Network analysis of PTSD and depressive symptoms in 158,139 treatment-seeking veterans with PTSD.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Sex differences in depressive symptoms and their networks in a treatment-seeking population - a cross-sectional study.

BACKGROUND: The higher prevalence of major depressive disorder (MDD) in females relative to males is well-established. Some authors have posited this difference arises to divergent symptom profiles in females vs. males. However, empirical tests of this hypothesis have yielded equivocal results. Here, we investigate sex differences in MDD of individual symptoms and symptom networks in a treatment-seeking sample. METHODS: We assessed depressive symptoms using Hamilton Depression Rating Scale (HDRS-17) in 590 treatment-seeking adults with MDD (300 females). We examined group differences in symptom endorsement. We investigated symptom networks and estimated Gaussian Graphical Models. Finally, we compared the female and male networks using the Network Comparison Test. RESULTS: Females scored significantly higher in psychological anxiety (p <0.001; rB = -0.155), somatic anxiety (p = .001; rB = -0.150) and feelings of guilt (p = .002; rB = -0.139). Male and female patients did not differ in depression sum scores. There were no sex differences in network structure or global strength. LIMITATIONS: Our study was sufficiently powered to detect only medium sized symptom differences. The generalizability of our study is limited to clinical samples and further studies are needed to investigate if findings also translate to outpatient samples. CONCLUSION: Females reported elevated anxiety symptoms and guilt. Clinicians should assess these symptom differences and tailor treatment to individual symptom profiles. No differences between sexes emerged in MDD network structures, indicating that features may be more similar than previously assumed. Sex differences in psychopathological features of MDD are important for future research and personalized treatment.

The network approach to posttraumatic stress disorder: a systematic review.

Background: The empirical literature of network analysis studies of posttraumatic stress symptoms (PTSS) has grown rapidly over the last years. Objective: We aimed to assess the characteristics of these studies, and if possible, the most and least central symptoms and the strongest edges in the networks of PTSS. Method: The present systematic review, conducted in PsycInfo, Medline, and Web of Science, synthesizes findings from 20 cross-sectional PTSS network studies that were accepted for publication between January 2010 and November 2018 (PROSPERO ID: CRD42018112825). Results: Results indicated that the network studies investigated a broad range of samples and that most studies used similar analytic approaches including stability analysis. Only strength centrality was generally adequately stable. Amnesia was consistently reported to have lowest strength, while there was substantial heterogeneity regarding which nodes had highest strength centrality. The strongest edge weights were typically within each DSM-IV/DSM-5 PTSD symptom cluster. Conclusions: Hypothesis-driven studies are needed to determine whether the heterogeneity in networks resulted from differences in samples or whether they are the product of underlying methodological reasons.

Antecedentes: La literatura empírica los estudios de análisis en redes de síntomas de estrés postraumático (SEPT) ha crecido rápidamente en los últimos años.Objetivos: Nuestro objetivo fue el evaluar las características de estos estudios y, de ser posible, evaluar cuáles eran aquellos síntomas más cardinales y cuáles no, y cuáles eran los enlaces más fuertes en las redes de los SEPT.Métodos: La presente revisión sistemática, realizada en PsycInfo, Medline, y Web of Science, sintetiza los hallazgos de 20 estudios transversales en redes sobre SEPT que se basaron sobre información transversal, y que fueron aceptados para publicación entre enero de 2010 y noviembre de 2018 (PROSPERO ID: CRD42018112825).Resultados: Los resultados indicaron que los estudios en redes investigaron un amplio rango de muestras, y que la mayoría de estudios emplearon enfoques analíticos similares, incluyendo el análisis de estabilidad. Solo la centralidad de la fuerza fue generalmente adecuadamente estable. Se informó consistentemente que la amnesia tenía la fuerza más baja, mientras que había una heterogeneidad sustancial con respecto a qué nodos tenían la centralidad de la fuerza más alta. Los pesos de los enlaces de red más fuertes se encontraban, por lo general, dentro de cada racimo de síntomas para trastorno de estrés postraumático contemplados en el DSM IV/DSM 5.Conclusiones: Se necesitan estudios derivados de hipótesis para determinar si la heterogeneidad de las redes resultó de las diferencias en las muestras, o si resultaron del producto de cuestiones metodológicas subyacentes.

Physical and psychological health of medical students involved in the coronavirus disease 2019 response in Switzerland.

Students involved in the COVID-19 response reported a similar proportion of COVID-19 symptoms or confirmed diagnoses, but lower levels of anxiety, depression and burnout compared with their non-involved peers.