Relationship between specific posttraumatic stress symptoms and suicidality in a sample of American veterans: A network analysis

Background: Traumatic events related to war and displacement may lead to development of posttraumatic stress symptoms (PTSS), but many war trauma survivors also report experiencing posttraumatic growth (PTG). However, the phenomenon of PTG remains poorly understood among refugees. Previous findings are also contradictory on whether more PTSS associate with PTG and what specific symptoms or aspects of growth may account for any possible link. Objective and Method: Here, we aimed to better understand posttraumatic growth among refugees, especially its structure and most important constituent elements, as well as how it associates with PTSS. We employed regression and network analysis methods with a large sample (N = 3,159) of Syrian and Iraqi refugees living in Turkey self-reporting on PTG and PTSS. Results: We found PTG and PTSS to be clearly distinct phenomena. Still, they often co-occurred, with a positive, slightly U-shaped relationship found between levels of PTSS and PTG. The main bridge between the constructs was identified from intrusive symptoms to having new priorities in life, although new priorities were more peripheral to the overall network structure of PTG. Meanwhile, discovering new psychological strengths and abilities and a new path in life emerged as elements most central to PTG itself. Conclusions: Many refugees report elements of PTG, even as they suffer from significant PTSS. The two phenomena appear distinct but positively associated, supporting the idea that intense cognitive processing involving distress may be necessary for growth after trauma. Our findings may inform efforts to support refugee trauma survivors in finding meaning and perhaps even growth after highly challenging experiences.

ObjectiveViolence, accidents and natural disasters are known to cause post-traumatic stress, which is typically accompanied by fear, suffering and impaired quality of life. Similar to chronic diseases, such events preoccupy...

Background: Potentially traumatic events (PTEs) are unfortunately common experiences among children and adolescents. Approximately one quarter of US children are exposed to a PTE before the age of four, with rates increasing to 60% by 16 years of age (Briggs-Gowan, Ford, Fraleigh, McCarthy, & Carter, 2010; Copeland, Keeler, Angold, & Costello, 2007). Exposure to PTEs during childhood is associated with a wide range of negative emotional, behavioral, and physical health consequences over the life course (Anda et al., 2006; Felitti et al., 1998; Gilbert et al., 2009; Shonkoff et al., 2012). Emerging research suggests that childhood trauma may also increase susceptibility to the development of chronic pain in adolescence and adulthood (Boey & Goh, 2001; Davis, Luecken, & Zautra, 2005; Larsson & Sund, 2007; Liakopoulou-Kairis et al., 2002; Mulvaney, Lambert, Garber, & Walker, 2006). However, most investigations of the link between childhood trauma and chronic pain have focused on adults with history of maltreatment. As a result, the contribution of other PTEs to the development of chronic pain among children and adolescents is poorly understood. Additionally, prior research has largely emphasized the prevalence of comorbid chronic pain and posttraumatic stress disorder (PTSD) diagnoses, rather than closely examining the associations between specific posttraumatic stress symptoms (PTSS), pain severity, and functional impairment. As such, much remains unknown regarding the interplay between exposure to PTEs, PTSS, and chronic pain in youth. Aims: The current study aimed to investigate the relationships between quantity and timing of PTEs, pain severity, and pain-related functional impairment among children with amplified musculoskeletal pain syndromes (AMPS). Additionally, this investigation examined the relationships between indices of PTSD symptomatology (i.e., overall symptom severity and symptom clusters) and pain. Finally, this study explored whether potential associations between childhood trauma and pain outcomes were moderated by anxiety, depression, PTSS, and family functioning. Methods: This study employed a cross-sectional design. Participants included 76 children ages 8-17 years (M = 14.08, SD = 2.14) diagnosed with AMPS and their caregivers presenting to the CHOP Center for Amplified Musculoskeletal Pain Syndromes. Participants completed assessments of childhood trauma history, family functioning, and child anxiety, depression, and PTSS online within two weeks before or after their initial consultation appointment. Medical records were reviewed to obtain information about demographic characteristics, pain severity, and pain-related functional disability from measures administered as part of routine clinical care. Results: While total quantity of PTEs was not associated with pain, PTEs reported during the first five years of life significantly predicted pain-related disability. This relationship varied as a function of both child depression and perceptions of family functioning, such that children who endorsed higher current depression and family functioning exhibited the strongest relationship between early trauma and disability. Total PTSS severity and specific symptom clusters were not associated with pain outcomes and did not moderate the relationship between early childhood PTEs and pain-related disability. Conclusions: Early childhood may be a sensitive period for the effects of PTEs on risk for functional disability in youth with AMPS. Additional research utilizing prospective and longitudinal designs is needed to better understand the biopsychosocial mechanisms underlying the relationship between early childhood trauma and pediatric chronic pain.

Posttraumatic stress disorder and depression adversely affect psychosocial functioning, both separately and especially when they co-occur. Despite the high prevalence of these conditions in veterans, it is unclear which specific posttraumatic stress disorder and depression symptoms contribute most to psychosocial functioning impairment. Network analysis can help elucidate these associations by examining symptoms and functioning difficulties as components of a dynamic system. Using cross-sectional data from 3,847 trauma-exposed U.S. veterans in the National Health and Resilience in Veterans Study, we constructed a Gaussian graphical model of individual posttraumatic stress disorder and depression symptoms and psychosocial functioning impairment. The cardinal symptoms of depression-anhedonia and depressed mood-showed the strongest associations with functioning impairment, followed by restricted affect, suicidal ideation, and irritability/anger. These five symptoms may serve as potential targets of interventions to bolster psychosocial functioning among trauma-exposed veterans. Future research should include the application of network models to intensive longitudinal data to gain insights into whether these symptoms may have a causal role in impairing psychosocial functioning. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Posttraumatic stress disorder (PTSD) and physical health problems, particularly somatic symptom disorder, are highly comorbid. Studies have only examined this co‐occurrence at the disorder level rather than assessing the associations between specific symptoms. Using network analysis to identify symptoms that act as bridges between these disorders may allow for the development of interventions to specifically target this comorbidity. We examined the association between somatization and PTSD symptoms via network analysis. This included 349 trauma‐exposed individuals recruited through the National Centre for Mental Health PTSD cohort who completed the Clinician‐Administered PTSD Scale for DSM‐5 and the Patient Health Questionnaire–15. A total of 215 (61.6%) individuals met the DSM‐5 diagnostic criteria for PTSD. An exploratory graph analysis identified four clusters of densely connected symptoms within the overall network: PTSD, chronic pain, gastrointestinal issues, and more general somatic complaints. Sleep difficulties played a key role in bridging PTSD and somatic symptoms. Our network analysis demonstrates the distinct nature of PTSD and somatization symptoms, with this association connected by disturbed sleep.

There is a growing body of literature demonstrating that experiences of oppression (e.g., racism, sexism, heterosexism, poverty) are associated with posttraumatic stress disorder symptoms. Traditional trauma assessments do not assess experiences of oppression and it is therefore imperative to develop instruments that do. To assess oppression-based traumatic stress broadly, and in an intersectional manner, we have developed the oppression-based traumatic stress inventory (OBTSI). The OBTSI includes two parts. Part A comprises open-ended questions asking participants to describe experiences of oppression as well as a set of questions to determine whether Criterion A for PTSD is met. Part B assesses specific posttraumatic stress symptoms anchored to the previously described experiences of oppression and also asks participants to identify the various types of discrimination they have experienced (e.g., based on racial group, sex/gender, sexual orientation, etc.). Clients from a mental health clinic and an undergraduate sample responded to the OBTSI and other self-report measures of depression, anxiety, and traditional posttraumatic stress (N = 90). Preliminary analyses demonstrate strong internal consistency reliability for the overall symptom inventory (α = 0.97) as well as for the four symptom clusters of posttraumatic stress symptoms in the DSM-5 (α ranging from 0.86 to 0.94). In addition to providing descriptive information, we also assess the convergent validity between the OBTSI and measures of anxiety, depression, and traditional posttraumatic stress and examine the factor structure. This study provides preliminary evidence that the OBTSI is a reliable and valid method of assessing oppression-based traumatic stress symptoms.

Coronavirus disease 2019 pandemic pointed out significant mental symptoms of frontline healthcare workers (HCWs). We aimed to estimate the prevalence and comorbidity of post-traumatic stress symptoms (PTSS), depression and anxiety symptoms in HCWs from Fangcang shelter hospitals during the pandemic. Demographic information, post-traumatic stress disorder checklist for DSM-5 (PCL-5), Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Questionnaire (GAD-7) were obtained online based on stratified random sampling design during April 2022, with 284 eligible responses. Hierarchical regression analyses were applied to investigate independent variables associated with psychological status outcomes (PHQ-9, GAD-7 and PCL-5), and the network analyses were applied to explore the comorbidity using all items of PCL-5, PHQ-9 and GAD-7. (1) 10.56%, 13.03% and 8.10% of HCWs reported PTSS, depression and anxiety symptoms. Fifty-three (18.66%) HCWs experienced at least one mental health disorder, among which 26.42-37.74% HCWs had comorbidity of two or three mental disorders; (2) several influence factors of mental health were identified, including medical professions, working hours, contacted patients (p < 0.05); (3) prominent bridge symptoms between PTSS and depression were sleep problems, suicide ideation, concentration difficulties and recklessness. Comorbidity between PTSS and anxiety was thought to mainly stem from negative affect, such as afraid, anxious, annoyed and worrying. Depressed mood and worry might be good targets during treatment of comorbidity of depression and anxiety. Our data suggest mild level of PTSS, depression and anxiety symptoms among HCWs during the pandemic and might give novel insights into assessment and intervention of comorbidity.

Post-traumatic stress disorder as moderator of other mental healthconditions.

The trajectory of depression-related symptom clusters following stroke: A network and latent class analysis.

The COVID-19 pandemic is a collective trauma causing profound psychological distress and, in some cases, positive psychological changes. The present study ascertained the most influential symptoms and strong connections between posttraumatic stress (PTS) symptoms and posttraumatic growth (PTG) elements. It also examined the symptoms/elements that acted as a bridge between the two, to elucidate how PTS and PTG co-exist. The PTSD Checklist (PCL-5) and Posttraumatic Growth Inventory (PTGI) were used to assess PTS symptoms and PTG, respectively, in a sample of 509 adults from Kashmir, India. The network analysis revealed negative trauma-related emotions as the most influential symptom in the PTS network, and the ability to do better things with life as the most influential element in the PTG network. Eight bridge symptoms/elements emerged between the PTS and PTG, namely intrusive thoughts, nightmares, more compassion for others, sleep disturbances, trauma-related amnesia, hypervigilance, willingness to express emotions, and counting on others more. The study identified the most influential symptom in the PTS network and the bridge symptoms in the combined network of PTS symptoms and PTG elements in the context of the COVID-19 pandemic in the present sample. The bridge symptoms helped in understanding how PTS and PTG co-existed in adults exposed to disasters such as COVID-19. Identification of these symptoms can be highly significant for developing targeted interventions. These implications have been discussed further in the present study. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Recent research suggests that focusing on specific symptoms, rather than general levels of impairment, may offer a more nuanced understanding of psychopathology. Given the unique social and psychological challenges posed by the COVID-19 pandemic, this study aims to explore the relationships between the three dimensions of perceived social support family support, friend support, and other support-and individual anxiety symptoms among college students. The pandemic context provides an opportunity to examine how different forms of social support may influence specific anxiety symptoms in a time of heightened stress and restricted social interactions. We conducted a network analysis of anxiety symptoms and perceived social support in a sample of 4105 college students. The network structures and bridge effects between social support and anxiety symptoms were examined at two time points (T1 and T2). A network comparison test (NCT) was conducted to assess differences in the network structures and bridge centrality indices across the two time points. In this sample, perceived social support was significantly associated with anxiety symptoms. Bridge centrality analysis indicated that, across both networks, family support generally correlated with lower levels of certain anxiety symptoms, serving as a protective factor. In contrast, friend support showed a mixed pattern-positively associated with some symptoms (e.g., irritability) but negatively associated with others (e.g., uncontrollable worry). These findings suggest that different forms of social support may have distinct effects on specific anxiety symptoms. Network analysis revealed that family support consistently served as a key protective factor against anxiety symptoms, while the influence of friend and other support weakened over time. These findings highlight the dynamic nature of support systems and provide implications for tailored mental health interventions in college students during and after the pandemic.

This study aims to conduct network analysis to identify the network structures of posttraumatic stress disorder (PTSD) symptoms, intolerance of uncertainty (IU), and personal growth initiative (PGI) in Chinese trauma-exposed children and adolescents. This study used data from 4,515 Chinese children and adolescents to investigate this relationship using undirected network analyses in combination with the Bayesian directed acyclic graph (DAG). The results indicate that IU has robust relationships with the specific symptoms 'exaggerated startle response', 'irritability/anger', and 'exaggerated startle response'. PGI shows strong relationships with the particular symptoms of 'difficulty concentrating', 'negative beliefs', and IU. The results of DAG show that key PTSD symptoms play a role in activating IU and PGI. These findings provide valuable insights into the association between PTSD symptoms, IU, and PGI, and offer significant guidance for developing intervention and treatment strategies for adolescents who have experienced trauma.

A network analysis investigating the associations between posttraumatic stress symptoms, markers of inflammation and metabolic syndrome

ABSTRACTBackground: Posttraumatic stress symptoms are interconnected. Knowledge about which symptoms of posttraumatic stress are more strongly interconnected or central than others may have implications for the targeting of clinical interventions. Exploring whether symptoms of posttraumatic stress may be differentially related to covariates can contribute to our knowledge on how posttraumatic stress symptoms arise and are maintained.Objective: This study aimed to identify the most central symptoms of posttraumatic stress and their interconnections, and to explore how covariates such as exposure, sex, neuroticism, and social support are related to the network of symptoms of posttraumatic stress.Method: This study used survey data from ministerial employees collected approximately 10 months after the 2011 Oslo bombing that targeted the governmental quarters (n = 190). We conducted network analyses using Gaussian graphical models and the lasso regularization.Results: The network analysis revealed reliably strong connections between intrusive thoughts and nightmares, feeling easily startled and overly alert, and between feeling detached and emotionally numb. The most central symptom in the symptom network was feeling emotionally numb. The covariates were generally not found to have high centrality in the symptom network. An exception was that being female was connected to a high physiological reactivity to reminders of the trauma.Conclusions: Ten months after a workplace terror attack emotional numbness appears to be of high centrality in the symptom network of posttraumatic stress. Fear circuitry and dysphoric symptoms may constitute two functional entities in chronic posttraumatic stress. Clinical interventions targeting numbness may be beneficial in the treatment of posttraumatic stress, at least after workplace terrorism.

The increasing rate of comorbid posttraumatic stress and depressive symptoms among young adults presents a unique symptom presentation and challenges to treatment. The current study examined psychosocial barriers--external locus of control-- and facilitators-- social support-- in the posttraumatic stress and depressive symptoms association. The current cross-sectional study was conducted among 701 Jamaican university participants, ages 18-30 years. Participants completed self-report measures of general demographic information as well as target variables which include the CES-D-10, Sense of control (external and internal locus of control), Short screening scale for DSM-IV posttraumatic stress disorder and social support measures. Majority of the sample was female (76.2%; n=534); and slightly more than half of the sample self-identified as Black/African ancestry (59.7%). External locus of control (LOC) partially mediated the relationship between posttraumatic stress and depressive symptoms, external locus of control (LOC) had a greater mediation magnitude than social support in the posttraumatic stress-depressive symptoms association (Indirect Effect=0.133, 95% CI-0.075-0.211). In post-hoc analyses women appeared more highly traumatized than their male counterparts (14.3%, χ2 =8.032, p=0.005). The sub-sample of highly traumatized individuals reported higher levels of depression, posttraumatic stress symptoms, external LOC, and lower levels of social support and internal LOC than did individuals with lower levels of trauma. Contrary to previous research, our findings indicate that external LOC partially mediated the relationship between posttraumatic stress and depressive symptoms among a Jamaica university sample more so than social support. These findings therefore suggest that psychosocial treatments should consider locus of control focused interventions or skill building for young adults who suffer from posttraumatic stress and depressive symptoms.