Dysfunctional posttraumatic cognitions, posttraumatic stress and depression in children and adolescents exposed to trauma: a network analysis

Abstract

Background The latest version of the International Classification of Diseases (ICD‐11) proposes a posttraumatic stress disorder (PTSD) diagnosis reduced to its core symptoms within the symptom clusters re‐experiencing, avoidance and hyperarousal. Since children and adolescents often show a variety of internalizing and externalizing symptoms in the aftermath of traumatic events, the question arises whether such a conceptualization of the PTSD diagnosis is supported in children and adolescents. Furthermore, although dysfunctional posttraumatic cognitions (PTCs) appear to play an important role in the development and persistence of PTSD in children and adolescents, their function within diagnostic frameworks requires clarification. Methods We compiled a large international data set of 2,313 children and adolescents aged 6 to 18 years exposed to trauma and calculated a network model including dysfunctional PTCs, PTSD core symptoms and depression symptoms. Central items and relations between constructs were investigated. Results The PTSD re‐experiencing symptoms strong or overwhelming emotions and strong physical sensations and the depression symptom difficulty concentrating emerged as most central. Items from the same construct were more strongly connected with each other than with items from the other constructs. Dysfunctional PTCs were not more strongly connected to core PTSD symptoms than to depression symptoms. Conclusions Our findings provide support that a PTSD diagnosis reduced to its core symptoms could help to disentangle PTSD, depression and dysfunctional PTCs. Using longitudinal data and complementing between‐subject with within‐subject analyses might provide further insight into the relationship between dysfunctional PTCs, PTSD and depression.

Posttraumatic stress disorder symptoms among trauma-exposed adolescents from low- and middle-income countries

“…This last finding is in line with previous research in indicating that greater avoidance predicts more severe PTSD symptoms (e.g., [ 47 ]) and with DSM-5 criteria, which distinguished these criteria from other symptoms [ 5 ]. Previous studies showed that maladaptive cognitive appraisals play an important role in the development and persistence of PTSD in children and adolescents [ 48 – 50 ]. The severity of B criterion symptoms was not predictive of having full PTSD vs. only PTSS in our analysis, which could imply that it is more relevant the presence of intrusion symptoms (i.e., a categorical aspect) rather than how severe these are for the final outcome (i.e., a dimensional aspect).…”

Latent cause inference during extinction learning in trauma-exposed individuals with and without PTSD

“…Participants from these studies fell into two broad categories: individuals who currently met diagnostic criteria for full or subthreshold PTSD, and individuals who were assessed as never having met criteria for PTSD or any other DSM-5 Axis-1 disorder. As per previous studies from our research group (e.g., Chen et al, 2020), subthreshold PTSD was defined according to two commonly-used sets of criteria, adapted for DSM-5 (see McLaughlin et al, 2015). Specifically, this required the presence of one Criterion B (intrusion) symptom, plus 1) either three symptoms from across Criteria C (avoidance) and D (negative alterations in mood or cognition), or two symptoms from Criterion E (alterations in arousal and physiological reactivity); or 2) one criterion C or D symptom plus one Criterion E symptom.…”

“…We were particularly interested in whether differences in inference across aversive conditioning and extinction learning were related to individual difference in avoidance symptoms, as inappropriate avoidance behaviour is thought to be a core mechanism maintaining resistance to extinction in anxiety disorders (Arnaudova et al, 2017;Pittig et al, 2020). Following recent theoretical developments that favour modelling psychological disorders as consisting of complex associations of interacting symptoms and other psychosocial factors (Borsboom, 2017), individual differences in latent cause inference were also related to multiple psychological symptom dimensions using network analysis (Greene et al, 2018;Armour et al, 2017;Fritz et al, 2018;de Haan et al, 2020).…”

Embracing data preservation, sharing, and re-use in traumatic stress research

“…Across observational and intervention research in traumatic stress, pooling individual-level data across studies for integrated analyses has demonstrated the value of re-using such data in new ways. For example, pooled data have been used to examine intervention effectiveness, improve estimates of PTSD risk prediction, and broaden network analyses of traumatic stress symptoms and trauma-related cognitions (De Haan et al, 2020;Fried et al, 2018;Mithoefer et al, 2018;Shalev et al, 2019;Stein, Davidson, Seedat, & Beebe, 2003).…”