ArticlePsychological medicine2020
Symptom structure of PTSD and co-morbid depressive symptoms - a network analysis of combat veteran patients.
Article in Psychological medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 59 papers.
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Who cites it
59 citing papers in PubMed, 121 citations in OpenAlex.
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- Understanding the relationship of trauma memory characteristics to symptoms of PTSD and depression in trauma-exposed children and adolescents: a comprehensive network analysis.European journal of psychotraumatology · 2026Article
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- Comorbidity network of post-traumatic stress and depressive symptoms during the COVID-19 pandemic in Korea.Epidemiology and health · 2026Article
- Gender-Specific Network Structures of Depression and PTSD Symptoms in Chinese Firefighters.Psychology research and behavior management · 2026Article
- Network relationships between emotional dysregulation and ADHD symptoms: an investigation of 13,207 clinical children and adolescents.European child & adolescent psychiatry · 2026Article
- Network characteristics of comorbid symptoms in alcohol use disorder.Annals of medicine · 2025Article
- Network analysis of PTSD symptoms following childbirth and comorbid conditions among women with sexual trauma history.Archives of women's mental health · 2025Article
- Longitudinal Association Between Posttraumatic Stress Symptoms and Depression Symptoms Among Chinese Adolescents During COVID-19: Evidence from Network Perspective.Child psychiatry and human development · 2025Article
- Symptom network connectivity in PTSD comorbid with depression in bereaved Chinese parents who have lost their only child.BMC psychiatry · 2025Article
- Evaluating short-term air pollution-related mental health resilience using a directional network.BMC public health · 2025Article
- Electroconvulsive therapy modulates the interplay between depressive symptoms in difficult-to-treat depression: A longitudinal network analysis.European psychiatry : the journal of the Association of European Psychiatrists · 2025Article
- Tattooing Among Combat Soldiers as a Coping Resource With Their Military Service Experiences.Stress and health : journal of the International Society for the Investigation of Stress · 2025Article
- Predictors and process moderators of EMDR therapy for depressive symptoms: protocol for a series of observational N-of-1 trials.Frontiers in psychology · 2025Article
- Linking intrinsic brain dysfunction to behavioral outcomes in combat-exposed males with PTSD symptoms.Frontiers in psychiatry · 2025Article
Corrections and comments
- Erratum issued
Authors and funding
9 authors at 5 institutions in 2 countries.
Funding
Abstract
backgroundDespite 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.
methodsPTSD 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.
resultsThe 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.
conclusionsFlashbacks 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.
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