Network Analysis of Post-Traumatic Stress Disorder Symptoms Among Trauma-Exposed Older Adults in Rural Communes in Hanoi and Quang Binh, Vietnam.

BACKGROUND

Post-traumatic stress disorder (PTSD) is common among trauma-exposed older adults but often under-recognized. Network analysis conceptualizes PTSD as a system of interacting symptoms and identifies the symptoms most central within the network. Evidence from older adults in Vietnam is scarce.

OBJECTIVE

To estimate the PTSD symptom network and identify the most central symptoms in trauma-exposed older Vietnamese adults.

METHODS

Cross-sectional data came from the second wave (2021-2022) of the Vietnam Health and Aging Study. From 301 community-dwelling adults aged ≥60 years, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) PTSD symptom network was estimated in the 90 participants with complete symptom data. PTSD symptoms were assessed with the Vietnamese-validated PTSD Checklist for DSM-5 (PCL-5). A regularized partial-correlation network (EBICglasso) was estimated from polychoric correlations. Node centrality was quantified using Expected Influence (EI), and stability was assessed using a case-dropping bootstrap.

RESULTS

The network comprised 19 of 20 PCL-5 nodes (D7 unavailable). Persistent negative emotional states (D4; EI = 1.306) and avoidance of trauma-related thoughts or feelings (C1; EI = 1.196) were the most central nodes, followed by psychological cue reactivity (B4; EI = 1.154). Sleep disturbance (E6; EI = 0.664) and physiological cue reactivity (B5; EI = 0.722) were comparatively peripheral. The ranking of the most central nodes was reproducible under the case-dropping bootstrap.

CONCLUSION

In older Vietnamese adults with lifetime war trauma, cognitive avoidance and persistent negative affect were the most central PTSD symptoms. Because the design was cross-sectional and the rural sample may not be representative, these findings are associational and cannot establish symptom causation or treatment priority. Trauma-focused approaches, including Prolonged Exposure and Cognitive Behavioral Therapy, warrant further evaluation.