Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
Psychol Med. 2023 Apr;53(5):1665-1680. doi: 10.1017/S0033291723000132. Epub 2023 Mar 17.
The network paradigm for psychiatric disorder nosology was proposed based on the hypothesis that mental disorders are caused by networks of symptoms that are themselves causally related. Researchers have widely applied and integrated this paradigm to examine a variety of mental disorders, particularly depression. Existing studies generally focus on the correlation structure of symptoms, inferring causal relationships. Thus, presumption of causality may not be justified. The goal of this review was to examine the assumptions necessary for causal inference in network studies of depression. Specifically, we examined whether and how network studies address common violations of causal assumptions (i.e. no measurement error, exchangeability, and positivity). Of the 41 studies reviewed, five (12%) studies discussed sources of confounding unrelated to measurement error; none discussed positivity; and five conducted post-hoc analysis for measurement error. Depression network studies, in principle, are conducted under the assumption that symptom relationships are causal. Yet, in practice, studies seldomly discussed or adequately tested assumptions required to infer causality. Researchers continue to design studies that are unable to support the credibility of the network paradigm for the study of depression. There is a critical need to ensure scientific efforts cease to perpetuate problematic designs and findings to a potentially unsubstantiated paradigm.
基于精神障碍分类学的网络范式假设精神障碍是由症状网络引起的，而这些症状本身存在因果关系。研究人员广泛应用并整合了这一范式来研究各种精神障碍，特别是抑郁症。现有研究通常侧重于症状的相关结构，推断因果关系。因此，假定因果关系可能没有道理。本综述的目的是检验抑郁网络研究中进行因果推断所需的假设。具体来说，我们研究了网络研究是否以及如何解决因果假设的常见违反问题（即无测量误差、可交换性和阳性）。在所审查的 41 项研究中，有 5 项（12%）研究讨论了与测量误差无关的混杂源；没有研究讨论阳性；有 5 项进行了测量误差的事后分析。原则上，抑郁网络研究假设症状关系是因果关系。然而，实际上，研究很少讨论或充分检验因果推断所需的假设。研究人员继续设计无法支持抑郁研究网络范式可信度的研究。迫切需要确保科学研究不再延续有问题的设计和发现，以免使潜在无根据的范式永久化。
