Symptom network connectivity in PTSD comorbid with depression in bereaved Chinese parents who have lost their only child

The death of a child is a highly traumatic event for parents and often leads to posttraumatic stress disorder (PTSD) and depression. PTSD and depression are frequently comorbid. However, the patterns of comorbidity at the symptom level among bereaved parents remain unclear. This study aims to identify the symptom network connectivity of PTSD comorbid with depression in bereaved Chinese parents who have lost their only child, known as Shidu parents in Chinese society. Data were obtained from 477 bereaved individuals who had lost an only child. A regularized partial correlation network was used to construct comorbidity networks of PTSD and depression symptoms. A relative importance network was computed to determine directionality among symptoms in the network. PTSD symptoms of diminished interest, irritability/anger, reckless/self-destructive behavior, a negative emotional state, the avoidance of reminders, and flashbacks acted as important bridging nodes. The relative importance network analysis show two bidirectional pathways (hypervigilance ⇆ exaggerated startle response ⇆ difficulty concentrating ⇆ sleeping difficulties ⇆ poor sleep ; irritability/anger ⇆ reckless/self-destructive behavior ⇆ could not get going ⇆ bothered by things), and exaggerated startle response, difficulty keeping mind, hypervigilance, and diminished interest have higher outstrength values with greater influence on a multitude of other symptoms within the comorbidity network. The findings highlight the important role of specific symptoms and identified bidirectional pathways underscore the interconnected nature of PTSD and depression symptoms, suggesting that targeting these core or highly influential symptoms may disrupt the broader network and improve therapeutic outcomes.