The symptoms at the center: Examining the comorbidity of posttraumatic stress disorder, generalized anxiety disorder, and depression with network analysis

Abstract

Comorbid mental health disorders are highly common in trauma-exposed individuals with posttraumatic stress disorder (PTSD), depression, and generalized anxiety disorder (GAD) among the most common co-occurring conditions. Network models of psychopathology offer a novel method to understand how this comorbidity manifests. The present study examined the presence of symptom communities (groups of highly connected symptoms) within a network of these disorders and hub symptoms (symptoms that connect such communities). Cross-sectional data were obtained from a community sample (N = 1184) of trauma exposed adults. Network analyses identified 5 communities: 1 containing all depression and GAD symptoms and 4 for PTSD. The PTSD communities corresponded to symptoms of intrusion and avoidance, hyperarousal, dysphoria, and negative affect. These communities had varying levels of connectivity to the Depression & GAD community. Symptoms of GAD (inability to relax) and PTSD (restricted or diminished positive emotion) were identified as key hub symptoms for the network. The results suggest symptoms of depression and GAD are highly interrelated and that PTSD is heterogeneous. The comorbidity among these diagnoses is thought to stem from their overlap with negative affect.

Comorbidity Network Analysis of Depression, Anxiety and Stress During the COVID-19 Pandemic

“…In the network, we determined the network structure and the expected in uence and bridge expected in uence of each node. The network structure shows that many symptoms (128/210) in the network are directly connected, which is consistent with the results of previous studies [30,31]. Moreover, the network structure shows that there are many correlations between stress and depression and anxiety symptoms.…”

Symptom structure of PTSD and co-morbid depressive symptoms – a network analysis of combat veteran patients

“…Importantly, the topic of overlapping symptoms gained renewed attention following the addition of Cluster D (i.e. Negative alterations in cognitions and mood associated with the traumatic event) to PTSD diagnosis per DSM-5 (American Psychiatric Association, 2013), which increased the number of potential overlapping symptoms between PTSD and depression (Mitchell et al, 2017;Price et al, 2019;but see O'Donnell et al (2014) showing similar PTSD-MDD comorbidity rates based on DSM-IV and DSM-5). Still, while providing a novel approach to conceptualize and understand the PTSD-MDD comorbidity, to date, only four studies included depressive symptoms in their network analysis of PTSD.…”

Post-traumatic stress disorder, psychiatric comorbidities and associated factors among refugees in Nakivale camp in southwestern Uganda

“…Among Somali refugees in Nairobi, PTSD was reported to be strongly associated with use of khat [40]. PTSD, depression and anxiety have common overlapping symptoms that can explain to some extent this high association [41,42]. Flory JD and Yehuda R. have argued that depression is possibly a trauma-related phenotype, a subtype of PTSD [43].…”