What question did this study set out to answer?

To explore the interaction mechanisms of PTSD and depression symptoms at a symptom level among college students.

May 3, 2026Open Access

Network structure analysis of post-traumatic stress and depressive symptoms among college students: identification of central and bridge symptoms

Key Points

To explore the interaction mechanisms of PTSD and depression symptoms at a symptom level among college students.
Cross-sectional survey conducted among 501 college students using IES-R and PHQ-9
Network analysis performed using Gaussian Graphical Model combined with graphical LASSO
Identified central and bridge symptoms using Expected Influence and Bridge Expected Influence measures.
Central symptoms identified included H2 (nervousness/exaggerated startle response, EI = 1.38), I4 (involuntary recall, EI = 1.33), and H4 (difficulty concentrating, EI = 1.09)
Bridge symptoms included I8 (trauma-related dreams, Bridge EI = 0.88), H1 (irritability, Bridge EI = 0.85), and I7 (intense emotional fluctuations, Bridge EI = 0.80)
Network stability demonstrated with a CS-coefficient of 0.75.

Abstract

Objective The comorbidity between post-traumatic stress disorder (PTSD) and depression has received increasing attention among college students; however, the interaction mechanisms at the symptom level remain unclear. This study employed network analysis to construct a cross-diagnostic network structure of post-traumatic stress and depressive symptoms among college students, identifying central symptoms and bridge symptoms to provide empirical evidence for precision-oriented psychological interventions. Methods A cross-sectional survey was conducted among 501 college students from a Chinese university using the Impact of Event Scale–Revised (IES-R) and the Patient Health Questionnaire-9 (PHQ-9). A Gaussian Graphical Model (GGM) combined with graphical LASSO was used to construct the symptom network. Expected Influence (EI) was calculated to identify central symptoms, and Bridge Expected Influence (Bridge EI) was used to identify bridge symptoms connecting post-traumatic stress and depressive domains. Network accuracy and stability were examined using bootstrap procedures. Results The symptom network revealed complex connectivity patterns among 31 symptom nodes. Central symptom analysis indicated that H2 (nervousness/exaggerated startle response, EI = 1.38), I4 (involuntary recall, EI = 1.33), and H4 (difficulty concentrating, EI = 1.09) exhibited the highest expected influence. Bridge symptom analysis showed that I8 (trauma-related dreams, Bridge EI = 0.88), H1 (irritability, Bridge EI = 0.85), and I7 (intense emotional fluctuations, Bridge EI = 0.80) were key bridges connecting the post-traumatic stress and depressive dimensions. The network demonstrated good stability, with a CS-coefficient of 0.75. Conclusion Nervousness/exaggerated startle response and involuntary recall are central symptoms in the post-traumatic stress–depression network among college students, while trauma-related dreams, irritability, and emotional fluctuations serve as key bridge symptoms connecting the two disorders. Clinical interventions should prioritize these hub symptoms to maximize treatment efficacy and disrupt cross-diagnostic symptom connectivity.

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