Symptom structure of complex posttraumatic stress disorder among de facto unattended children in China: A network analysis

Backgrounds: Complex posttraumatic stress disorder (CPTSD) is closely related to childhood trauma, yet there is a dearth of studies that have explored the symptoms of CPTSD among children in adversity. Objective: The current study aimed to explore the structure of the CPTSD network and to identify central symptoms in a sample of de facto unattended children in China. Methods: In total, 244 children and adolescents were included in the analysis, ranging from 9 to 16 years old (11.72 ± 1.64), with 45.49 % girls and 53.67 % boys. The International Trauma Questionnaire (ITQ) was used to assess CPTSD symptoms. We used a regularized partial correlation network to identify which symptoms had a high level of strength centrality or bridge centrality, and a Bayesian network to identify the upstream symptoms. Results: The results showed that avoidance and emotional numbing had the highest level of strength centrality. Exaggerated startle response and emotional numbing had the highest level of bridge centrality. Last, re-experiencing was identified as upstream in the Bayesian network. Developmental differences are observed in CPTSD symptom centrality compared to adult populations. Conclusions: These findings offer insight into key symptoms of CPTSD in vulnerable children and adolescents. We revealed that children and adolescents in adversity who exhibit avoidance, emotional numbing, and re-experiencing should be given more attention.