Applying network analysis to psychological comorbidity and health behavior: Depression, PTSD, and sexual risk in sexual minority men with trauma histories.

Abstract

Objective High rates of depression and PTSD contribute to sexual risk, particularly in men who have sex with men (MSM) who have experienced childhood sexual abuse. The comorbidity between depression and PTSD and mechanisms by which they contribute to sexual risk in MSM remain unclear. This study sought to demonstrate the feasibility and utility of a novel network approach to (1) characterize symptom interconnections between depression and PTSD in MSM, (2) identify specific symptoms related to sexual risk behavior, and (3) compare symptom networks across groups at different levels of risk. Method Cross-sectional baseline data were collected from 296 HIV-negative urban MSM as part of a multi-site randomized intervention trial. Symptoms of depression and PTSD were self-reported along with sexual risk behavior. Analyses were performed in R using regularized partial correlation network modeling. Results Network analyses revealed complex associations between depression and PTSD symptoms and in relation to sexual risk behavior. While symptoms clustered within their respective disorders, depression and PTSD were connected at key symptom nodes (e.g., sleep, concentration). Specific symptoms (e.g., avoiding thoughts and feelings) were linked to sexual risk behavior. Network comparisons across risk groups suggested avoidant processes could be more readily activated in higher-risk individuals, whereas hyperarousal symptoms may be more salient for lower-risk individuals. Conclusions This study is one of the earliest network analyses of depression and PTSD, and first to extend this inquiry to health behavior. Symptom-level investigations may clarify mechanisms underlying psychological comorbidity and behavioral risk in MSM and refine targets for intervention/prevention.

The Study of Psychopathology from the Network Analysis Perspective: A Systematic Review

“…Two studies analyzed depression and PTSD [70, 71] and found that symptoms of depression and PTSD formed separated clusters but they were also connected by bridge symptoms, such as “sleep disruption” or “concentration difficulties” (online suppl. Table 2).…”

Posttraumatic Stress Disorder Symptoms and Reckless Behaviors: A Network Analysis Approach

“…To date, no network analytic study of which we are aware has examined the relations between a variety of reckless behaviors and specific PTSD symptoms and/or symptom clusters. One study examined the association between PTSD and one form of reckless behaviors—risky sexual behavior (Choi, Batchelder, Ehlinger, Safren, & O'Cleirigh, 2017). In a United States–based sample of 296 men who have sex with other men, the authors found that the strongest connection between PTSD, as diagnosed using criteria from the fourth edition of the DSM ( DSM‐IV ), and risky sexual behavior was through PTSD Symptom C1: avoidance of memories, thoughts, and feelings related to the traumatic event.…”

“…In a United States-based sample of 296 men who have sex with other men, the authors found that the strongest connection between PTSD, as diagnosed using criteria from the fourth edition of the DSM (DSM-IV), and risky sexual behavior was through PTSD Symptom C1: avoidance of memories, thoughts, and feelings related to the traumatic event. The authors concluded that these results underscored the importance of including skills that increase mindfulness and tolerance of distressing memories in interventions for PTSD (Choi et al, 2017).…”

Dynamic Network Analysis of Negative Emotions and DSM‐5 Posttraumatic Stress Disorder Symptom Clusters During Conflict

“…In a recent paper, researchers showed that these PTSD network structures replicated well across four different samples of traumatized patients receiving treatment (Fried et al., ). Studies have also investigated the comorbidity of PTSD with other diagnostic constructs, such as depression and substance abuse (Afzali et al., 2016; Choi, Batchelder, Ehlinger, Safren, & O'Cleirigh, ). However, to our knowledge, no network study has modeled PTSD symptoms together with specific individual negative emotions.…”