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Order effects in PTSD network analysis: important implications for diagnostic conceptualization, treatment refinement, and research

Published online by Cambridge University Press:  02 December 2020

Benjamin Trachik Open the ORCID record for Benjamin Trachik [Opens in a new window] ,
Toby D. Elliman ,
Michelle L. Ganulin ,
Michael N. Dretsch ,
Lyndon A. Riviere ,
Oscar A. Cabrera ,
Jeffrey L. Thomas  and
Charles W. Hoge
Benjamin Trachik*
Affiliation:
US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA 98433, USA
Toby D. Elliman
Affiliation:
Walter Reed Army Institute of Research, Silver Spring, MD, USA
Michelle L. Ganulin
Affiliation:
US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA 98433, USA
Michael N. Dretsch
Affiliation:
US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA 98433, USA
Lyndon A. Riviere
Affiliation:
Walter Reed Army Institute of Research, Silver Spring, MD, USA
Oscar A. Cabrera
Affiliation:
US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA 98433, USA
Jeffrey L. Thomas
Affiliation:
Walter Reed Army Institute of Research, Silver Spring, MD, USA
Charles W. Hoge
Affiliation:
Walter Reed Army Institute of Research, Silver Spring, MD, USA
*
Author for correspondence: Benjamin Trachik, E-mail: Benjamin.j.trachik.mil@mail.mil
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Abstract

Background

For decades confirmatory factor analysis (CFA) has been the preeminent method to study the underlying structure of posttraumatic stress disorder (PTSD); however, methodological limitations of CFA have led to the emergence of other analytic approaches. In particular, network analysis has become a gold standard to investigate the structure and relationships between PTSD symptoms. A key methodological limitation, however, which has significant clinical implications, is the lack of data on the potential impact of item order effects on the conclusions reached through network analyses.

Methods

The current study, involving a large sample (N = 5055) of active duty army soldiers following deployment to Iraq, assessed the vulnerability of network analyses and prevalence rate to item order effects. This was done by comparing symptom networks of the DSM-IV PTSD checklist items to these same items distributed in random order. Half of the participants rated their symptoms on traditionally ordered items and half the participants rated the same items, but in random order and interspersed between items from other validated scales. Differences in prevalence rate and network composition were examined.

Results

The prevalence rate differed between the ordered and random item samples. Network analyses using the ordered survey closely replicated the conclusions reached in the existing network analyses literature. However, in the random item survey, network composition differed considerably.

Conclusion

Order effects appear to have a significant impact on conclusions reached from PTSD network analysis. Prevalence rates were also impacted by order effects. These findings have important diagnostic and clinical treatment implications.

Keywords

PTSDnetwork analysisorder effectsdiagnostic criteriaconfirmatory factor analysis
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 13 , October 2022 , pp. 2492 - 2499
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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