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Examining unique and prospective relationships among self-injurious thoughts and behaviors and posttraumatic stress disorder: a network analysis in two trauma-exposed samples

Published online by Cambridge University Press:  01 July 2020

Elizabeth G. Spitzer Open the ORCID record for Elizabeth G. Spitzer [Opens in a new window] ,
Natasha Benfer ,
Kelly L. Zuromski ,
Brian P. Marx  and
Tracy K. Witte
Elizabeth G. Spitzer*
Affiliation:
Department of Psychology, Auburn University, Auburn, Alabama, USA National Center for PTSD at Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
Natasha Benfer
Affiliation:
Department of Psychology, Auburn University, Auburn, Alabama, USA
Kelly L. Zuromski
Affiliation:
Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
Brian P. Marx
Affiliation:
National Center for PTSD at Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
Tracy K. Witte
Affiliation:
Department of Psychology, Auburn University, Auburn, Alabama, USA
*
Author for correspondence: Elizabeth G. Spitzer, E-mail: [email protected]
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Abstract

Background

As self-injurious thoughts and behaviors (SITB) remain a pressing public health concern, research continues to focus on risk factors, such as posttraumatic stress disorder (PTSD). Network analysis provides a novel approach to examining the PTSD-SITB relationship. This study utilized the network approach to elucidate how individual PTSD symptoms may drive and maintain SITB.

Methods

We estimated cross-sectional networks in two samples of trauma-exposed adults (Sample 1: N = 349 adults; Sample 2: N = 1307 Veterans) to identify PTSD symptoms that may act as bridges to SITB. Additionally, we conducted a cross-lagged panel network in Sample 2 to further clarify the temporal relationship between PTSD symptoms and SITB during a 2-year follow-up. Finally, in both samples, we conducted logistic regressions to examine the utility of PTSD symptoms in prospectively predicting SITB, over a 15-day period (Sample 1) and over a 2-year period (Sample 2), allowing us to examine both short- and long-term prediction.

Results

Two PTSD symptoms (i.e. negative beliefs and risky behaviors) emerged as highly influential on SITB in both cross-sectional networks. In the cross-lagged panel network, distorted blame emerged as highly influential on SITB over time. Finally, risky behaviors, unwanted memories, and psychological distress served as the strongest predictors of SITB across the two samples.

Conclusions

Overall, our results suggest that treatments targeting negative beliefs and risky behaviors may prevent SITB in community and Veteran populations, whereas treatments targeting distorted blame and unwanted memories may help reduce SITB for individuals with a history of combat trauma.

Keywords

Network analysisposttraumatic stressself-injurious thoughts and behaviorssuicideVeterans
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 4 , March 2022 , pp. 664 - 674
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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