Abstract
Posttraumatic stress disorder (PTSD) researchers have increasingly used psychological network models to investigate PTSD symptom interactions, as well as to identify central driver symptoms. It is unclear, however, how generalizable such results are. We have developed a meta-analytic framework for aggregating network studies while taking between-study heterogeneity into account and applied this framework in the first-ever meta-analytic study of PTSD symptom networks. We analyzed the correlational structures of 52 different samples with a total sample size of n = 29,561 and estimated a single pooled network model underlying the data sets, investigated the scope of between-study heterogeneity, and assessed the performance of network models estimated from single studies. Our main findings are that: (a) We identified large between-study heterogeneity, indicating that it should be expected for networks of single studies to not perfectly align with one-another, and meta-analytic approaches are vital for the study of PTSD networks. (b) While several clear symptom-links, interpretable clusters, and significant differences between strength of edges and centrality of nodes can be identified in the network, no single or small set of nodes that clearly played a more central role than other nodes could be pinpointed, except for the symptom "amnesia" that was clearly the least central symptom. (c) Despite large between-study heterogeneity, we found that network models estimated from single samples can lead to similar network structures as the pooled network model. We discuss the implications of these findings for both the PTSD literature as well as methodological literature on network psychometrics. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Highlights
We used a combination of a keyword pertaining to the network approach and a keyword denoting a focus on Post-traumatic Stress Symptoms (PTSS)
The current study summarized and synthesized findings in the field of network models of posttraumatic stress disorder (PTSD), with the aim of advancing current knowledge and bringing together existing results
There may not be such a thing as one overall PTSD network structure and future research may benefit from focusing on sub-populations when aiming to construct a pooled PTSD network structure
Summary
A novel theoretical framework proposed in the study of psychopathology grew popular and prominent, especially in clinical and psychiatric research domains: the network approach (Borsboom et al, 2011; Borsboom, 2017; Borsboom & Cramer, 2013; Cramer et al, 2010; Epskamp, van Borkulo, et al, 2018; Fried et al, 2015; Fried, van Borkulo, Cramer, et al, 2016; Fried, van Borkulo, Epskamp, et al, 2016; Isvoranu et al, 2016, 2017; Klaiber et al, 2015; Rhemtulla et al, 2016; Robinaugh et al, 2020; van Rooijen et al, 2018). Over the past half-decade, numerous studies have been published that investigate associations between symptomatology (McNally et al, 2015; van Loo et al, 2017), potential risk factors (Armour et al, 2017; Choi et al, 2017; Mancini et al, 2019; Simons et al, 2019) and pathways to comorbidity (Djelantik et al, 2020; Gilbar, 2020; Lazarov et al, 2019; Malgaroli et al, 2018; Price et al, 2019; Vanzhula et al, 2019), yielding novel results and hypotheses In response to this rapid research expansion and in an aim to synthesize current findings in the field, a thorough systematic review of the network approach to posttraumatic stress disorder (PTSD) has been recently carried out (Birkeland et al, 2020). While certainly important contributions, such narrative work cannot handle cross-study heterogeneity in a systematic way, and results could be impacted by investigating several potentially underpowered (and unstable) results based on individual samples, rather than investigating the results of a single well-powered metaanalytic analysis
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