A network analysis of DSM-5 posttraumatic stress disorder and functional impairment in UK treatment-seeking veterans

Ross, Jana; Murphy, Dominic; Armour, Chérie

doi:10.1016/j.janxdis.2018.05.007

Cited by 61 publications

(62 citation statements)

References 67 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Psychological Medicine Spiller et al, 2017;Afzali et al, 2017a;McNally et al, 2017a;Greene et al, 2018;Ross et al, 2018;Vanzhula et al, 2018). For adequate power, sample size should be considerably larger than the number of parameters estimated in analyses, which given the number of variables in PTSD-related networks, tends to be relatively high (Spiller et al, 2017;Afzali et al, 2017aAfzali et al, , 2017bMcNally et al, 2017a, Fried et al, 2018) 1 † .…”

mentioning

confidence: 99%

“…For example, while amnesia is found to be the least central symptom in most PTSD network studies (McNally et al ., 2015, Armour et al ., 2017, Birkeland and Heir, 2017, Bryant et al ., 2017, Mitchell et al ., 2017, Spiller et al ., 2017, Afzali et al ., 2017 a , McNally et al ., 2017 a , Benfer et al ., 2018, Fried et al ., 2018, Moshier et al ., 2018, Papini et al ., 2018, Phillips et al ., 2018, Ross et al ., 2018, Vanzhula et al ., 2018, von Stockert et al ., 2018), symptoms emerging as most central vary considerably across studies, including, among others, getting emotionally upset due to trauma reminders, hypervigilance, intrusive thoughts, concentration difficulties, nightmares, future foreshortening, negative trauma related emotions, detachment, loss of interest, emotional numbing, physical reactions to trauma reminders, and flashbacks (Phillips et al ., 2018). Recently, it has been suggested that these mixed findings might be the result of corresponding differences in traumatic events, such as, for example, man-made trauma v. natural disasters, as this has been shown to affect PTSD presentation, and hence, network structure (Ross et al ., 2018; Sullivan et al ., 2018). Interestingly, when limiting past research to include only veteran samples, a more consistent result pattern emerges, demonstrating high centrality of getting emotionally upset by trauma reminders (Armour et al ., 2017; Mitchell et al ., 2017; Fried et al ., 2018; Moshier et al ., 2018; von Stockert et al ., 2018).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Symptom structure of PTSD and co-morbid depressive symptoms – a network analysis of combat veteran patients

et al. 2019

View full text Add to dashboard Cite

Background Despite extensive research, symptom structure of posttraumatic stress disorder (PTSD) is highly debated. The network approach to psychopathology offers a novel method for understanding and conceptualizing PTSD. However, extant studies have mainly used small samples and self-report measures among sub-clinical populations, while also overlooking co-morbid depressive symptoms. Methods PTSD symptom network topology was estimated in a sample of 1489 treatment-seeking veteran patients based on a clinician-rated PTSD measure. Next, clinician-rated depressive symptoms were incorporated into the network to assess their influence on PTSD network structure. The PTSD-symptom network was then contrasted with the network of 306 trauma-exposed (TE) treatment-seeking patients not meeting full criteria for PTSD to assess corresponding network differences. Finally, a directed acyclic graph (DAG) was computed to estimate potential directionality among symptoms, including depressive symptoms and daily functioning. Results The PTSD symptom network evidenced robust reliability. Flashbacks and getting emotionally upset by trauma reminders emerged as the most central nodes in the PTSD network, regardless of the inclusion of depressive symptoms. Distinct clustering emerged for PTSD and depressive symptoms within the comorbidity network. DAG analysis suggested a key triggering role for re-experiencing symptoms. Network topology in the PTSD sample was significantly distinct from that of the TE sample. Conclusions Flashbacks and psychological reactions to trauma reminders, along with their strong connections to other re-experiencing symptoms, have a pivotal role in the clinical presentation of combat-related PTSD among veterans. Depressive and posttraumatic symptoms constitute two separate diagnostic entities, but with meaningful between-disorder connections, suggesting two mutually-influential systems.

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

Symptom structure of PTSD and co-morbid depressive symptoms – a network analysis of combat veteran patients

et al. 2019

View full text Add to dashboard Cite

show abstract

“…These symptoms appear similar to the DSM-5 PTSD symptoms of 'detachment' and 'diminished interest' that have previously been shown to be associated with greater levels of functional impairment in veterans with PTSD. 26 Again, this could imply the need to specifically target these symptoms during treatment. It is also important to acknowledge that the ITQ may not be able to differentiate between CPTSD and personality disorder and that future research should aim to explore this further.…”

Section: Discussionmentioning

confidence: 99%

A validation study of the International Trauma Questionnaire to assess post-traumatic stress disorder in treatment-seeking veterans

Murphy

Shevlin

Pearson³

et al. 2020

Br J Psychiatry

Self Cite

View full text Add to dashboard Cite

BackgroundVeterans with post-traumatic stress disorder (PTSD) typically report a poorer treatment response than those who have not served in the Armed Forces. A possible explanation is that veterans often present with complex symptoms of PTSD. ICD-11 PTSD and complex PTSD (CPTSD) have not previously been explored in a military sample.AimsThis study aimed to validate the only measure of ICD-11 PTSD and CPTSD, the International Trauma Questionnaire, and assess the rates of the disorder in a sample of treatment-seeking UK veterans.MethodA sample of help-seeking veterans (N = 177) was recruited from a national charity in the UK that provides clinical services to veterans. Participants completed measures of ICD-11 PTSD and CPTSD as well as childhood and adult traumatic life events. Confirmatory factor analysis was used to assess the latent structure of PTSD and CPTSD symptoms, and rates of the disorders were estimated.ResultsThe majority of the participants (70.7%) reported symptoms consistent with a diagnosis of either PTSD or CPTSD. Results indicated the presence of two separate disorders, with CPTSD being more frequently endorsed (56.7%) than PTSD (14.0%). CPTSD was more strongly associated with childhood trauma than PTSD.ConclusionsThe International Trauma Questionnaire can adequately distinguish between PTSD and CPTSD within clinical samples of veterans. There is a need to explore the effectiveness of existing and new treatments for CPTSD in military personnel.

show abstract

“…It is noteworthy that due to methodological consideration, such as cross-sectional designs, various types of trauma, time since exposure, full diagnosis vs., sub-syndrome and so on-it seems that stability within PTSD clusters, but high lack of consistency of between-clusters connectivity of network model (e.g. Ross, Murphy, & Armour, 2018) is the norm.…”

Section: Introductionmentioning

confidence: 99%

Associations between moral injury, PTSD clusters, and depression among Israeli veterans: a network approach

Levi‐Belz

Greene

Zerach

2020

European Journal of Psychotraumatology

View full text Add to dashboard Cite

Background: Moral Injury (MI) is one of the adverse consequences of combat. Following exposure to potentially morally injurious events (PMIEs)--events perceived as violations of deep moral beliefs by oneself or trusted individuals--a significant minority of veterans could develop posttraumatic stress disorder (PTSD) and depression. Objective: The current study represents the first attempt to apply a network analysis model to examine an exploratory empirical conceptualization of a network of PMIEs during military service, post-traumatic stress disorder (PTSD) symptom clusters, depression, and combat exposure among Israel Defence Forces veterans. Method: A volunteer sample of 191 Israeli combat veterans were recruited during 2017, and completed validated self-report questionnaires tapping PMIEs, PTSD, and depression in a cross-sectional design study. A regularized Gaussian graphical model was estimated. Results: Network analysis revealed strong bridge associations between the PTSD nodes and most of the PMIEs nodes. The nodes of PMIE-betrayal and PTSD negative alterations in cognitions and mood (NACM) symptom cluster were found to have a bridging function between other PMIEs and PTSD. Depression was found to be connected to most of the PMIEs and PTSD nodes. Conclusions: The study's findings offer an overview of the complex relationships between PMIEs and PTSD clusters among Israeli veterans. PMIEs--notably, betrayal-based experiences--are related to PTSD clusters directly and through depressive symptoms. Some possible mechanisms for the links between PMIEs and PTSD and the clinical implications related to specific interventions are discussed. ARTICLE HISTORY

show abstract

A network analysis of DSM-5 posttraumatic stress disorder and functional impairment in UK treatment-seeking veterans

Cited by 61 publications

References 67 publications

Symptom structure of PTSD and co-morbid depressive symptoms – a network analysis of combat veteran patients

Symptom structure of PTSD and co-morbid depressive symptoms – a network analysis of combat veteran patients

A validation study of the International Trauma Questionnaire to assess post-traumatic stress disorder in treatment-seeking veterans

Associations between moral injury, PTSD clusters, and depression among Israeli veterans: a network approach

Contact Info

Product

Resources

About