van der Does Florentine H S, Kitano Masato, Nagamine Masanori, Saito Taku, van der Wee Nic J A, Chiba Toshinori, Edo Naoki, Vermetten Eric, Giltay Erik J
Department of Psychiatry, Leiden University Medical Center (LUMC), Leiden, the Netherlands.
Division of Behavioral Science, National Defense Medical College Research Institute, Saitama, Japan.
Eur J Psychotraumatol. 2025 Dec;16(1):2528313. doi: 10.1080/20008066.2025.2528313. Epub 2025 Jul 28.
A more inclusive approach for addressing the diverse spectrum of mental health experiences is needed. Network theory frames psychopathological complaints as complex dynamic systems, that can be modelled in a network of mutually interacting symptoms. These networks may provide important markers of symptom improvement or exacerbation, and inform strategies for early intervention and treatment. In previous research, we identified five distinct Post-Traumatic Stress Disorder (PTSD) symptom severity trajectories within a cohort of first responders from the Japan Ground Self-Defense Force (JGSDF), deployed following the Great East Japan Earthquake (GEJE) of 2011: Resilient, Recovery, Incomplete Recovery, Late-Onset, and Chronic. The current study was aimed at investigating differences in symptom dynamics within the four non-resilient PTSD symptom severity trajectories using the innovative method of Dynamic Time Warping (DTW).: This study sample was selected from a cohort of 55 632 JGSDF personnel, who completed at least four yearly mental health surveys between 2013 and 2018, and experienced PTSD symptoms over the course of follow-up. DTW, a statistical technique for identifying patterns in time-series data, was employed to model undirected and directed (temporal) symptom networks. The sample consisted of 10211 personnel [97.8% male, mean age 36.7 ( = 7.5)]. In the undirected DTW analyses, we found that lower network density was associated with a chronic symptom severity trajectory. Directed DTW analyses revealed that in improving post-traumatic stress, dissociation-like symptoms were the first to decrease, whereas emotional reactivity to trauma reminders was the most persistent symptom. In worsening post-traumatic stress, avoidance symptoms emerged earliest, while dissociation-like symptoms were the last to intensify.: These findings highlight the importance of DTW network density in the chronicity of symptoms of post-traumatic stress. Furthermore, an increase in avoidance symptoms may serve as an early marker of worsening PTSD, signalling a need for timely intervention.
需要一种更具包容性的方法来应对心理健康体验的多样性。网络理论将心理病理学主诉视为复杂的动态系统，可以在相互作用的症状网络中进行建模。这些网络可能提供症状改善或加重的重要标志，并为早期干预和治疗策略提供信息。在先前的研究中，我们在2011年东日本大地震（GEJE）后部署的日本陆上自卫队（JGSDF）首批响应者队列中确定了五种不同的创伤后应激障碍（PTSD）症状严重程度轨迹：复原型、恢复型、不完全恢复型、迟发型和慢性型。本研究旨在使用动态时间规整（DTW）的创新方法调查四种非复原型PTSD症状严重程度轨迹内症状动态的差异。本研究样本选自55632名JGSDF人员的队列，他们在2013年至2018年期间至少完成了四次年度心理健康调查，并在随访过程中出现了PTSD症状。DTW是一种用于识别时间序列数据模式的统计技术，用于对无向和有向（时间）症状网络进行建模。样本包括10211名人员[男性占97.8%，平均年龄36.7岁（标准差=7.5）]。在无向DTW分析中，我们发现较低的网络密度与慢性症状严重程度轨迹相关。有向DTW分析显示，在改善创伤后应激方面，解离样症状最先减少，而对创伤提示的情绪反应是最持久的症状。在创伤后应激恶化方面，回避症状最早出现，而解离样症状最后加剧。这些发现突出了DTW网络密度在创伤后应激症状慢性化中的重要性。此外，回避症状的增加可能是PTSD恶化的早期标志，表明需要及时干预。
