Exploring the development of posttraumatic stress disorder symptoms in COVID-19 epidemic in China: a network analysis

The COVID-19 epidemic is a novel collective traumatic event. Different types of traumatic events lead to different symptomatic structures of posttraumatic stress disorder (PTSD). To understand the symptom structure of PTSD in the context of this particular traumatic event and its possible development, we explored the interrelationships among PTSD symptoms and the interrelationships between PTSD symptoms and anxiety, depression, suicidal ideation, and quality of life. Participants were recruited from the psychological assistance hotline platform based at Central China Normal University. 308 participants who met the provisional diagnosis of PTSD were included in the analysis. This study estimated the interrelationships among PTSD symptoms, with the symptom in addition to four covariates of anxiety, depression, suicidal ideation, and quality of life by network analysis to construct Gaussian graphical models and directed acyclic graphs. The core of the PTSD symptom network was nightmares. Five pairs of symptoms showed the strongest connections: Hypervigilance and exaggerated startle response, avoidance of thoughts and avoidance of reminders, negative beliefs and negative trauma-related emotions, nightmares and flashbacks, and flashbacks and emotional cue reactivity. The network did not change significantly with the inclusion of anxiety, depression, suicidal ideation, and quality of life. Nightmares may be the core of the development of PTSD resulting from the COVID-19 epidemic. In this particular context, interventions for PTSD focus on nightmares may contribute to the relief of other symptoms and improve the efficiency and effectiveness of the intervention.