Comparing the Network Structure of ICD-11 PTSD and Complex PTSD in Three African Countries

Abstract

Background: Symptom network analysis has become an essential tool for researchers and clinicians investigating the structure of mental disorders. Two common methods have been used; one relies on partial correlations, and the second relies on zero order correlations with forced-directed algorithm. The combination enables a multi-dimensional view of mental disorders and provide complimentary information. This combination was used to examine symptom connections for ICD-11 Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD) as the symptoms for these disorders have been known to be organized in a multi-dimensional and hierarchical fashion. We aimed to examine whether networks of ICD-11 CPTSD symptoms reproduced across samples from three African countries. Methods: We produced network models based on data from 2,524 participants in Nigeria (n = 1006), Kenya (n = 1018), and Ghana (n = 500). PTSD and CPTSD symptoms were measured using the International Trauma Questionnaire1. Outcomes: The CPTSD network analysis using force-directed method alongside partial correlations based on Gaussian Graphical Models (GGM) revealed the multidimensional-hierarchal structure of CPTSD. The within-cluster symptoms of Disturbances in Self Organization (DSO) and PTSD were strongly correlated with each other in all networks, and the cross-cluster symptoms were lower. The most central symptom was ‘feelings of worthlessness’, a symptom of Negative Self-Concept that is part of the CPTSD cluster. The networks were very similar across the three countries. Interpretation: Findings support the ICD-11 model of PTSD and CPTSD in three African countries Funding: An internal research grant was awarded to MBE from Ariel University (grant no. RA1700000037). Declaration of Interests: None. Ethics Approval Statement: The study complied with the Helsinki declaration regarding human experimentation. All procedures involving human subjects were approved by Ariel’s University IRB [AU-MBE-2018-1029].