Mental disorders as networks of problems: a review of recent insights

Abstract

PurposeThe network perspective on psychopathology understands mental disorders as complex networks of interacting symptoms. Despite its recent debut, with conceptual foundations in 2008 and empirical foundations in 2010, the framework has received considerable attention and recognition in the last years.MethodsThis paper provides a review of all empirical network studies published between 2010 and 2016 and discusses them according to three main themes: comorbidity, prediction, and clinical intervention.ResultsPertaining to comorbidity, the network approach provides a powerful new framework to explain why certain disorders may co-occur more often than others. For prediction, studies have consistently found that symptom networks of people with mental disorders show different characteristics than that of healthy individuals, and preliminary evidence suggests that networks of healthy people show early warning signals before shifting into disordered states. For intervention, centrality—a metric that measures how connected and clinically relevant a symptom is in a network—is the most commonly studied topic, and numerous studies have suggested that targeting the most central symptoms may offer novel therapeutic strategies.ConclusionsWe sketch future directions for the network approach pertaining to both clinical and methodological research, and conclude that network analysis has yielded important insights and may provide an important inroad towards personalized medicine by investigating the network structures of individual patients.Electronic supplementary materialThe online version of this article (doi:10.1007/s00127-016-1319-z) contains supplementary material, which is available to authorized users.

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“…The methodological field of psychological network psychometrics has moved remarkably quickly from visualizing correlation matrices in 2010 (Cramer et al, 2010) to using sophisticated statistical models in 2014 (Van Borkulo et al, 2014). The gap between clinical sciences and methodology is slowly closing, in part due to several tutorial papers (Costantini et al, 2017; Epskamp, Borsboom, & Fried, 2017; Epskamp & Fried, 2017) that have enabled clinical researchers to apply network models to a large number of disorders (for a review see Fried, van Borkulo et al, 2017). …”

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