Longitudinal PTSD network structure: Measuring PTSD symptom networks over a five year period

Background: Network modeling has been applied in a range of trauma exposed samples, yet results are limited by an over reliance on cross-sectional data. The current analyses used posttraumatic stress disorder (PTSD) symptom data collected over a five-year period to estimate a more robust between-subject network and an associated symptom change network. Methods: A PTSD symptom network is measured in a sample of military veterans across four time points (Ns = 1254, 1231, 1106, 925). The repeated measures permits isolating between-subject associations by limiting effects of within-subject variability. The result is a highly reliable PTSD symptom network. A symptom slope network depicting covariation of symptom change over time is also estimated. Results: Negative trauma-related emotions had particularly strong associations with the network. Trauma-related amnesia, sleep disturbance, and self-destructive behavior had weaker overall associations with other PTSD symptoms. Conclusions: PTSD’s network structure appears stable over time. There is no single “most important” node or node cluster. The relevance of self-destructive behavior, sleep disturbance, and trauma-related amnesia to the PTSD construct may deserve additional consideration.

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From Age 4 to 8, Children Become Increasingly Aware About Normative Situations for Adults to Consume Alcohol

Alcohol and Alcoholism ◽

10.1093/alcalc/agz093 ◽

2019 ◽

Vol 55 (1) ◽

pp. 104-111 ◽

Cited By ~ 2

Author(s):

Carmen Voogt ◽

Koen Smit ◽

Marloes Kleinjan ◽

Roy Otten ◽

Tessa Scheffers ◽

...

Keyword(s):

Repeated Measures ◽

Online Survey ◽

Initial Level ◽

Sampling Strategy ◽

Cross Sectional Study ◽

Cross Sectional ◽

Parents And Children ◽

Post Hoc ◽

Frequent Drinking ◽

Over Time

Abstract Aims Limited cross-sectional studies have indicated that young children have some knowledge of the type of situations in which adults usually consume alcohol. However, it is unclear when and how this knowledge develops over time. This study tests the hypothesis that between the ages of 4 and 8, children become more knowledgeable about common drinking situations (e.g. ‘partying’) and uncommon situations (e.g. ‘driving’). Methods Data of two independent samples were used: a cross-sectional study (parents) and a three-wave longitudinal study (children). Parents and children were recruited via a convenience and random sampling strategy, respectively. To identify common, ambivalent, and uncommon drinking situations, parents (N = 158; 47% men) completed an online survey in which they indicated how common it is that any adult would drink alcohol in the 18 situations of the Dutch electronic appropriate beverage (eABT). Children (N = 329; 48.9% boys) completed the Dutch eABT to assess their knowledge of situations in which adults usually consume alcohol. Results General linear model repeated measures with post-hoc pairwise comparisons showed that parents’ perceptions of common, ambivalent, and uncommon situations in which adults consume alcohol predicted the initial level and the change over time in children’s knowledge of adults’ alcohol use in these situations. Conclusions Children aged 4–8 become increasingly knowledgeable about drinking norms in specific situations which implies that they know in what kind of situation alcohol consumption is a common human behavior. This knowledge may put them at risk for early alcohol initiation and frequent drinking later in life.

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Impacts of rTMS on Refractory Depression and Comorbid PTSD Symptoms at a Military Treatment Facility

Military Medicine ◽

10.1093/milmed/usaa148 ◽

2020 ◽

Vol 185 (9-10) ◽

pp. e1420-e1427

Author(s):

Sean Wilkes ◽

Celia Ona ◽

Michael Yang ◽

Pingyang Liu ◽

Amber Benton ◽

...

Keyword(s):

Repeated Measures ◽

Mixed Model ◽

Repetitive Transcranial Magnetic Stimulation ◽

Active Duty ◽

Ptsd Symptoms ◽

Refractory Depression ◽

Antidepressant Medications ◽

Treatment Of Depression ◽

Changes Over Time ◽

Over Time

Abstract Introduction Repetitive transcranial magnetic stimulation (rTMS) as a treatment for depression has been studied for over two decades. Repetitive TMS was approved by the Food and Drug Administration in 2008 for the treatment of depression after at least one failed trial of an antidepressant medication of adequate dose and duration. This study evaluated whether rTMS treatments may be associated with measurable improvements in depression and post-traumatic stress disorder (PTSD) symptoms for treated military beneficiaries in Hawaii suffering from depression. It also examined the number of failed medication trials that patients underwent before rTMS treatment. Materials and Methods A retrospective chart review of 77 rTMS patients who received and completed treatment between January 1, 2010 and October 31, 2016 was performed. Under a typical treatment regimen, patients receive rTMS for 6 weeks as well as weekly psychiatric assessments, which included completion of Beck’s Depression Inventory (BDI) and PTSD Checklist (PCL). A mixed model repeated measures analysis was done assuming an autoregressive order one covariance structure to evaluate changes over time. Adjusted analyses were done to assess whether changes over time differed by age, prior diagnosis of PTSD, active duty status, and gender. Results The majority of patients were from the army (74%) and 56% were on active duty. Just over half (53%) were male. Most patients (52%) had completed trials of three or more different antidepressant medications before initiation of treatment with rTMS. The mean number of antidepressant trials was 2.7. BDI and PCL scores were significantly lower at end of treatment on average compared to the pretreatment baseline scores. Mean differences for BDI and PCL were significant with P < 0.001 15, 30, and 45 days after TMS treatment was initiated. Overall, 44% of patients experienced a reduction ≥10 points on BDI, and 38% experienced a reduction ≥10 points on PCL. Additionally, scores fell similarly regardless of whether or not patients had a comorbid diagnosis of PTSD. Conclusions Our research suggests that rTMS treatments may produce a reduction in symptoms of both depression and PTSD in patients with refractory depression and comorbid PTSD. It may be a useful alternative to antidepressants in the treatment of depression in the military population, including those with comorbid PTSD. Broader implementation of this treatment modality may prove beneficial for the purposes of military readiness, given current policies and restrictions on service members who are initiated on antidepressant medications.

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Association between cognitive phenotype in unaffected siblings and prospective 3- and 6-year clinical outcome in their proband affected by psychosis

Psychological Medicine ◽

10.1017/s0033291720000719 ◽

2020 ◽

pp. 1-11

Author(s):

Thijs J. Burger ◽

Frederike Schirmbeck ◽

Jentien M. Vermeulen ◽

Piotr J. Quee ◽

Mariken B. de Koning ◽

...

Keyword(s):

Repeated Measures ◽

Psychotic Disorders ◽

Cognitive Vulnerability ◽

Familial Risk ◽

Related Factors ◽

Cross Sectional ◽

The Impact ◽

Cognitive Alterations ◽

Over Time

Abstract Background Cognitive alterations are a central and heterogeneous trait in psychotic disorders, driven by environmental, familial and illness-related factors. In this study, we aimed to prospectively investigate the impact of high familial risk for cognitive alterations, unconfounded by illness-related factors, on symptomatic outcomes in patients. Methods In total, 629 probands with non-affective psychosis and their sibling not affected by psychosis were assessed at baseline, 3- and 6-year follow-up. Familial cognitive risk was modeled by three cognitive subtypes (‘normal’, ‘mixed’ and ‘impaired’) in the unaffected siblings. Generalized linear mixed models assessed multi-cross-sectional associations between the sibling cognitive subtype and repeated measures of proband symptoms across all assessments. Between-group differences over time were assessed by adding an interaction effect of time and sibling cognitive subtype. Results Probands affected by psychosis with a sibling of the impaired cognitive subtype were less likely to be in symptomatic remission and showed more disorganization across all time points. When assessing differences over time, probands of siblings with the impaired cognitive subtype showed less remission and less improvement of disorganization after 3 and 6 years relative to the other subtypes. They also showed less reduction of positive, negative and excitement symptoms at 6-year follow-up compared to probands with a sibling of the normal cognitive subtype. Conclusions Cross-sibling pathways from higher levels of familial cognitive vulnerability to worse long-term outcomes may be informative in identifying cognition-related environmental and genetic risks that impact psychotic illness heterogeneity over time.

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A Prospective Investigation of the Impact of Distinct Posttraumatic (PTSD) Symptom Clusters on Suicidal Ideation

Cognitive Therapy and Research ◽

10.1007/s10608-016-9829-2 ◽

2017 ◽

Vol 41 (4) ◽

pp. 645-653 ◽

Cited By ~ 11

Author(s):

Maria Panagioti ◽

Ioannis Angelakis ◽

Nicholas Tarrier ◽

Patricia Gooding

Keyword(s):

Depressive Symptoms ◽

Suicidal Ideation ◽

Ptsd Symptom ◽

Symptom Clusters ◽

Self Report ◽

Ptsd Symptoms ◽

Cross Sectional ◽

The Impact

AbstractInconsistent findings have been reported by previous cross-sectional studies regarding the association between specific posttraumatic stress disorder (PTSD) symptom clusters and suicidality. To advance the understanding of the role of specific PTSD symptoms in the development of suicidality, the primary aim of this study was to investigate the predictive effects of the three specific PTSD symptom clusters on suicidal ideation prospectively. Fifty-six individuals diagnosed with PTSD completed a two-stage research design, at baseline and 13–15 months follow-up. The clinician administered PTSD scale (CAPS) was used to assess the severity of the PTSD symptom clusters and validated self-report measures were used to assess suicidal ideation, severity of depressive symptoms and perceptions of defeat entrapment. The results showed that only the hyperarousal symptom cluster significantly predicted suicidal ideation at follow-up after controlling for baseline suicidal ideation, severity of depressive symptoms and perceptions of defeat and entrapment. These findings suggest that both disorder-specific and transdiagnostic factors are implicated in the development of suicidal ideation in PTSD. Important clinical implications are discussed in terms of predicting and treating suicidality in those with PTSD.

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Cross-Sectional and Longitudinal Studies

Research Methods in the Social Sciences: An A-Z of key concepts ◽

10.1093/hepl/9780198850298.003.0018 ◽

2021 ◽

pp. 72-76

Author(s):

Andrew Bell

Keyword(s):

Longitudinal Studies ◽

Repeated Measures ◽

Survival Duration ◽

Data Sets ◽

Cross Sectional ◽

Comparison Time ◽

Cross Sectional Studies ◽

Sectional Analysis ◽

Unit Of Observation ◽

Over Time

This chapter focuses on cross-sectional and longitudinal studies. cross-sectional studies involve the analysis of usually quantitative data collected at a single snapshot in time. The unit of observation might be people or countries, and those are measured only once, all at approximately the same time. In contrast, longitudinal studies (also referred to as repeated measures studies) involve analysis on multiple occasions over time, where the same individuals (or countries) — the panel — are measured on each occasion. As such, the unit of observation is occasions, and there are multiple occasions/measures of each individual. A subcategory of longitudinal studies is event-history/survival/duration analysis, where the dependent variable is binary and the focus is on causes of changes between the two states of the outcome. Note that in comparison, time series analysis typically involves fewer individuals (often only one) and a larger number of time points. A third type of study, situated in between longitudinal and cross-sectional studies, is repeated cross-sectional analysis, which involves the analysis of multiple cross-sectional data sets over time, and different individuals are measured in each wave of the survey. Here, the unit of observation is individuals, and there are multiple individuals measured in each survey wave.

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The Association of PTSD Symptom Severity With Localized Hippocampus and Amygdala Abnormalities

Chronic Stress ◽

10.1177/2470547017724069 ◽

2017 ◽

Vol 1 ◽

pp. 247054701772406 ◽

Cited By ~ 19

Author(s):

Teddy J. Akiki ◽

Christopher L. Averill ◽

Kristen M. Wrocklage ◽

Brian Schweinsburg ◽

J. Cobb Scott ◽

...

Keyword(s):

Ptsd Symptom ◽

Cross Sectional Study ◽

Ptsd Symptoms ◽

Structural Shape ◽

Cross Sectional ◽

Fine Grained ◽

The Right ◽

Post Hoc ◽

The Relationship ◽

Shape Analyses

Background The hippocampus and amygdala have been repeatedly implicated in the psychopathology of posttraumatic stress disorder (PTSD). While numerous structural neuroimaging studies examined these two structures in PTSD, these analyses have largely been limited to volumetric measures. Recent advances in vertex-based neuroimaging methods have made it possible to identify specific locations of subtle morphometric changes within a structure of interest. Methods In this cross-sectional study, we used high-resolution magnetic resonance imaging to examine the relationship between PTSD symptomatology, as measured using the Clinician Administered PTSD Scale for the DSM-IV, and structural shape of the hippocampus and amygdala using vertex-wise shape analyses in a group of combat-exposed U.S. Veterans (N = 69). Results Following correction for multiple comparisons and controlling for age and cranial volume, we found that participants with more severe PTSD symptoms showed an indentation in the anterior half of the right hippocampus and an indentation in the dorsal region of the right amygdala (corresponding to the centromedial amygdala). Post hoc analysis using stepwise regression suggest that among PTSD symptom clusters, arousal symptoms explain most of the variance in the hippocampal abnormality, whereas reexperiencing symptoms explain most of the variance in the amygdala abnormality. Conclusion The results provide evidence of localized abnormalities in the anterior hippocampus and centromedial amygdala in combat-exposed U.S. Veterans suffering from PTSD symptoms. This novel finding provides a more fine-grained analysis of structural abnormalities in PTSD and may be informative for understanding the neurobiology of the disorder.

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An examination of idiographic networks of posttraumatic stress disorder symptoms

10.31234/osf.io/aqkvb ◽

2019 ◽

Author(s):

Jonathan Wendall Reeves ◽

Aaron Jason Fisher

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Repeated Measures ◽

Stress Disorder ◽

Individual Treatment ◽

Ptsd Symptoms ◽

Intraindividual Variation ◽

Repeated Measures Design ◽

Centrality Metrics ◽

Over Time

Although applying network theory to posttraumatic stress disorder (PTSD) has yielded promising insights, the lack of equivalence between inter- and intraindividual variation limits the generalizability of these findings to any one individual with PTSD. Better understanding how PTSD symptoms occur and vary over time within an individual instead requires exploring the idiographic network structure of PTSD. To do so, the present study used an intensive repeated measures design to estimate intraindividual networks of PTSD symptoms on a person-by-person basis. Twenty individuals (N = 20) who met criteria for PTSD completed daily surveys assessing PTSD symptoms four times per day for approximately 30 days. Employing a recently validated method provided by Fisher, Reeves, Lawyer, Medaglia, and Rubel (2017), we then used these data to estimate a contemporaneous and temporal network of PTSD symptoms for each individual on a person-by-person basis. We then calculated centrality metrics to determine the relative importance of each symptom in each idiographic network. Across all contemporaneous networks, negative trauma-related cognitions and emotions tended to most commonly be the most central symptoms. Further, across all temporal networks, (a) negative trauma-related emotions were the most common driver of variation in other symptoms over time and (b) distressing trauma-related dreams and sleep disturbance were the most common downstream consequences of variation in other PTSD symptoms over time. Finally, we also review data from two randomly selected participants to illustrate how this approach could be used to identify maintenance factors of PTSD for each individual and guide individual treatment planning.

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The Relationship Between Working Alliance and Symptom Improvement in Cognitive Therapy for Posttraumatic Stress Disorder

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.602648 ◽

2021 ◽

Vol 12 ◽

Author(s):

Esther T. Beierl ◽

Hannah Murray ◽

Milan Wiedemann ◽

Emma Warnock-Parkes ◽

Jennifer Wild ◽

...

Keyword(s):

Posttraumatic Stress Disorder ◽

Treatment Outcome ◽

Posttraumatic Stress ◽

Working Alliance ◽

Stress Disorder ◽

Ptsd Symptom ◽

Ptsd Symptoms ◽

Symptom Change ◽

Symptom Scores ◽

The Relationship

Background: Working alliance has been shown to predict outcome of psychological treatments in multiple studies. Conversely, changes in outcome scores have also been found to predict working alliance ratings.Objective: To assess the temporal relationships between working alliance and outcome in 230 patients receiving trauma-focused cognitive behavioral treatment for posttraumatic stress disorder (PTSD).Methods: Ratings of working alliance were made by both the patient and therapist after sessions 1, 3, and 5 of a course of Cognitive Therapy for PTSD (CT-PTSD). Autoregressive, cross-lagged panel models were used to examine whether working alliance predicted PTSD symptom severity at the next assessment point and vice versa. Linear regressions tested the relationship between alliance and treatment outcome.Results: Both patients' and therapists' working alliance ratings after session 1 predicted PTSD symptom scores at the end of treatment, controlling for baseline scores. At each assessment point, higher therapist working alliance was associated with lower PTSD symptoms. Crossed-lagged associations were found for therapist-rated alliance, but not for patient-rated alliance: higher therapists' alliance ratings predicted lower PTSD symptom scores at the next assessment point. Similarly, lower PTSD symptoms predicted higher therapist working alliance ratings at the next assessment point. Ruminative thinking was negatively related to therapists' alliance ratings.Conclusions: Working alliance at the start of treatment predicted treatment outcome in patients receiving CT-PTSD and may be an important factor in setting the necessary conditions for effective treatment. For therapists, there was a reciprocal relationship between working alliance and PTSD symptom change in their patients during treatment, suggesting that their alliance ratings predicted symptom change, but were also influenced by patients' symptom change.

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Posttraumatic Anger, Recalled Peritraumatic Emotions, and PTSD in Victims of Violent Crime

Journal of Interpersonal Violence ◽

10.1177/0886260511403753 ◽

2011 ◽

Vol 26 (17) ◽

pp. 3561-3579 ◽

Cited By ~ 22

Author(s):

M. J. J. Kunst ◽

F. W. Winkel ◽

S. Bogaerts

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Ptsd Symptom ◽

Longitudinal Design ◽

Future Research ◽

Ptsd Symptoms ◽

Cross Sectional ◽

Threat Perceptions

A mixed cross-sectional and longitudinal design was employed to explore the association between posttraumatic anger and posttraumatic stress disorder (PTSD; symptoms) in victims of civilian violence. It was speculated that this relationship is mainly due to concurrent recalled peritraumatic emotions. Such emotions may be interpreted to result from anger-rooted threat perceptions and to share similarities with posttraumatic intrusion symptoms. In addition, predictors of PTSD maintenance were investigated. Cross-sectional data indicated that posttraumatic anger and several indices of PTSD were highly interconnected. Recalled peritraumatic emotions partly accounted for the relation between posttraumatic anger and posttraumatic intrusions ( n = 177). Only posttraumatic intrusions were associated with PTSD symptom persistence at follow-up ( n = 56). Findings were discussed in light of study limitations and directions for future research.

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Assessment of trunk lateral flexion range of movement using a novel method in first class cricket players

Journal of Athletic Training ◽

10.4085/564-20 ◽

2021 ◽

Author(s):

Andrew Nealon ◽

Jill Cook ◽

Sean Docking

Keyword(s):

Longitudinal Study ◽

Repeated Measures ◽

Test Reliability ◽

Lateral Flexion ◽

Range Of Movement ◽

Cross Sectional ◽

Rater Reliability ◽

Competitive Season ◽

The Stability ◽

Over Time

Abstract Objectives: Lateral flexion range of movement (LF ROM) is used to assess and monitor recovery of side strain injury in athletes. This study established a reliable and pragmatic measure of LF ROM and investigated the stability of the measure over time in athletes. Design: 1) Cross-sectional reliability study and 2) Cohort longitudinal study. Setting: Elite cricket teams in COUNTRY-AAA and COUNTRY-BBB Participants: Cricket players Methods: 1) The intra- and inter-rater reliability of two methods of measuring LF ROM were assessed (distance to the floor or distance to fibular head). Ten healthy first-class cricket bowlers were tested by three experienced physiotherapists. Intra-class correlations (2,1) were calculated for absolute agreement for all 3 testers. 2) Professional cricket fast bowlers were recruited from COUNTRY-AAA and COUNTRY-BBB domestic and international competitions. Lateral flexion range of movement was measured monthly during the pre- and competitive season. A one-way repeated measures analysis of variance was performed to identify difference within the pre-season, within the competitive season, and between competitive seasons. Main Outcome Measures: Lateral flexion range of movement towards and away from the bowling arm. Results: Both methods had good intra- and inter-test reliability (ICC>0.84). As LF ROM to the floor was easier for clinicians it was used for the longitudinal study. Lateral flexion range of movement did not significantly alter throughout the pre- and competitive season or between seasons (p>0.05). Conclusions: This new method of describing LF ROM demonstrates good intra- and inter-rater reliability and stability over time and can be used as an outcome measure in side-strain injury.

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