The network structure of posttraumatic stress disorder among Filipina migrant domestic workers: comorbidity with depression

Background: Labour migrants are exposed to potentially traumatic events throughout the migration cycle, making them susceptible to developing mental disorders. Posttraumatic stress disorder (PTSD) is often comorbid with depression. Comorbidity worsens the course of illness, prognosis, treatment response, and increases suicidal risk. Using network analysis, this study examined the structure of PTSD and depression in a sample of migrant domestic workers, an especially vulnerable community of labour migrants. This study sought to derive the central or most important symptoms, strongest edges or relationships among symptoms, and bridge symptoms between PTSD and depression. Methods: Data were obtained from 1,375 Filipina domestic workers in Macao SAR, China. Data from a subsample of 1,258 trauma-exposed participants were analysed using R software. Results: Most of the strongest edges were within the same disorder and, for PTSD, within the same symptom cluster. Highest node centrality were PCL-5's 'avoid thoughts', 'lose interest', 'negative emotions', and 'not concentrate', and PHQ-9's 'sleep difficulties'. The bridge symptoms were PHQ-9's 'sleep difficulties,' 'psychomotor agitation/retardation,' and 'fatigue,' PCL-5's 'not concentrate', and PHQ-9's 'worthlessness' and 'anhedonia'. Limitations: Results may not generalize to Filipino migrant workers in other occupations and to male migrant workers. Potentially relevant symptoms like somatic symptoms and fear of somatic and mental symptoms were not included. Conclusions: Central and bridge symptoms are the most important nodes in the network. Developing interventions targeting these symptoms, particularly depression symptoms, is a promising alternative to PTSD treatment given substantial barriers to specialist care for this population.