Using Clinical Expertise and Empirical Data in Constructing Networks of Trauma Symptoms in Refugee Youth

BackgroundIn recent years, many adolescents have fled their home countries due to war and human rights violations, consequently experiencing various traumatic events and putting them at risk of developing mental health problems. The symptomatology of refugee youth was shown to be multifaceted and often falling outside of traditional diagnoses. The present study aims to investigate the symptomatology of this patient group by assessing the network structure of a wide range of symptoms. Further, we assess clinicians’ perceptions of symptoms relations in order to evaluate the clinical validity of the empirical network.MethodsEmpirical data on Post-Traumatic Stress Disorder (PTSD), depression and other trauma symptoms from N=366 refugee youth was collected during the routine diagnostic process of an outpatient centre for refugee youth in Germany. Additionally, four clinicians of this outpatient centre were asked how they perceive symptom relations in their patients using a newly developed tool. Separate networks were constructed based on 1) empirical symptom data and 2) clinicians’ perceived symptom relations (PSR). ResultsBoth the network based on empirical data and the network based on clinicians’ PSR showed that symptoms of PTSD and depression related most strongly within each respective cluster, externalizing symptoms were weakly connected to the network and intrusions were central. Some differences were found within the clinicians’ PSR as well as between the PSR and the empirical network. Still, the general PSR-network structure showed a moderate to good fit to the empirical data.ConclusionOur results suggest that due to their limited connectedness, both central PTSD symptoms and central depression symptoms need to be targeted in treatment, with a focus on intrusions. Further, using clinicians’ PSR for network construction offered a promising possibility to gain information on symptom networks and their clinical validity.