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

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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.

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Estimating psychological networks and their accuracy: A tutorial paper

Sacha Epskamp, Denny Borsboom, Eiko I Fried (2017)

The usage of psychological networks that conceptualize behavior as a complex interplay of psychological and other components has gained increasing popularity in various research fields. While prior publications have tackled the topics of estimating and interpreting such networks, little work has been conducted to check how accurate (i.e., prone to sampling variation) networks are estimated, and how stable (i.e., interpretation remains similar with less observations) inferences from the network structure (such as centrality indices) are. In this tutorial paper, we aim to introduce the reader to this field and tackle the problem of accuracy under sampling variation. We first introduce the current state-of-the-art of network estimation. Second, we provide a rationale why researchers should investigate the accuracy of psychological networks. Third, we describe how bootstrap routines can be used to (A) assess the accuracy of estimated network connections, (B) investigate the stability of centrality indices, and (C) test whether network connections and centrality estimates for different variables differ from each other. We introduce two novel statistical methods: for (B) the correlation stability coefficient, and for (C) the bootstrapped difference test for edge-weights and centrality indices. We conducted and present simulation studies to assess the performance of both methods. Finally, we developed the free R-package bootnet that allows for estimating psychological networks in a generalized framework in addition to the proposed bootstrap methods. We showcase bootnet in a tutorial, accompanied by R syntax, in which we analyze a dataset of 359 women with posttraumatic stress disorder available online. Electronic supplementary material The online version of this article (doi:10.3758/s13428-017-0862-1) contains supplementary material, which is available to authorized users.

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Author and article information

Journal

Journal ID (nlm-journal-id): 0375361

Journal ID (nlm-ta): J Child Psychol Psychiatry

Journal ID (iso-abbrev): J Child Psychol Psychiatry

Title: Journal of child psychology and psychiatry, and allied disciplines

ISSN (Print): 0021-9630

ISSN (Electronic): 1469-7610

Publication date Nihms-submitted: 12 October 2020

Publication date (Print): 01 January 2020

Publication date (Electronic): 07 November 2019

Publication date PMC-release: 21 October 2020

Volume: 61

Issue: 1

Pages: 77-87

Affiliations

[1 ]Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland

[2 ]Department of Psychosomatics and Psychiatry, University Children’s Hospital Zurich, Zurich, Switzerland

[3 ]Department of Clinical Psychology, Leiden University, Leiden, The Netherlands

[4 ]Institute of Psychology, University of Siegen, Siegen, Germany

[5 ]Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia

[6 ]School of Psychology, University of New South Wales, Sydney, NSW, Australia

[7 ]School of Psychology, Victoria University of Wellington, Wellington, New Zealand

[8 ]Department of Psychology, National Taiwan University, Taipei, Taiwan

[9 ]Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK

[10 ]Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), Cambridge, UK

[11 ]Department of Psychology, Centre for Emotional Health Clinic, Macquarie University, Sydney, NSW, Australia

[12 ]Sussex Partnership NHS Foundation Trust, West Sussex Child and Adolescent Mental Health Service, West Sussex, UK

[13 ]Norfolk & Suffolk Foundation Trust, Norwich, UK

[14 ]Department of Child and Adolescent Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

[15 ]De Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands

[16 ]Department of Psychology, University of Bath, Bath, UK

[17 ]Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

[18 ]Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil

[19 ]Department of Human Development, Institute of Psychology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

[20 ]Kentucky Children’s Hospital, University of Kentucky, Lexington, KY, USA

[21 ]Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA

[22 ]Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

[23 ]Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

[24 ]School of Psychology, Flinders University, Adelaide, SA, Australia

[25 ]Faculty of Social Sciences, Psychology, University of Tampere, Tampere, Finland

[26 ]School of Management, University of Tampere, Tampere, Finland

[27 ]Murdoch Childrens Research Institute, Melbourne, Vic, Australia

[28 ]Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic, Australia

[29 ]Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK

[30 ]South London and Maudsley NHS Foundation Trust, London, UK

[31 ]Department of Psychology, King’s College London Institute of Psychiatry, London, UK

[32 ]Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK

Author notes

Correspondence Anke de Haan, Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Binzmuehlestrasse 14/8, 8050 Zurich, Switzerland; Anke.deHaan@ 123456kispi.uzh.ch