| 其他摘要 | As two common mental disorders after trauma, PTSD and MDD are highly comorbid. About half of people suffering PTSD also have MDD. The comorbidity of PTSD and MDD has many adverse consequences. Therefore, research on this topic is of great significance for understanding the mechanism of comorbidity of PTSD and MDD, establishing effective assessment and screening, and developing a precise intervention system.
Traditional explanations for the high comorbidity between PTSD and MDD (e.g., the overlapping symptom hypothesis, shared factor hypothesis, causality hypothesis, etc.) are all based on the latent variable perspective, ignoring the uniqueness of symptoms and the interactions between symptoms. Based on the emerging psychopathological network perspective, this study deconstructs the comorbidity of PTSD and MDD into a symptom network system composed of the symptoms and their correlations, using advanced quantitative review network method, longitudinal cross lag panel networks, and simulated intervention technology. A network approach was used to systematically examine the co-occurring pattern of PTSD and MDD symptoms. Further, trauma, the essential prerequisite for the comorbidity of PTSD and MDD, was included in the network. By examining the activation effect of trauma on symptoms of PTSD and MDD, the moderating effect on the correlation between symptoms, and the differences between PTSD and MDD networks at different levels and types of trauma, we systematically explored the impact of trauma on the co-occurring pattern of PTSD and MDD symptoms, so as to comprehensively reveal the underlying psychopathological mechanisms of their comorbidity.
The results of the first part of the study on the co-occurring model of PTSD and MDD symptoms show that: 1) The symptom network of PTSD and MDD stably presents a relatively independent network structure in which PTSD and MDD are clustered separately, and the clusters are connected by their overlapping symptoms-sleep problems, reflecting that the two represent different psychopathological processes after trauma; 2) In the longitudinal network of PTSD and MDD symptoms, PTSD symptoms have an overwhelmingly strong predictive effect on MDD, indicating that PTSD may be an "antecedent" and MDD as the "consequences" in the comorbidity of the two; 3) Different symptoms have different potential intervention effects in the comorbidity of PTSD and MDD; "psychological responses to trauma" may be an effective treatment target, and "negative beliefs about the future" may be an effective preventme target.
The second part of the research on the role of trauma in the co-occurring model of PTSD and MDD symptoms shows: 1) Trauma independently activates PTSD through re-experiencing symptoms (intrusive thoughts, psychological and physiological reactions to trauma, etc.) and activates MDD symptoms through sadness; 2) Trauma may link PTSD to MDD by acting as a bridge between the "irritability" of PTSD and the "low self-worth" of MDD; 3) Specific focus on "emotional distant" with higher level of trauma exposure, and "lack of interest" with lower level of trauma exposure might be needed; 4) Compared with non-interpersonal trauma types, "irritability" and "low self-worth" are related to "suicidal ideation" more strongly in interpersonal trauma type.
In general, the findings of this series of studies support the view that PTSD and MDD represent two independent psychological constructs after trauma, and partially support the demoralization model that post-traumatic PTSD is an antecedent of MDD; the "psychological response to trauma" is identified as the central symptom and the potential therapeutic intervention target in the comorbidity of PTSD and MDD; and the important driving role of the overlapped sleep problems in the comorbidity of PTSD and MDD and the development of MDD after trauma; it was also found that trauma impacts PTSD and MDD not only through the dose effect (i.e., the higher the trauma exposure, the more severe PTSD and MDD), but also directly affects the underlying psychopathological pathways bridging PTSD and MDD; and strong correlations between irritability and low self-worth with suicidal ideation under the type of interpersonal trauma. Based on these findings, a possible integrated comorbid model of "trauma-PTSD=MDD" was proposed, providing important information for understanding the underlying psychopathological mechanisms of comorbid PTSD and MDD and developing accurate and effective early screening and intervention measures. |
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