Symptom Centrality and Bridge Symptoms in Self-Injurious Thoughts and Behaviors and Posttraumatic Stress Disorder: A Multi-Sample Network Analysis in Trauma-Exposed Adults

Abstract

As self-injurious thoughts and behaviors (SITB) remain a pressing public health concern, research continues to focus on risk factors, such as posttraumatic stress disorder (PTSD). Prior research on SITB and PTSD has primarily been conducted using a regression framework and structural equation modeling to understand the relationship between these constructs and confirmatory factor analysis to understand how individual symptoms are related to one another. This body of literature has demonstrated a consistent, yet weak, relationship between SITB and PTSD and has not offered specific treatment targets. Network analysis has recently been applied to psychopathology as an alternative conceptualization of individual symptom comorbidity between different forms of psychopathology. Using network analysis, symptoms that are most central (i.e. have the strongest and largest number of connections to other symptoms and play the largest role in the network) to the network of SITB and PTSD symptoms, as well as bridge symptoms (i.e., symptoms that connect sets of symptoms in a network) between SITB and PTSD can be identified. In the current study, we used network analysis to further elucidate the relationship between SITB and PTSD symptoms in two distinct samples of individuals. The first sample consists of 349 adults who have experienced a DSM-5 Criterion A traumatic event and lifetime suicide ideation, and the second sample consists of 1,307 combat-exposed OEF/OIF/OND Veterans. Three PTSD symptoms were identified as the most central in both networks: persistent negative emotional state, physiological reactions of the trauma, and unwanted memories, suggesting that these symptoms have the greatest influence in the overall network of SITB and PTSD. In addition, three symptoms were identified as the strongest bridges in both networks: negative beliefs, risky behaviors, and suicidal ideation, suggesting that these symptoms may play an important role in the development of the co-occurrence of symptoms across SITB and PTSD. We also discuss the most influential symptoms and symptoms that played the greatest bridging role in each sample as well as clinical treatment implications and future directions for research.