Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, PR China.
Department of Methodology and Statistics, Tilburg University, Tilburg, the Netherlands.
J Affect Disord. 2022 Aug 1;310:32-42. doi: 10.1016/j.jad.2022.05.002. Epub 2022 May 4.
The risk factors of Posttraumatic Stress Symptoms (PTSS) and depressive symptoms have been well-established, but whether the network structure of their symptoms changes over time remains unclear. This study aims to examine the six-year changes of network structure of PTSS and depressive symptoms among Wenchuan earthquake adult survivors in China.
In this pooled cross-sectional study, respondents were sampled from the same population at each of the five waves (N = 1343, 1205, 1177, 1376, and 1339). The network structure of them was investigated using network analyses.
The study shows network connections stable across waves were the positive connections between hyperarousal and intrusions, hyperarousal and somatic symptoms, and two dimensions of positive effects. Stable negative connections were those between depressed affects and positive effects, avoidance and depressed affects, avoidance with interpersonal symptoms and avoidance with somatic symptoms. Across waves, fearful emotion consistently was the strongest bridge symptom connecting with PTSS symptoms. However, for PTSS the strongest bridge symptom varied across time as it was avoidance in wave 1 but were hyperarousal in other four waves.
This study was based on a pooled cross-sectional survey, which inhibits conclusions regarding causal influences between symptoms at the individual patient level.
The network structure of PTSS and depressive symptoms was partly stable, yet also varied across survey waves. Core symptom clusters for PTSS and depressive symptoms were avoidance and depressed affect, respectively. The central role of these clusters in PTSS and depressive symptoms has important implications to future psychiatric programs.
创伤后应激症状（PTSS）和抑郁症状的风险因素已得到充分证实，但它们的症状网络结构是否随时间变化尚不清楚。本研究旨在探讨中国汶川地震成年幸存者中 PTSS 和抑郁症状的六年网络结构变化。
在这项汇总的横断研究中，在每五个时间点（N=1343、1205、1177、1376 和 1339），从同一人群中抽取受访者进行样本。使用网络分析来调查他们的网络结构。
研究表明，网络连接在各波次间稳定，包括警觉过度和侵入性、警觉过度和躯体症状，以及两个积极影响维度之间的正连接。稳定的负连接是抑郁情绪和积极影响、回避和抑郁情绪、回避和人际关系症状以及回避和躯体症状之间的连接。跨波次，恐惧情绪始终是与 PTSS 症状连接最强的桥梁症状。然而，对于 PTSS，最强的桥梁症状因时间而异，在第 1 波次是回避，而在其他 4 波次中则是警觉过度。
本研究基于汇总的横断调查，这限制了在个体患者水平上对症状之间因果影响的结论。
PTSS 和抑郁症状的网络结构部分稳定，但在各调查波次之间也有所变化。PTSS 和抑郁症状的核心症状群分别是回避和抑郁情绪。这些集群在 PTSS 和抑郁症状中的核心作用对未来的精神科计划具有重要意义。
