiety 31, 494–505.CrossRefGoogle Scholar
Sullivan, GM and Neria, Y (2009) Pharmacotherapy of PTSD: current Status and controversies. Psychiatric Annals 39, 342–347.CrossRefGoogle Scholar
Sullivan, CP, Smith, AJ, Lewis, M and Jones, RT (2018) Network analysis of PTSD symptoms following mass violence. Psychological Trauma-Theory Research Practice and Policy 10, 58–66.CrossRefGoogle Scholar
Svetlicky, V, Solomon, Z, Benbenishty, R, Levi, O and Lubin, G (2010) Combat exposure, posttraumatic stress symptoms and risk-taking behavior in veterans of the Second Lebanon War. Israel Journal of Psychiatry and Related Sciences 47, 276–283.Google Scholar
Trull, TJ, Widiger, TA and Burr, R (2001) A structured interview for the assessment of the five-factor model of personality: facet-level relations to the axis II personality disorders. Journal of Personality 69, 175–198.CrossRefGoogle Scholar
Tsai, J, Harpaz-Rotem, I, Armour, C, Southwick, SM, Krystal, JH and Pietrzak, RH (2015) Dimensional structure of DSM-5 posttraumatic stress disorder symptoms: results from the national health and resilience in veterans study. Journal of Clinical Psychiatry 76, 546–553.CrossRefGoogle Scholar
van Borkulo, CD and Millner, SE (2016) Network Comparison Test: Statistical comparison of two networks based on three invariance measures. R package version 2.0.1. https://cran.r-project.org/web/packages/NetworkComparisonTest/index.html.Google Scholar
van de Leemput, IA, Wichers, M, Cramer, AOJ, Borsboom, D, Tuerlinckx, F, Kuppens, P, van Nes, EH, Viechtbauer, W, Giltay, EJ, Aggen, SH, Derom, C, Jacobs, N, Kendler, KS, van der Maas, HLJ, Neale, MC, Peeters, F, Thiery, E, Zachar, P and Scheffer, M (2014) Critical slowing down as early warning for the onset and termination of depression. Proceedings of the National Academy of Sciences of the United States of America 111, 87–92.CrossRefGoogle Scholar
Vanzhula, IA, Calebs, B, Fewell, L and Levinson, CA (2018) Illness pathways between eating disorder and post-traumatic stress disorder symptoms: understanding comorbidity with network analysis. European Eating Disorders Review 27, 147–160.CrossRefGoogle Scholar
von Stockert, SHH, Fried, EI, Armour, C and Pietrzak, RH (2018) Evaluating the stability of DSM-5 PTSD symptom network structure in a national sample of US military veterans. Journal of Affective Disorders 229, 63–68.CrossRefGoogle Scholar
Wang, SB, Jones, PJ, Dreier, M, Elliott, H and Grilo, CM (2018) Core psychopathology of treatment-seeking patients with binge-eating disorder: a network analysis investigation. Psychological Medicine 49, 1923–1928.CrossRefGoogle Scholar
Watson, D (2009) Differentiating the mood and anxiety disorders: a quadripartite model. Annual Review of Clinical Psychology 5, 221–247.CrossRefGoogle Scholar
Weathers, FW, Keane, TM and Davidson, JRT (2001) Clinician-administered PTSD scale: a review of the first ten years of research. Depression and Anxiety 13, 132–156.CrossRefGoogle Scholar
Westphal, M, Olfson, M, Gameroff, MJ, Wickramaratne, P, Pilowsky, DJ, Neugebauer, R, Lantigua, R, Shea, S and Neria, Y (2011) Functional impairment in adults with past posttraumatic stress disorder: findings from primary care. Depression and Anxiety 28, 686–695.CrossRefGoogle Scholar
Wilcox, S (2010) Social relationships and PTSD symptomatology in combat veterans. Psychological Trauma-Theory Research Practice and Policy 2, 175–182.CrossRefGoogle Scholar
Williams, DR and Rast, P (2018) Back to the basics: rethinking partial correlation network methodology. British Journal of Mathematical and Statistical Psychology 1–26.Google Scholar
Wisco, BE, Marx, BP, Miller, MW, Wolf, EJ, Mota, NP, Krystal, JH, Southwick, SM and Pietrzak, RH (2016 a) Probable posttraumatic stress disorder in the US veteran population according to DSM-5: results from the national health and resilience in veterans study. Journal of Clinical Psychiatry 77, 1503–1510.CrossRefGoogle Scholar
Wisco, BE, Miller, MW, Wolf, EJ, Kilpatrick, D, Resnick, HS, Badour, CL, Marx, BP, Keane, TM, Rosen, RC and Friedman, MJ (2016 b) The impact of proposed changes to ICD-11 on estimates of PTSD prevalence and comorbidity. Psychiatry Research 240, 226–233.CrossRefGoogle Scholar
World Health Organization (2018) International statistical classification of diseases and related health problems (11th Revision). Retrieved from https://icd.who.int/browse11/l-m/en.Google Scholar
Yufik, T and Simms, LJ (2010) A meta-analytic investigation of the structure of posttraumatic stress disorder symptoms. Journal of Abnormal Psychology 119, 764–776.CrossRefGoogle Scholar
Supplementary material: File

Lazarov et al. supplementary material

Lazarov et al. supplementary material 1

Download Lazarov et al. supplementary material(File)
File 3.3 MB