Changes in the network structure of posttraumatic stress disorder symptoms at different time points among youth survivors: A network analysis

Background Despite considerable studies focused on the symptoms of posttraumatic stress disorder (PTSD), little is understood about how symptoms of PTSD change over time. The study aimed to use a network analysis approach to understand the nature of the association between PTSD symptoms at different time points among children and adolescents who experience an earthquake. Methods A longitudinal study enrolled 1623 youth survivors who completed 3 assessments with the Children's Revised Impact of Event Scale at 2 weeks, 3 months and 6 months after the Lushan earthquake. The epicentre was Baoxing Country that located in the Ya'an city (Sichuan Province in China). A network analysis approach was used to investigate how symptom networks change at different time points. Results A total of 1623 youth survivors (768 male and 855 female) completed three assessments. Different centrality symptoms existed at different time points. Flashback and upset by reminders were centrality symptoms at 2 weeks, 3 months and 6 months. The overall network connectivity was significantly stronger at 3 months than at 2 weeks (5.663 vs. 5.140, s = 0.523, p = 0.000), and significantly stronger at 6 months than at 2 weeks (6.094 vs. 5.663, s = 0.432, p = 0.020). Limitations Participants from a specific region might limit the generalizability of our results. A self-report questionnaire was used to assess PTSD symptoms. Conclusions Re-experience cluster (flashback and upset by reminders) and their interactions might play a key role in PTSD symptom evolution. Over time, the global connectivity becomes stronger, suggesting that youth survivors are more vulnerable in the chronic phases.