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.