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Symptom structure of PTSD and co-morbid depressive symptoms – a network analysis of combat veteran patients

  • Amit Lazarov (a1) (a2), Benjamin Suarez-Jimenez (a1), Ofir Levi (a3) (a4) (a5), Daniel D. L. Coppersmith (a6) (a7), Gadi Lubin (a3) (a8), Daniel S. Pine (a7), Yair Bar-Haim (a9), Rany Abend (a7) and Yuval Neria (a10)...
  • Please note a correction has been issued for this article.



Despite extensive research, symptom structure of posttraumatic stress disorder (PTSD) is highly debated. The network approach to psychopathology offers a novel method for understanding and conceptualizing PTSD. However, extant studies have mainly used small samples and self-report measures among sub-clinical populations, while also overlooking co-morbid depressive symptoms.


PTSD symptom network topology was estimated in a sample of 1489 treatment-seeking veteran patients based on a clinician-rated PTSD measure. Next, clinician-rated depressive symptoms were incorporated into the network to assess their influence on PTSD network structure. The PTSD-symptom network was then contrasted with the network of 306 trauma-exposed (TE) treatment-seeking patients not meeting full criteria for PTSD to assess corresponding network differences. Finally, a directed acyclic graph (DAG) was computed to estimate potential directionality among symptoms, including depressive symptoms and daily functioning.


The PTSD symptom network evidenced robust reliability. Flashbacks and getting emotionally upset by trauma reminders emerged as the most central nodes in the PTSD network, regardless of the inclusion of depressive symptoms. Distinct clustering emerged for PTSD and depressive symptoms within the comorbidity network. DAG analysis suggested a key triggering role for re-experiencing symptoms. Network topology in the PTSD sample was significantly distinct from that of the TE sample.


Flashbacks and psychological reactions to trauma reminders, along with their strong connections to other re-experiencing symptoms, have a pivotal role in the clinical presentation of combat-related PTSD among veterans. Depressive and posttraumatic symptoms constitute two separate diagnostic entities, but with meaningful between-disorder connections, suggesting two mutually-influential systems.


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Author for correspondence: Amit Lazarov, E-mail:


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The online version of this article has been updated since original publication. A notice detailing the changes has also been published.


This work reflects equal contribution of the first three authors


This work reflects equal contribution of the two senior authors



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Symptom structure of PTSD and co-morbid depressive symptoms – a network analysis of combat veteran patients

  • Amit Lazarov (a1) (a2), Benjamin Suarez-Jimenez (a1), Ofir Levi (a3) (a4) (a5), Daniel D. L. Coppersmith (a6) (a7), Gadi Lubin (a3) (a8), Daniel S. Pine (a7), Yair Bar-Haim (a9), Rany Abend (a7) and Yuval Neria (a10)...
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