Skip to main content
×
Home

Application of network methods for understanding mental disorders: pitfalls and promise

  • S. Guloksuz (a1) (a2), L-K. Pries (a1) and J. van Os (a1) (a3)
Abstract

Galvanized with the availability of sophisticated statistical techniques and large datasets, network medicine has emerged as an active area of investigation. Following this trend, network methods have been utilized to understand the interplay between symptoms of mental disorders. This realistic approach that may provide an improved framework into understanding mental conditions and underlying mechanisms is certainly to be welcomed. However, we have noticed that symptom network studies tend to lose sight of the fundamentals, overlook major limitations embedded in study designs, and make inferences that are difficult to justify with current findings. There is concern that disregarding these flaws may halt the progress of the network approach in psychiatry. Therefore, in this paper, we first attempt to identify the pitfalls: (1) a reductionist understanding of medicine and psychiatry, thereby inadvertently reintroducing the dichotomy of medicine (lung cancer) and psychiatry (depression), (2) a shortsighted view of signs and symptoms, (3) overlooking the limitations of available datasets based on scales with embedded latent class structures, (4) overestimating the importance of the current findings beyond what is supported by the study design. By addressing current issues, the hope is to navigate this rapidly growing field to a more methodologically sound and reproducible path that will contribute to our understanding of mental disorders and its underlying mechanisms.

Copyright
Corresponding author
*Address for correspondence: J. van Os, Department of Psychiatry and Psychology, Maastricht University Medical Centre, P.O. BOX 616, 6200 MD Maastricht, The Netherlands. (Email: j.vanos@maastrichtuniversity.nl)
References
Hide All
Adams D (2014). Dirk Gently's Holistic Detective Agency. Gallery Books: New York.
Atbasoglu EC, Guloksuz S (2013). Science, psychiatry, and the DSM. Turkish Journal of Psychiatry 24, 202212.
Bak M, Drukker M, Hasmi L, van Os J (2016). An n=1 clinical network analysis of symptoms and treatment in psychosis. PLoS ONE 11, e0162811.
Barabási A-L, Gulbahce N, Loscalzo J (2011). Network medicine: a network-based approach to human disease. Nature Reviews Genetics 12, 5668.
Beard C, Millner AJ, Forgeard MJ, Fried EI, Hsu KJ, Treadway MT, Leonard CV, Kertz SJ, Bjorgvinsson T (2016). Network analysis of depression and anxiety symptom relationships in a psychiatric sample. Psychological Medicine 46, 33593369.
Bhatt M, Kant S, Bhaskar R (2012). Pulmonary tuberculosis as differential diagnosis of lung cancer. South Asian Journal of Cancer 1, 3642.
Boccaletti S, Bianconi G, Criado R, Del Genio CI, Gómez-Gardenes J, Romance M, Sendina-Nadal I, Wang Z, Zanin M (2014). The structure and dynamics of multilayer networks. Physics Reports 544, 1122.
Borsboom D (2017). A network theory of mental disorders. World Psychiatry 16, 513.
Borsboom D, Fried F, Epskamp S, Waldrop L, van Borkulo C, van der Maas H, Cramer A (2017). Psychopathology Networks Replicate with Stunning Precision (http://psychosystems.org/psychopathology-networks-replicate-with-stunning-precision/). Accessed 12 April 2017.
Bos EH, Wanders RB (2016). Group-level symptom networks in depression. JAMA Psychiatry 73, 411.
Boschloo L, van Borkulo CD, Borsboom D, Schoevers RA (2016). A prospective study on how symptoms in a network predict the onset of depression. Psychotherapy and Psychosomatics 85, 183184.
Bringmann L, Lemmens L, Huibers M, Borsboom D, Tuerlinckx F (2015). Revealing the dynamic network structure of the Beck Depression Inventory-II. Psychological Medicine 45, 747757.
Bryant RA, Creamer M, O'donnell M, Forbes D, McFarlane AC, Silove D, Hadzi-Pavlovic D (2017). Acute and chronic posttraumatic stress symptoms in the emergence of posttraumatic stress disorder: a network analysis. JAMA Psychiatry 74, 135142.
Cooley ME (2000). Symptoms in adults with lung cancer: a systematic research review. Journal of Pain and Symptom Management 19, 137153.
Cramer AO, Borsboom D, Aggen SH, Kendler KS (2012). The pathoplasticity of dysphoric episodes: differential impact of stressful life events on the pattern of depressive symptom inter-correlations. Psychological Medicine 42, 957965.
Eklund A, Nichols TE, Knutsson H (2016). Cluster failure: why fMRI inferences for spatial extent have inflated false-positive rates. Proceedings of the National Academy of Sciences of the United States of America 113, 79007905.
Forbes MK, Wright AG, Marjon K, Krueger R (in press). Evidence that psychopathology symptom networks do not replicate. Journal of Abnormal Psychology.
Fried EI (2015). Problematic assumptions have slowed down depression research: why symptoms, not syndromes are the way forward. Frontiers in Psychology 6, 309.
Fried EI, Bockting C, Arjadi R, Borsboom D, Amshoff M, Cramer AO, Epskamp S, Tuerlinckx F, Carr D, Stroebe M (2015). From loss to loneliness: the relationship between bereavement and depressive symptoms. Journal of Abnormal Psychology 124, 256265.
Fried EI, Cramer AO (2016). Moving forward: challenges and directions for psychopathological network theory and methodology. Perspectives on Psychological Science (https://osf.io/mh3cf/). Accessed 12 April 2017.
Fried EI, Epskamp S, Nesse RM, Tuerlinckx F, Borsboom D (2016). What are ‘good’ depression symptoms? Comparing the centrality of DSM and non-DSM symptoms of depression in a network analysis. Journal of Affective Disorders 189, 314320.
Fried EI, van Borkulo CD, Cramer AO, Boschloo L, Schoevers RA, Borsboom D (2017). Mental disorders as networks of problems: a review of recent insights. Social Psychiatry and Psychiatric Epidemiology 52, 110.
Friedberg EC (2008). Sydney brenner. Nature Reviews Molecular Cell Biology 9, 89.
Goh K-I, Cusick ME, Valle D, Childs B, Vidal M, Barabási A-L (2007). The human disease network. Proceedings of the National Academy of Sciences of the United States of America 104, 86858690.
Guloksuz S, van Os J (2017). The slow death of the concept of schizophrenia. Manuscript submitted for publication.
Gustafsson M, Nestor CE, Zhang H, Barabasi AL, Baranzini S, Brunak S, Chung KF, Federoff HJ, Gavin AC, Meehan RR, Picotti P, Pujana MA, Rajewsky N, Smith KG, Sterk PJ, Villoslada P, Benson M (2014). Modules, networks and systems medicine for understanding disease and aiding diagnosis. Genome Medicine 6, 82.
Hidalgo CA, Blumm N, Barabasi AL, Christakis NA (2009). A dynamic network approach for the study of human phenotypes. PLoS Computational Biology 5, e1000353.
Hood L, Heath JR, Phelps ME, Lin B (2004). Systems biology and new technologies enable predictive and preventative medicine. Science 306, 640643.
Hopwood P, Stephens RJ (2000). Depression in patients with lung cancer: prevalence and risk factors derived from quality-of-life data. Journal of Clinical Oncology 18, 893893.
Isvoranu AM, Borsboom D, van Os J, Guloksuz S (2016). A network approach to environmental impact in psychotic disorder: brief theoretical framework. Schizophrenia Bulletin 42, 870873.
Isvoranu AM, van Borkulo CD, Boyette LL, Wigman JT, Vinkers CH, Borsboom D, Group I (2017). A network approach to psychosis: pathways between childhood trauma and psychotic symptoms. Schizophrenia Bulletin 43, 187196.
Jokela M, Virtanen M, Batty GD, Kivimäki M (2016). Inflammation and specific symptoms of depression. JAMA Psychiatry 73, 8788.
Kapur S, Phillips AG, Insel TR (2012). Why has it taken so long for biological psychiatry to develop clinical tests and what to do about it? Molecular Psychiatry 17, 11741179.
Kendler KS (2016). The phenomenology of major depression and the representativeness and nature of DSM criteria. American Journal of Psychiatry 173, 771780.
Kendler KS, Parnas J (2015). Philosophical Issues in Psychiatry: Explanation, Phenomenology, and Nosology. JHU Press: Baltimore.
King LS (1968). Signs and symptoms. JAMA 206, 10631065.
Lublin FD, Reingold SC, Cohen JA, Cutter GR, Sørensen PS, Thompson AJ, Wolinsky JS, Balcer LJ, Banwell B, Barkhof F (2014). Defining the clinical course of multiple sclerosis The 2013 revisions. Neurology 83, 278286.
McGorry P (2016). Early intervention: mission cramp versus mission creep? Aust N Z J Psychiatry 50, 10331035.
McGorry P, Nelson B (2016). Why we need a transdiagnostic staging approach to emerging psychopathology, early diagnosis, and treatment. JAMA Psychiatry 73, 191192.
McNally RJ (2016). Can network analysis transform psychopathology? Behaviour Research and Therapy 86, 95104.
McNally RJ (2017). Networks and nosology in posttraumatic stress disorder. JAMA Psychiatry 74, 124125.
Miller AH, Raison CL (2016). The role of inflammation in depression: from evolutionary imperative to modern treatment target. Nature Reviews Immunology 16, 2234.
Munafò MR, Nosek BA, Bishop DVM, Button KS, Chambers CD, Percie du Sert N, Simonsohn U, Wagenmakers E-J, Ware JJ, Ioannidis JPA (2017). A manifesto for reproducible science. Nature Human Behaviour 1, 0021.
National Research Council (2011). Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease. National Academies Press: Washington.
Pao W, Girard N (2011). New driver mutations in non-small-cell lung cancer. Lancet Oncology 12, 175180.
Proctor RN (2012). The history of the discovery of the cigarette–lung cancer link: evidentiary traditions, corporate denial, global toll. Tobacco Control 21, 8791.
Reyes-Gibby CC, Swartz MD, Yu X, Wu X, Yennurajalingam S, Anderson KO, Spitz MR, Shete S (2013). Symptom clusters of pain, depressed mood, and fatigue in lung cancer: assessing the role of cytokine genes. Supportive Care in Cancer 21, 31173125.
Toh C-K, Gao F, Lim W-T, Leong S-S, Fong K-W, Yap S-P, Hsu AA, Eng P, Koong H-N, Thirugnanam A (2006). Never-smokers with lung cancer: epidemiologic evidence of a distinct disease entity. Journal of Clinical Oncology 24, 22452251.
van Borkulo C, Boschloo L, Borsboom D, Penninx BW, Waldorp LJ, Schoevers RA (2015). Association of symptom network structure with the course of depression. JAMA Psychiatry 72, 12191226.
Van Den Heuvel MP, Pol HEH (2010). Exploring the brain network: a review on resting-state fMRI functional connectivity. European Neuropsychopharmacology 20, 519534.
van Os J (2013). The dynamics of subthreshold psychopathology: implications for diagnosis and treatment. American Journal of Psychiatry 170, 695698.
van Os J (2015). Mental disorder: a public health problem stuck in an individual-level brain disease perspective? World Psychiatry 14, 4748.
van Os J, Verhagen S, Marsman A, Peeters F, Bak M, Marcelis M, Drukker M, Reininghaus U, Jacobs N, Lataster T, Simons C, ESM-MERGE investigators, Lousberg R, Guloksuz S, Leue C, Groot PC, Viechtbauer W, Delespaul P (2017). The experience sampling method as an mHealth tool to support self-monitoring, self-insight and personalised health care in clinical practice. Depression and Anxiety (in press).
Verhagen SJ, Hasmi L, Drukker M, van Os J, Delespaul PA (2016). Use of the experience sampling method in the context of clinical trials. Evidence Based Mental Health 19, 8689.
Vidal M, Cusick ME, Barabasi A-L (2011). Interactome networks and human disease. Cell 144, 986998.
Wichers M, Wigman JT, Bringmann LF, de Jonge P (2017). Mental disorders as networks: some cautionary reflections on a promising approach. Social Psychiatry and Psychiatric Epidemiology 52, 143145.
Wigman JT, de Vos S, Wichers M, van Os J, Bartels-Velthuis AA (2017). A transdiagnostic network approach to psychosis. Schizophrenia Bulletin 43, 122132.
Wigman JT, van Os J, Borsboom D, Wardenaar KJ, Epskamp S, Klippel A, MERGE, Viechtbauer W, Myin-Germeys I, Wichers M (2015). Exploring the underlying structure of mental disorders: cross-diagnostic differences and similarities from a network perspective using both a top-down and a bottom-up approach. Psychological Medicine 45, 23752387.
Zhou X, Menche J, Barabasi AL, Sharma A (2014). Human symptoms-disease network. Nature Communications 5, 4212.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 8
Total number of PDF views: 198 *
Loading metrics...

Abstract views

Total abstract views: 563 *
Loading metrics...

* Views captured on Cambridge Core between 5th June 2017 - 25th November 2017. This data will be updated every 24 hours.