A network analysis of DSM-5 posttraumatic stress disorder symptoms and correlates in US military veterans
A network analysis of DSM-5 posttraumatic stress disorder symptoms and correlates in US military veterans
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DOI：
10.1016/j.janxdis.2016.11.008
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发表时间：
2017-01-01
影响因子：
10.3
通讯作者：
Pietrzak, Robert H.
中科院分区：
文献类型：
--
作者：
Armour, Cherie;Fried, Eiko I.;Pietrzak, Robert H.
目的：心理测量学的最新发展使网络模型能够应用于分析心理障碍，如创伤后应激障碍。这种方法不是将症状理解为潜在共同原因的指标，而是认为症状因因果相互作用而在综合征中共同出现。目前的研究有两个目标：(1)检验20种DSM-5创伤后应激障碍症状的网络结构；(2)将临床相关变量纳入网络，以调查PTSD症状是否表现出与自杀意念、抑郁、焦虑、身体功能/生活质量(QOL)、精神功能(QOL、年龄和性别)的差异关系。方法：我们利用具有全国代表性的美国退伍军人样本；并分析了221名退伍军人的数据，这些退伍军人报告了具有临床意义的DSM-5 PTSD症状。使用最先进的正则化偏相关模型对网络进行估计。结果：由20个条目组成的DSM-5创伤后应激障碍网络显示，症状在网络内呈正相关。尤其是噩梦和闪回；自我或他人的责备与负面的创伤相关情绪、超然和受限制的情感；以及高度警惕和夸大的惊吓反应之间出现了特别强的联系。最主要的症状是与创伤相关的消极情绪、闪回、脱离和生理线索反应。将与临床相关的协变量纳入网络，揭示了自毁行为与自杀意念、注意力困难与焦虑、抑郁和心理生活质量以及抑郁与受限影响之间的路径。结论：这些结果证明了网络方法在模拟DSM-5创伤后应激障碍症状结构方面的有效性，并提示特定的DSM-5创伤后应激障碍症状与临床结果之间存在不同的关联。这些结果的含义，以告知评估和治疗，这是讨论。(C)2016爱思唯尔有限公司。保留所有权利。
Objective: Recent developments in psychometrics enable the application of network models to analyze psychological disorders, such as PTSD. Instead of understanding symptoms as indicators of an underlying common cause, this approach suggests symptoms co-occur in syndromes due to causal interactions. The current study has two goals: (1) examine the network structure among the 20 DSM-5 PTSD symptoms, and (2) incorporate clinically relevant variables to the network to investigate whether PTSD symptoms exhibit differential relationships with suicidal ideation, depression, anxiety, physical functioning/quality of life (QoL), mental functioning(QoL, age, and sex.Method: We utilized a nationally representative U.S. military veteran's sample; and analyzed the data from a subsample of 221 veterans who reported clinically significant DSM-5 PTSD symptoms. Networks were estimated using state-of-the-art regularized partial correlation models. Data and code are published along with the paper.Results: The 20-item DSM-5 PTSD network revealed that symptoms were positively connected within the network. Especially strong connections emerged between nightmares and flashbacks; blame of self or others and negative trauma-related emotions, detachment and restricted affect; and hypervigilance and exaggerated startle response. The most central symptoms were negative trauma-related emotions, flashbacks, detachment, and physiological cue reactivity. Incorporation of clinically relevant covariates into the network revealed paths between self-destructive behavior and suicidal ideation; concentration difficulties and anxiety, depression, and mental QoL; and depression and restricted affect.Conclusion: These results demonstrate the utility of a network approach in modeling the structure of DSM-5 PTSD symptoms, and suggest differential associations between specific DSM-5 PTSD symptoms and clinical outcomes in trauma survivors. Implications of these results for informing the assessment and treatment of this disorder, are discussed. (C) 2016 Elsevier Ltd. All rights reserved.