Causal discovery replicates symptomatic and functional interrelations of posttraumatic stress across five patient populations

Benjamin Pierce, Thomas Kirsh, Adam R. Ferguson, Thomas C. Neylan, Sisi Ma, Erich Kummerfeld, Beth E. Cohen, Jessica L. Nielson

Research output: Contribution to journalArticlepeer-review


Introduction: Approximately half of individuals with posttraumatic stress disorder (PTSD) may meet criteria for other psychiatric disorders, and PTSD symptoms are associated with diminished health and psychosocial functioning. However, few studies examine the longitudinal progression of PTSD symptoms concurrent with related symptom domains and functional outcomes, such that may neglect important longitudinal patterns of symptom progression beyond PTSD specifically. Methods: Therefore, we used longitudinal causal discovery analysis to examine the longitudinal interrelations among PTSD symptoms, depressive symptoms, substance abuse, and various other domains of functioning in five longitudinal cohorts representing veterans (n = 241), civilians seeking treatment for anxiety disorders (n = 79), civilian women seeking treatment for post-traumatic stress and substance abuse (n = 116), active duty military members assessed 0–90 days following TBI (n = 243), and civilians with a history of TBI (n = 43). Results: The analyses revealed consistent, directed associations from PTSD symptoms to depressive symptoms, independent longitudinal trajectories of substance use problems, and cascading indirect relations from PTSD symptoms to social functioning through depression as well as direct relations from PTSD symptoms to TBI outcomes. Discussion: Our findings suggest PTSD symptoms primarily drive depressive symptoms over time, tend to show independence from substance use symptoms, and may cascade into impairment in other domains. The results have implications for refining conceptualization of PTSD co-morbidity and can inform prognostic and treatment hypotheses about individuals experiencing PTSD symptoms along with co-occurring distress or impairment.

Original languageEnglish (US)
Article number1018111
JournalFrontiers in Psychiatry
StatePublished - Jan 26 2023

Bibliographical note

Funding Information:
This project was supported by NIH/NIMH grant R01MH116156 (JN). The funders had no role in the design and conduct of the study, data collection, management, analysis, interpretation, or manuscript preparation.

Publisher Copyright:
Copyright © 2023 Pierce, Kirsh, Ferguson, Neylan, Ma, Kummerfeld, Cohen and Nielson.


  • comorbidity
  • depression
  • longitudinal
  • machine learning
  • post-traumatic stress disorder
  • replication
  • substance abuse disorders

PubMed: MeSH publication types

  • Journal Article


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