A Network Approach to PTSD: Comparing Interview and Self-Report Networks

Abstract

PTSD may be characterized by networks of causal interactions among symptoms, and network analyses can identify central symptoms and processes that may be targeted for precise treatment. In this emerging area, few studies have examined treatment-seeking individuals with PTSD, limiting the clinical utility and generalizability of network analytic findings. In addition, there has been a reliance on self-report, as opposed to interviewer-assessed measures of PTSD symptoms, and a lack of systematic comparisons of the two assessment modalities. This study examined both self-report and interviewer-assessed PTSD network models. Treatment-seeking adults with primary PTSD (N = 350) completed interview and self-report measures of PTSD severity (PTSD Symptom Scale – Interview; Posttraumatic Stress Diagnostic Scale). Analyses included regularized partial correlation network estimation, stability analyses, centrality and community detection analyses, and network comparison tests. Centrality profiles were similar across the networks (rs = .71). Reactivity to trauma cues and interpersonal detachment demonstrating the strongest centrality, suggesting that cue reactivity and interpersonal processes may drive or be driven by other PTSD symptoms. The self-report network featured more and stronger relationships between symptoms compared to the interview network (global strength delta = 4.57, p = .002), particularly those with strong content similarities, such as avoidance of internal and external reminders, suggesting that interview assessments may offer superior specificity compared to self-report in assessing PTSD symptom relationships. Future network analytic studies should take into account assessment modality, and both re-experiencing and dysphoric symptoms, particularly interpersonal phenomena, should factor into targeted treatment and prevention approaches. Supplemental materials include Supplemental Method, Supplemental Tables 1 and 2, and Supplemental Figures 1 through 6.