Using clinical expertise and empirical data in constructing networks of trauma symptoms in refugee youth

Schumacher, Lea; Burger, Julian; Zoellner, F; Zindler, Areej; Epskamp, Sacha; Barthel, Dana

doi:10.1080/20008198.2021.1920200

Cited by 8 publications

(3 citation statements)

References 37 publications

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“…To date, however, evidence on the network of PTSD symptoms among conflict‐affected children and adolescents is scarce, although it is estimated that one in six children worldwide live in areas impacted by armed conflict (Save the Children, 2019 ). The few existing studies only included conflicted‐affected youth as a subgroup (de Haan et al., 2020 ) or relied on small samples of predominantly male and unaccompanied youth living in secure high‐income settings (Pfeiffer et al., 2019 ; Schumacher et al., 2021 ), limiting the generalizability to other groups of conflict‐affected youth living in active and post‐conflict regions. As the severity and patterns of PTSD symptoms can vary extremely based on the type and number of traumatic events (Alisic et al., 2014 ; Cloitre et al., 2009 ; Kelley et al., 2009 ), it is conceivable that the PTSD symptom networks of conflict‐affected youth may differ from youth who have been mainly exposed to other traumatic events.…”

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The network structure of posttraumatic stress symptoms in war‐affected children and adolescents

et al. 2022

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Background: It is unclear whether findings from previous network analyses of posttraumatic stress disorder (PTSD) symptoms among children and adolescents are generalizable to youth living in war-torn settings and whether there are differences in the structure and connectivity of symptoms between children and adolescents. This study examined the network structure of PTSD symptoms in a sample of war-affected youth and compared the symptom networks of children and adolescents. Methods: The overall sample comprised 2007 youth (6-18 years old) living in Burundi, Democratic Republic of Congo, Iraq, Palestine, Tanzania, and Uganda amid or close to war and armed conflict. Youth reported their PTSD symptoms using a self-report questionnaire in Palestine and structured clinical interviews in all other countries. We computed the networks of the overall sample and of two sub-samples of 412 children (6-12 years) and 473 adolescents (13-18 years) and compared the structure and global connectivity of symptoms among children and adolescents. Results:In both the overall sample and the sub-samples, re-experiencing and avoidance symptoms were most strongly connected. The adolescents' network had a higher global connectivity of symptoms than the children's network. Hyperarousal symptoms and intrusions were more strongly connected among adolescents compared to children. Conclusion:The findings lend support to a universal concept of PTSD among youth characterized by core deficits in fear processing and emotion regulation. However, different symptoms may be particularly important in different developmental stages, with avoidance and dissociative symptoms dominating in childhood and intrusions and hypervigilance gaining importance in adolescence. Stronger symptom connections may render adolescents more vulnerable to the persistence of symptoms.

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confidence: 99%

The network structure of posttraumatic stress symptoms in war‐affected children and adolescents

et al. 2022

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“…The experts, in our case clinician and patient, can formalize case formulations without specifying probability distributions themselves, circumventing the technical limitation of implementing formalization techniques in clinical practice. Prior literature focused on similar approaches to eliciting perceived relationships, for instance using Perceived Causal Relations (Deserno et al, 2020; Frewen et al, 2012), and Perceived Symptom Relations (Schumacher et al, 2021). These approaches have been extended to the idiographic context, referred to as Perceived Causal Problem Networks (Klintwall et al, 2021).…”

Section: A Formal Integration Of Case Formulation and Personalized Ne...mentioning

confidence: 99%

A clinical PREMISE for personalized models: Toward a formal integration of case formulations and statistical networks.

Burger¹,

Epskamp²,

Veen³

et al. 2022

Journal of Psychopathology and Clinical Science

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Over the past decade, the idiographic approach has received significant attention in clinical psychology, incentivizing the development of novel approaches to estimate statistical models, such as personalized networks. Although the notion of such networks aligns well with the way clinicians think and reason, there are currently several barriers to implementation that limit their clinical utility. To address these issues, we introduce the Prior Elicitation Module for Idiographic System Estimation (PREMISE), a novel approach that formally integrates case formulations with personalized network estimation via prior elicitation and Bayesian inference. PREMISE tackles current implementation barriers of personalized networks; incorporating clinical information into personalized network estimation systematically allows theoretical and data-driven integration, supporting clinician and patient collaboration when building a dynamic understanding of the patient’s psychopathology. To illustrate its potential, we estimate clinically informed networks for a patient suffering from obsessive–compulsive disorder. We discuss open challenges in selecting statistical models for PREMISE, as well as specific future directions for clinical implementation.

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“…These reservations have led to the conception of a new approach that aims to integrate rather than contrast case conceptualization and statistical network models Scholten, Lischetzke, & Glombiewski, 2021). This line of research proposes to use clinical expertise and patient experience to construct networks of perceived relationships (Deserno et al, 2020;Klintwall, Bellander, & Cervin, 2021;Schumacher et al, 2021). In a subsequent step, networks based on case conceptualizations can be "updated" via Bayesian inference using EMA data collected by the patient.…”

Section: Integrating Case Conceptualization and Idiographic Networkmentioning

confidence: 99%

Integrating Clinician and Patient Case Conceptualization with Momentary Assessment Data to Construct Idiographic Networks: Moving toward Personalized Treatment for Eating Disorders

Burger¹,

Ralph‐Nearman²,

Levinson³

2022

Preprint

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Eating disorders are serious psychiatric illnesses with treatments ineffective for about 50% of individuals due to 1) high heterogeneity of symptom presentation even within the same diagnoses, 2) a lack of personalized treatments to address this heterogeneity, and 3) the fact that clinicians are left to rely upon their own judgment to decide how to personalize treatment. Idiographic (personalized) networks can be estimated from ecological momentary assessment data, and have been used to investigate central symptoms, which are theorized to be fruitful treatment targets. However, both efficacy of treatment target selection and implementation with ‘real world’ clinicians could be maximized if clinician input is integrated into such networks. An emerging line of research is therefore proposing to integrate case conceptualizations and statistical routines, tying together the benefits from clinical expertise as well as patient experience and idiographic networks. The current pilot compares personalized treatment implications from different approaches to constructing idiographic networks. For three patients with a diagnosis of anorexia nervosa, we compared idiographic networks 1) based on the case conceptualizations from clinicians and patients, 2) estimated from patient EMA data (the current default in the literature), and 3) based on a combination of case conceptualization and patient EMA data networks, drawing on informative priors in Bayesian inference. Centrality-based treatment recommendations differed to varying extent between these approaches for different patients. We discuss implications from these findings, as well as how these models may inform clinical practice by pairing evidence-based treatments with identified treatment targets.

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Using clinical expertise and empirical data in constructing networks of trauma symptoms in refugee youth

Abstract: View related articlesView Crossmark data This article has been awarded the Centre for Open Science 'Open Materials' badge.

Cited by 8 publications

References 37 publications

The network structure of posttraumatic stress symptoms in war‐affected children and adolescents

The network structure of posttraumatic stress symptoms in war‐affected children and adolescents

A clinical PREMISE for personalized models: Toward a formal integration of case formulations and statistical networks.

Integrating Clinician and Patient Case Conceptualization with Momentary Assessment Data to Construct Idiographic Networks: Moving toward Personalized Treatment for Eating Disorders

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