Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.
US Department of Veterans Affairs National Center for PTSD, VA Connecticut, Healthcare System, West Haven, Connecticut, USA.
Depress Anxiety. 2021 May;38(5):554-562. doi: 10.1002/da.23112. Epub 2020 Nov 15.
In recent years, a new framework for analyzing and understanding posttraumatic stress disorder (PTSD) was introduced; the network approach. Up until now, network analysis studies of PTSD were largely conducted on small to medium sample sizes (N < 1,000), which might be a possible cause of variability in main findings. Moreover, only a limited number of network studies investigated comorbidity.
In this study, we utilized a large sample to conduct a network analysis of 17 symptoms of PTSD (DSM-IV), and compared it to the result of a second network consisting of symptoms of PTSD and depression (based on Patient Health Questionnaire-9 [PHQ-9]). Our sample consisted of 502,036 treatment-seeking veterans, out of which 158,139 had fully completed the assessment of symptoms of PTSD and a subsample of 32,841 with valid PCL and PHQ-9 that was administered within 14 days or less.
Analyses found that in the PTSD network, the most central symptoms were feeling distant or cut off from others, followed by feeling very upset when reminded of the event, and repeated disturbing memories or thoughts of the event. In the combined network, we found that concentration difficulties and anhedonia are two of the five most central symptoms.
Our findings replicate the centrality of intrusion symptoms in PTSD symptoms' network. Taking into account the large sample and high stability of the network structure, we believe our study can answer some of the criticism regarding stability of cross-sectional network structures.
近年来，一种新的分析和理解创伤后应激障碍（PTSD）的框架被引入，即网络方法。到目前为止，PTSD 的网络分析研究主要在小到中等样本量（N<1000）上进行，这可能是主要发现存在差异的一个原因。此外，只有有限数量的网络研究调查了共病。
在这项研究中，我们利用大样本对 PTSD 的 17 种症状进行了网络分析，并将其与由 PTSD 和抑郁症状组成的第二个网络的结果进行了比较（基于患者健康问卷-9 [PHQ-9]）。我们的样本包括 502036 名寻求治疗的退伍军人，其中 158139 人完全完成了 PTSD 症状的评估，其中 32841 人的 PCL 和 PHQ-9 有效，在 14 天或更短时间内进行了评估。
分析发现，在 PTSD 网络中，最中心的症状是感觉与他人疏远或隔绝，其次是当被提醒事件时感到非常不安，以及反复出现关于事件的令人不安的记忆或想法。在联合网络中，我们发现注意力困难和快感缺失是五个最中心症状中的两个。
我们的研究结果复制了 PTSD 症状网络中入侵症状的中心性。考虑到样本量大且网络结构稳定性高，我们相信我们的研究可以回答一些关于横断面网络结构稳定性的批评。
