Symptom network connectivity of PTSD comorbid with depression in bereaved Chinese parents

Abstract

Background The death of a child is a highly traumatic event for parents and often leads to posttraumatic stress disorder (PTSD) and depression. PTSD and depression are frequent comorbid. However, the patterns of comorbidity at the symptom level among bereaved parents remain unclear. This study aims to identify symptom network connectivity of PTSD comorbid with depression in bereaved parents who have lost their only child, known as Shidu parents in Chinese society. Methods Data were obtained from 477 bereaved individuals who had lost an only child. A Gaussian graphical model (GGM) was used to construct two comorbidity networks of PTSD and depression with and without overlapping symptoms. A directed acyclic graph (DAG) was computed to determine potential directionality among symptoms in the network without overlapping symptoms. Results In the GGM, symptoms from alterations in arousal and reactivity (Cluster E) and negative alterations in cognition and mood (Cluster D) tended to be key bridging nodes in both networks with and without overlapping symptoms. The DAG results indicated the important triggering role of an exaggerated startle response and several negative alterations in cognition and mood symptoms. Conclusions The results suggest a crucial role of the exaggerated startle response in the comorbidity network between PTSD and depression among bereaved Chinese parents. This finding may serve as a significant target for psychological interventions in this population.