Network analysis of PTSD, depression, and anxiety symptom Co-occurrence among U.S. veterans seeking treatment

Abstract

BackgroundFor the past twenty years, veterans have sustained an unprecedented operational tempo, which can lead to co-occurring mental health disorders. When veterans present for clinical services, the symptom constellation can be challenging to treat due to the overlap of posttraumatic stress, depression, and generalized anxiety symptoms. With limitations, researchers have traditionally used latent variable models to investigate the association between these constructs, whereas network analysis provides a novel approach to study symptom- and disorder-level associations. MethodIn our evaluation of symptom co-occurrence among veterans, we used a sample of treatment-seeking veterans (N = 591) who completed self-report measures of PTSD, depression, and generalized anxiety. ResultsOur cross-sectional network analysis yielded five empirically distinct communities: intrusion and avoidance, hyperarousal and numbing, negative alterations, depression, and generalized anxiety symptoms. LimitationsThe data is cross-sectional and should be modeled in longitudinal networks. ConclusionsNetwork associations underscore the heterogeneity of PTSD and also highlight overlapping and diverging symptoms of depression and generalized anxiety. These findings are discussed within the context of existing research on veterans, and recommendations for further study and treatment interventions are provided.