Segal Adva, Wald Ilan, Lubin Gad, Fruchter Eyal, Ginat Keren, Ben Yehuda Ariel, Pine Daniel S, Bar-Haim Yair
School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.
Division of Mental Health, Medical Corps, Israel Defense Forces, Ramat Gan, Israel.
Psychol Med. 2020 Apr;50(5):746-753. doi: 10.1017/S0033291719000539. Epub 2019 Mar 28.
Combat exposure is associated with elevated risk for post-traumatic stress disorder (PTSD). Despite considerable research on PTSD symptom clustering, it remains unknown how symptoms of PTSD re-organize following combat. Network analysis provides a powerful tool to examine such changes.
A network analysis approach was taken to examine how symptom networks change from pre- to post-combat using longitudinal prospective data from a cohort of infantry male soldiers (Mage = 18.8 years). PTSD symptoms measured using the PTSD Checklist (PCL) were assessed after 6 months of combat training but before deployment and again after 6 months of combat (Ns = 910 and 725 at pre-deployment and post-combat, respectively).
Stronger connectivity between PTSD symptoms was observed post-combat relative to pre-deployment (global strength values of the networks were 7.54 pre v. 7.92 post; S = .38, p < 0.05). Both the re-experiencing symptoms cluster (1.92 v. 2.12; S = .20, p < 0.03) and the avoidance symptoms cluster (2.61 v. 2.96; S = .35, p < 0.005) became more strongly inter-correlated post-combat. Centrality estimation analyses revealed that psychological reaction to triggers was central and linked the intrusion and avoidance sub-clusters at post-combat. The strength of associations between the arousal and reactivity symptoms cluster remained stable over time (1.85 v. 1.83; S = .02, p = .92).
Following combat, PTSD symptoms and particularly the re-experiencing and avoidance clusters become more strongly inter-correlated, indicating high centrality of trigger-reactivity symptoms.
经历战斗与创伤后应激障碍（PTSD）风险升高有关。尽管对PTSD症状聚类进行了大量研究，但战斗后PTSD症状如何重新组织仍不清楚。网络分析提供了一个强大的工具来研究此类变化。
采用网络分析方法，利用一组步兵男性士兵（平均年龄 = 18.8岁）的纵向前瞻性数据，研究从战前到战后症状网络如何变化。使用PTSD检查表（PCL）测量的PTSD症状在战斗训练6个月后但部署前进行评估，并在战斗6个月后再次评估（战前和战后分别有910人和725人）。
与部署前相比，战斗后观察到PTSD症状之间的连接更强（网络的全局强度值战前为7.54，战后为7.92；S = 0.38，p < 0.05）。重新体验症状聚类（1.92对2.12；S = 0.20，p < 0.03）和回避症状聚类（2.61对2.96；S = 0.35，p < 0.005）在战斗后相互关联更强。中心性估计分析表明，对触发因素的心理反应是核心，并在战斗后连接侵入和回避子聚类。唤醒和反应性症状聚类之间关联的强度随时间保持稳定（1.85对1.83；S = 0.02，p = 0.92）。
战斗后，PTSD症状，尤其是重新体验和回避聚类相互关联更强，表明触发 - 反应性症状具有高度核心地位。
