Network Analysis of Post-Traumatic Stress Disorder Symptoms Among Trauma-Exposed Older Adults in Rural Communes in
Pham Thi Ngoc Bich1, Le Xuan Hung2, Ho Thi Kim Thanh1
1Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam.
Background:
Post-traumatic stress disorder (PTSD) is common among trauma-exposed older adults but often under-recognized. Network analysis conceptualizes PTSD as a system of interacting symptoms and identifies the symptoms most central within the network. Evidence from older adults in Vietnam is scarce.
Objective:
To estimate the PTSD symptom network and identify the most central symptoms in trauma-exposed older Vietnamese adults.
Methods:
Cross-sectional data came from the second wave (2021-2022) of the Vietnam Health and Aging Study. From 301 community-dwelling adults aged ≥60 years, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) PTSD symptom network was estimated in the 90 participants with complete symptom data. PTSD symptoms were assessed with the Vietnamese-validated PTSD Checklist for DSM-5 (PCL-5). A regularized partial-correlation network (EBICglasso) was estimated from polychoric correlations. Node centrality was quantified using Expected Influence (EI), and stability was assessed using a case-dropping bootstrap.
Results:
The network comprised 19 of 20 PCL-5 nodes (D7 unavailable). Persistent negative emotional states (D4; EI = 1.306) and avoidance of trauma-related thoughts or feelings (C1; EI = 1.196) were the most central nodes, followed by psychological cue reactivity (B4; EI = 1.154). Sleep disturbance (E6; EI = 0.664) and physiological cue reactivity (B5; EI = 0.722) were comparatively peripheral. The ranking of the most central nodes was reproducible under the case-dropping bootstrap.
Conclusion:
In older Vietnamese adults with lifetime war trauma, cognitive avoidance and persistent negative affect were the most central PTSD symptoms. Because the design was cross-sectional and the rural sample may not be representative, these findings are associational and cannot establish symptom causation or treatment priority. Trauma-focused approaches, including Prolonged Exposure and Cognitive Behavioral Therapy, warrant further evaluation.
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