Network Analysis of Neurobehavioral and Post-Traumatic Stress Disorder Symptoms One Year after Traumatic Brain Injury: A Veterans Affairs Traumatic Brain Injury Model Systems Study

Abstract

Traumatic brain injury (TBI) is often experienced under stressful circumstances that can lead to symptoms of posttraumatic stress disorder (PTSD) and neurobehavioral symptoms of brain injury. There is considerable symptom overlap in the behavioral expression of these conditions. Psychometric network analysis is a useful approach to investigate the role of specific symptoms in connecting these two disorders and is well-suited to explore their interrelatedness. This study applied network analysis to examine the associations among PTSD and TBI symptoms in a sample of Service Members and Veterans (SM/Vs) with a history of TBI one year after injury.Responses to the Neurobehavioral Symptom Inventory (NSI) and PTSD Checklist-Civilian version (PCL-C) were obtained from participants who completed comprehensive inpatient rehabilitation services across five VA polytrauma rehabilitation centers. Participants (N = 612) were 93.1% male with an average age of 36.98 years at injury. The analysis produced a stable network. Within the NSI symptom groups, the frustration symptom was an important bridge between the affective and cognitive TBI symptoms. The PCL-C nodes formed their own small cluster with hyperarousal yielding connections with the affective, cognitive, and somatic symptom groups. Consistent with this observation, the hyperarousal node had the second strongest bridge centrality in the network. Hyperarousal appears to play a key role in holding together this network of distress and thus represents a prime target for intervention among individuals with elevated symptoms of PTSD and a history of TBI. Network analysis offers an empirical approach to visualizing and quantifying the associations among symptoms. The identification of symptoms that are central to connecting multiple conditions can inform diagnostic precision and treatment selection.

Comparing psychopathy across measurement modalities.

“…Some scholars argue that the features of psychopathy may represent robustly connected symptoms, which co-occur mainly due to their propensity to influence and reinforce each other, rather than reflect a common latent factor (Verschuere et al, 2018). As such, PNA is an ideal framework through which to examine psychopathy because it has yielded novel insights into complex disorders such as traumatic brain injury and posttraumatic stress disorder (Klyce et al, 2021; Armour et al, 2017). Centrality estimates can be considered alongside estimates from analyses using a latent variable approach to provide complimentary, yet distinct, psychometric information (Marsman et al, 2018).…”

Pharmacotherapeutic potential of pomegranate in age-related neurological disorders

“…Their study found no differences in brain damage, measurements, or volumes between groups, but they managed to find that the treatment subjects had lower diffusivity in the anterior and posterior limbs of the internal capsule compared to the controls, and that resting-state functional connectivity displayed greater correlation and covariance in multiple networks in treatment cases, with alterations most visible in the visual network in per-protocol analyses (Matthews et al, 2019 ). Traumatic brain injury (TBI) is frequently induced by stressful conditions, which can result in symptoms of post-traumatic stress disorder (PTSD) and neurobehavioral symptoms of brain damage (Klyce et al, 2021 ). Daradkeh et al investigated the impact of pomegranate juice intake on nutritional and behavioral results following traumatic brain damage.…”

Comparing Psychopathy Across Measurement Modalities

“…In this view, symptoms are measured as individual, functioning components that play a distinct role within the context of a given pathology (e.g., traumatic brain injury; Klyce et al, 2021). Dynamic systems theory is thus distinct from a latent variable approach, such that the latter assumes individual symptoms are necessarily indicators of a common cause (i.e., latent factor).…”

“…The inclusion of theoretically relevant covariates (e.g., impulsivity facets in a network of psychopathy items) in partial correlation networks provides the potential for important insights into the structure of a given trait or disorder, as edges between items and covariates are not due to the covariation among items (e.g., Armour et al, 2017). The examination of variables at different conceptual levels (e.g., domains, facets) using PNA further allows for identification of the individual items most responsible for the associations commonly observed between latent factors (e.g., Klyce et al, 2021;West & Chester, 2021).…”

“…Some scholars argue that the features of psychopathy may represent robustly connected symptoms, which co-occur mainly due to their propensity to influence and reinforce each other, rather than reflect a common latent factor (Verschuere et al, 2018). As such, PNA is an ideal framework through which to examine psychopathy as it has yielded novel insights into complex disorders such as traumatic brain injury and PTSD (e.g., Klyce et al, 2021;Armour et al, 2017). Centrality estimates can be considered alongside estimates from analyses utilizing a latent variable approach to provide complimentary, yet distinct, psychometric information (Marsman et al, 2018).…”