The network structure of posttraumatic stress symptoms in war‐affected children and adolescents

Abstract

Background: It is unclear whether findings from previous network analyses of posttraumatic stress disorder (PTSD) symptoms among children and adolescents are generalizable to youth living in war-torn settings and whether there are differences in the structure and connectivity of symptoms between children and adolescents. This study examined the network structure of PTSD symptoms in a sample of war-affected youth and compared the symptom networks of children and adolescents. Methods: The overall sample comprised 2007 youth (6-18 years old) living in Burundi, Democratic Republic of Congo, Iraq, Palestine, Tanzania, and Uganda amid or close to war and armed conflict. Youth reported their PTSD symptoms using a self-report questionnaire in Palestine and structured clinical interviews in all other countries. We computed the networks of the overall sample and of two sub-samples of 412 children (6-12 years) and 473 adolescents (13-18 years) and compared the structure and global connectivity of symptoms among children and adolescents. Results:In both the overall sample and the sub-samples, re-experiencing and avoidance symptoms were most strongly connected. The adolescents' network had a higher global connectivity of symptoms than the children's network. Hyperarousal symptoms and intrusions were more strongly connected among adolescents compared to children. Conclusion:The findings lend support to a universal concept of PTSD among youth characterized by core deficits in fear processing and emotion regulation. However, different symptoms may be particularly important in different developmental stages, with avoidance and dissociative symptoms dominating in childhood and intrusions and hypervigilance gaining importance in adolescence. Stronger symptom connections may render adolescents more vulnerable to the persistence of symptoms.

Exploring gender differences in complex developmental trauma symptomatology among children and adolescents involved in child welfare

“…Consistent with the child networks, this subscale had the highest strength centrality for adolescents, in addition to emotion dysregulation, behavioral dysregulation, and those related to negative self-identity (low confidence and negative self-image). The centrality of the emotion dysregulation and negative self-concept symptoms is consistent with previous network studies of PTSD symptoms in children and adolescents (Bartels et al, 2019, De Haan et al, 2020Scharpf et al, 2022). Together with the importance of attachment dysregulation symptoms, these patterns support the transdiagnostic model of developmental mechanisms that explain the link between childhood trauma and psychopathology (McLaughlin et al, 2020) and is consistent with the conceptualization of developmental trauma disorder (DTD; van der Kolk et al, 2009).…”

“…De Haan et al (2020) also investigated PTSD and depression symptoms in an international sample of children and youth, finding re-experiencingrelated PTSD symptoms and impaired concentration in depression to be the most central. Additionally, Scharpf et al (2022) examined PTSD symptom networks in a sample of waraffected children and adolescents from across six countries. Re-experiencing and avoidance were most strongly connected to other symptoms in the full sample, as well as child-and adolescentspecific networks.…”

“…Recent perspectives on psychopathology suggest that mental health challenges, including post-traumatic stress disorder (PTSD), may be best conceptualized as a systemic network wherein symptoms are mutually reinforcing and interdependently influential (Borsboom, 2021). To date, several studies have examined PTSD symptom networks in children and adolescents (Bartels et al, 2019;De Haan et al, 2019;Scharpf et al, 2022), but none have specifically explored complex trauma symptoms. Moreover, previous work indicates differences between boys and girls in rates and domains of psychopathology across childhood and adolescence, including trauma-related symptoms (Hayward, 2021;Hudziak, 2007), yet no studies have examined these gender differences from a network perspective.…”

Exploring networks of complex developmental trauma symptomatology among children and adolescents involved in child welfare

“…The centrality indices in all networks underscore the primacy of the attachment-specific symptoms, negative self-concept, and emotional dysregulation, irrespective of developmental stage and gender. The (Bartels et al, 2019;De Haan et al, 2020;Scharpf et al, 2022). Together with the importance of attachment dysregulation symptoms, these patterns support the transdiagnostic model of developmental mechanisms that explain the link between childhood trauma and psychopathology (McLaughlin et al, 2020) and is consistent with the conceptualization of developmental trauma disorder (DTD; van der Kolk et al, 2009).…”

Symptom network analysis of parent–child depression and anxiety in treatment-seeking youth.

“…For example, Elliott et al (2020) found that nodes central to pretreatment anorexia nervosa symptom networks were prognostic indicators for recovery. Systematic reviews of symptom network analyses show that this statistical approach has been widely applied as a technique for better understanding symptom relationships across adults (Contreras et al, 2019; McNally et al, 2022; Robinaugh et al, 2020) and youth (Anderson et al, 2015; Boschloo et al, 2016; Cervin et al, 2020; Goldschmidt et al, 2018; Grassie et al, 2022; Heeren & McNally, 2016; Martel et al, 2016; Russell et al, 2017; Ruzzano et al, 2015; Scharpf et al, 2023; Schweren et al, 2018; Smith et al, 2017). However, while the utility of symptom network analyses in driving clinical research and intervention-related outputs is exciting, more research are needed to support the use of network analysis results in clinical practice (Bringmann et al, 2022; Castro et al, 2019).…”