Subjects: Psychology >> Social Psychology submitted time 2023-03-27 Cooperative journals: 《心理学报》
Abstract： Previous studies have found temporal differences in posttraumatic stress disorder (PTSD) development. Clinical workers and researchers have also demonstrated that symptoms of PTSD differ by stage after traumatic events. Recently, the symptom network perspective has contributed substantially to the development of psychopathology due to its important advantage in understanding the role of psychological symptoms in mental disorders. An increasing number of analyses adopting the network approach to study PTSD symptoms have also provided novel insights into PTSD symptomatology. However, changes in children's long-term PTSD symptomatology are poorly understood. The current study aims to identify changes in the network of PTSD symptoms among children through the network approach.A four-year longitudinal study was conducted from 4 months after the Wenchuan earthquake. Four assessments were conducted at four (T1;September 2008), 29 (T2; October 2010), 40 (T3; September 2011) and 52 (T4; September 2012) months following the earthquake. Ultimately, 197 children completed assessments at each time point. The children were in grades four and six at T1 and attended two primary schools located in Beichuan County. Symptoms of PTSD were assessed by the University of California at Los Angeles PTSD Reaction Index based on the DSM-IV. Network analysis was implemented with the qgraph package in R following the standard guidelines by Epskamp and Fried.Flashbacks exhibited relatively high centrality at all time points, while other symptoms with high centrality varied across time points. Emotional cue reactivity exhibited high centrality at 4 months, and its centrality decreased over time. Foreshortened future exhibited high centrality at 4, 29 and 40 months, but its centrality decreased to a low level at 52 months. Intrusive thoughts exhibited low centrality at 4 months, but the centrality of this symptom increased to a high level at 29 months. Physiological cue reactivity exhibited low centrality at 4 months, and its centrality increased over time. These findings indicated the distinct temporal variability in the centrality of some PTSD symptoms. The global connectivity of the network increased from 4 to 40 months and then decreased at 52 months.The current study enhanced the knowledge of child PTSD symptomatology. Flashbacks might play a key role in the evolution of PTSD symptoms. In addition, different core symptoms might contribute to early and chronic PTSD structures. Emotional cue reactivity and foreshortened future might play key roles in early PTSD structures and then recover in later stages following disasters. Physiological cue reactivity and intrusive thoughts might be core symptoms in chronic PTSD structures. The phenomenon of the increased connectivity of the PTSD symptom network at 40 months may be one reason why previous trauma leads to vulnerability to PTSD. Overall, our study highlighted temporal differences in PTSD symptoms. Different core symptoms in early and chronic PTSD structures should be treated as targets at different stages following disasters in clinical practice.
Subjects: Psychology >> Social Psychology submitted time 2023-03-27 Cooperative journals: 《心理学报》
Abstract： Traumatic events have been recognized as important precipitants of sleep problems. Meanwhile, traumatic insomnia is one of the criteria for diagnosing post-traumatic stress disorder (PTSD). However, whether trauma-induced sleep problems are secondary symptoms of PTSD or a core feature of PTSD has not yet reached a consistent conclusion. Recently, the emerging cross-lagged panel network analysis method has played an important role in understanding the role of symptoms in psychopathology. The advantage is that the role of each symptom can be systematically analyzed, and the longitudinal predictive pathway of each symptom can be estimated, thereby inferring the leading symptoms of psychiatric disorders. The present study aims to explore the role of trauma-induced sleep problems in the evolution of PTSD among children and adolescents through the cross-lagged panel network analysis. Three months after the Zhouqu debris flow, we started this 2-year longitudinal study. Three assessments were performed at 3 months (T1), 15 months (T2) and 27 months (T3) after the disaster. We enrolled students from 2 primary schools and 3 secondary schools in the hardest-hit areas. Ultimately, 1, 460 children and adolescents completed three rounds of evaluation. At T1, there were 702 students from grades 4 to 6, and 758 students from grades 7 to 9. The average age of the participant was 12.89 (SD = 2.29). Symptoms of PTSD were assessed with the University of California at Los Angeles PTSD Reaction Index based on the DSM-IV. The cross-lagged panel network analysis was conducted using R packages glmnet and qgraph. Results showed that at T1→T2, sleep problems had the highest out-expected influence centrality, followed by physiological cue reactivity. They were sources of activation for the nodes receiving its edges, that is, they were easy to activate other symptoms in the PTSD network. Sleep problems at T1 positively predicted a lot of other PTSD symptoms at T2, including intrusive thoughts, nightmares, flashbacks, emotional cue reactivity, restricted positive affect, restricted negative affect, irritability/anger, hypervigilance and exaggerated startle response. The results also revealed several indirect influence paths such as sleep problems predicting nightmares then affecting flashbacks. However, when it comes to T2→T3, it is detachment rather than sleep problems that had the highest out- expected influence. It positively predicted diminished interest, restricted positive affect, sleep problems and irritability/anger. We also found some feedback loop: detachment→ restricted positive affect→diminished interest→detachment. This is the first study to explore activation paths of PTSD symptoms among children and adolescents through the cross-lagged panel network analysis. These findings have improved the understanding of the role of trauma-induced sleep problems in the long-term development of PTSD. The results showed that sleep problems at 3 months after the disaster activated a large number of symptoms in PTSD at 15 months after the disaster. Therefore, it is inferred that early sleep problems were the core symptom in the development of PTSD among children and adolescents in the early post-disaster period. However, its predictability decreased in the later period (15 months to 27 months). In conclusion, these findings emphasize the time specificity of the impact of traumatic sleep problems on PTSD symptoms. We recommend that trauma-induced sleep problems should be given greater priority in the diagnostic criteria for PTSD among children and adolescents in the early post-disaster period. Meanwhile, early psychological assistance should vigorously develop treatments based on sleep problems to prevent the occurrence and development of PTSD. One year or longer after the traumatic event, the intervention target should be set to physiological cue reactivity and detachment.
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