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Dynamic networks of PTSD symptoms during conflict

Published online by Cambridge University Press:  28 February 2018

Talya Greene ,
Marc Gelkopf ,
Sacha Epskamp  and
Eiko Fried
Talya Greene*
Affiliation:
Department of Community Mental Health, University of Haifa, Haifa, Israel
Marc Gelkopf
Affiliation:
Department of Community Mental Health, University of Haifa, Haifa, Israel NATAL, Israel Trauma Center for Victims of Terror and War, Tel Aviv, Israel
Sacha Epskamp
Affiliation:
Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
Eiko Fried
Affiliation:
Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
*
Author for correspondence: Talya Greene, E-mail: tgreene@univ.haifa.ac.il
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Abstract

Background

Conceptualizing posttraumatic stress disorder (PTSD) symptoms as a dynamic system of causal elements could provide valuable insights into the way that PTSD develops and is maintained in traumatized individuals. We present the first study to apply a multilevel network model to produce an exploratory empirical conceptualization of dynamic networks of PTSD symptoms, using data collected during a period of conflict.

Methods

Intensive longitudinal assessment data were collected during the Israel–Gaza War in July–August 2014. The final sample (n = 96) comprised a general population sample of Israeli adult civilians exposed to rocket fire. Participants completed twice-daily reports of PTSD symptoms via smartphone for 30 days. We used a multilevel vector auto-regression model to produce contemporaneous and temporal networks, and a partial correlation network model to obtain a between-subjects network.

Results

Multilevel network analysis found strong positive contemporaneous associations between hypervigilance and startle response, avoidance of thoughts and avoidance of reminders, and between flashbacks and emotional reactivity. The temporal network indicated the central role of startle response as a predictor of future PTSD symptomatology, together with restricted affect, blame, negative emotions, and avoidance of thoughts. There were some notable differences between the temporal and contemporaneous networks, including the presence of a number of negative associations, particularly from blame. The between-person network indicated flashbacks and emotional reactivity to be the most central symptoms.

Conclusions

This study suggests various symptoms that could potentially be driving the development of PTSD. We discuss clinical implications such as identifying particular symptoms as targets for interventions.

Keywords

ESMintensive longitudinal assessmentmultilevel VARnetwork analysisposttraumatic stresstraumawar
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 14 , October 2018 , pp. 2409 - 2417
Copyright
Copyright © Cambridge University Press 2018 

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