Depression and PTSD in the aftermath of strict COVID-19 lockdowns: a cross-sectional and longitudinal network analysis

Figures & data

Figure 1. (a–e) Undirected networks of PTSD and depression symptoms at T1 (Figure 1a; N = 340), at T2 (Figure 1b; N = 311), at T3 (Figure 1c; N = 290), T4 (Figure 1d; N = 288), and T1–T4 longitudinal slopes network (Figure 1e; N = 254).

Notes: C1 = Feel bothered. C2 = Poor appetite. C3 = Feel blue. C4 = Lack feeling good. C5 = Trouble keeping my mind. C6 = Depressed mood. C7 = Effortful. C8 = Hopelessness. C9 = Feel failure. C10 = Fearful. C11 = Restless sleep. C12 = Lack happiness. C13 = Talk less. C14 = Lonely. C15 = Find people unfriendly. C16 = Lack enjoyment. C17 = Crying. C18 = Sadness. C19 = Feel disliked. C20 = Cannot get going. P1 = Intrusive thought. P2 = Nightmare. P3 = Flashback. P4 = Emotional cue. P5 = Physiological cue. P6 = Avoid thought. P7 = Upset. P8 = Avoid reminder. P9 = Loss of interest. P10 = Detachment. P11 = Restricted affect. P12 = Foreshortened future. P13 = Sleep disturbance. P14 = Irritability/anger. P15 = Difficulty concentrating. P16 = Hypervigilance. P17 = Exaggerated startle. Blue edges indicate positive associations between nodes, while red edges indicate negative associations. Thickness of edges indicate their strength. Light-blue nodes are bridge nodes identified via the bridge expected influence (BEI) scores. Orange nodes are individual items of CES-D not identified as bridge nodes. Green nodes are individual items of PDS-C not identified as bridge nodes.

Figure 2. Symptom centrality plots based on the strength centrality index of cross-sectional undirected networks (T1, T2, T3, T4) and longitudinal change trajectory slope network.

Notes: (R) = reverse scored and worded. Bother = Feel bothered. PAppetite = Poor appetite. Blue = Feel blue. Good (R) = Lack feeling good. Mindless = Trouble keeping my mind. Depressed = Depressed mood. Effort = Effortful. Hope (R) = Hopelessness. Failure = Feel failure. Fear = Fearful. RestSleep = Restless sleep. Happy (R) = Lack happiness. TalkLess = Talk less. Lonely = Lonely. Unfriendly = Find people unfriendly. Enjoy (R) = Lack enjoyment. Cry = Crying. Sad = Sadness. Disliked = Feel disliked. NotGetGo = Cannot get going. ThIntrusive = Intrusive thought. Nightmare = Nightmare. Flashback = Flashback. EmoReact = Emotional cue. PhyReact = Physiological cue. ThAvoid = Avoid thought. Upset = Upset. RemAvoid = Avoid reminder. LInterest = Loss of interest. Detach = Detachment. RestrictA = Restricted affect. FortFuture = Foreshortened future. DisSleep = Sleep disturbance. Irritate = Irritability/anger. DiffConcen = Difficulty concentrating. HVigilant = Hypervigilance. Startle = Exaggerated startle.

Figure 3. Symptom bridge centrality plots based on the bridge expected influence (BEI) index of cross-sectional undirected networks (T1, T2, T3, T4) and longitudinal change trajectory slope network.

Notes: (R) = reverse scored and worded. Bother = Feel bothered. PAppetite = Poor appetite. Blue = Feel blue. Good (R) = Lack feeling good. Mindless = Trouble keeping my mind. Depressed = Depressed mood. Effort = Effortful. Hope (R) = Hopelessness. Failure = Feel failure. Fear = Fearful. RestSleep = Restless sleep. Happy (R) = Lack happiness. TalkLess = Talk less. Lonely = Lonely. Unfriendly = Find people unfriendly. Enjoy (R) = Lack enjoyment. Cry = Crying. Sad = Sadness. Disliked = Feel disliked. NotGetGo = Cannot get going. ThIntrusive = Intrusive thought. Nightmare = Nightmare. Flashback = Flashback. EmoReact = Emotional cue. PhyReact = Physiological cue. ThAvoid = Avoid thought. Upset = Upset. RemAvoid = Avoid reminder. LInterest = Loss of interest. Detach = Detachment. RestrictA = Restricted affect. FortFuture = Foreshortened future. DisSleep = Sleep disturbance. Irritate = Irritability/anger. DiffConcen = Difficulty concentrating. HVigilant = Hypervigilance. Startle = Exaggerated startle.

Table 1. Item description, identification number, and descriptive statistics of PDS-C and CES-D nodes at T1–4.

Measure	T1 (N = 340)	T2 (N = 311)	T3 (N = 290)	T4 (N = 288)
PTSD (PDSC)	M (SD)
1 Intrusive thought	0.85 (0.72)	0.63 (0.62)	0.57 (0.60)	0.50 (0.60)
2 Nightmare	0.38 (0.56)	0.21 (0.45)	0.23 (0.49)	0.17 (0.41)
3 Flashback	0.46 (0.66)	0.44 (0.59)	0.42 (0.62)	0.51 (0.71)
4 Emotional cue	0.73 (0.82)	0.60 (0.76)	0.60 (0.77)	0.61 (0.76)
5 Physiological cue	0.34 (0.61)	0.28 (0.54)	0.31 (0.62)	0.34 (0.65)
6 Avoid thought	0.81 (0.97)	0.75 (0.98)	0.71 (0.97)	0.72 (0.99)
7 Upset	0.44 (0.70)	0.45 (0.68)	0.47 (0.68)	0.47 (0.71)
8 Avoid reminder	0.46 (0.77)	0.54 (0.80)	0.46 (0.79)	0.46 (0.77)
9 Loss of interest	0.84 (0.87)	0.78 (0.82)	0.72 (0.75)	0.70 (0.78)
10 Detachment	0.69 (0.86)	0.63 (0.82)	0.62 (0.80)	0.55 (0.76)
11 Restricted affect	0.44 (0.72)	0.48 (0.73)	0.46 (0.72)	0.48 (0.74)
12 Foreshortened future	0.71 (0.88)	0.72 (0.87)	0.69 (0.79)	0.68 (0.84)
13 Sleep disturbance	0.81 (0.85)	0.83 (0.88)	0.83 (0.81)	0.75 (0.81)
14 Irritability/anger	0.93 (0.83)	0.85 (0.79)	0.86 (0.76)	0.78 (0.79)
15 Difficulty concentrating	0.98 (0.85)	0.97 (0.79)	0.91(0.79)	0.93 (0.84)
16 Hypervigilance	0.62 (0.84)	0.68 (0.86)	0.72 (0.84)	0.67 (0.84)
17 Exaggerated startle	0.63 (0.79)	0.73 (0.87)	0.77 (0.85)	0.74 (0.84)
Depression (CESD)	M (SD)
1 Feel bothered	1.16 (0.86)	1.08 (0.79)	1.10 (0.77)	1.05 (0.78)
2 Poor appetite	0.54 (0.76)	0.57 (0.84)	0.56 (0.74)	0.49 (0.71)
3 Feel blue	0.76 (0.88)	0.66 (0.80)	0.67 (0.78)	0.68 (0.81)
4 Lack feeling good	2.74 (1.03)	2.37 (1.03)	2.44 (0.99)	2.35 (0.97)
5 Trouble keeping my mind	1.09 (0.91)	1.09 (0.80)	1.10 (0.75)	1.01 (0.81)
6 Depressed mood	1.00 (0.88)	0.89 (0.79)	0.88 (0.74)	0.88 (0.76)
7 Effortful	0.76 (0.83)	0.76 (0.76)	0.79 (0.76)	0.73 (0.77)
8 Hopelessness	2.29 (0.98)	2.15 (0.91)	2.22 (0.88)	2.20 (0.89)
9 Feel failure	0.60 (0.77)	0.64 (0.74)	0.70 (0.82)	0.66 (0.71)
10 Fearful	0.75 (0.82)	0.63 (0.80)	0.68 (0.83)	0.58 (0.71)
11 Restless sleep	0.99 (1.02)	1.04 (0.96)	1.03 (0.91)	0.93 (0.93)
12 Lack happiness	2.41 (0.88)	2.24 (0.87)	2.24 (0.89)	2.24 (0.85)
13 Talk less	0.93 (0.96)	0.84 (0.84)	0.88 (0.87)	0.75 (0.75)
14 Lonely	0.86 (0.94)	0.80 (0.87)	0.91 (0.90)	0.80 (0.88)
15 Find people unfriendly	0.35 (0.63)	0.43 (0.66)	0.49 (0.71)	0.48 (0.64)
16 Lack enjoyment	2.27 (0.95)	2.19 (0.87)	2.13 (0.86)	2.18 (0.88)
17 Cry	0.84 (0.78)	0.70 (0.75)	0.75 (0.78)	0.70 (0.75)
18 Sadness	0.87 (0.78)	0.76 (0.74)	0.78 (0.79)	0.73 (0.73)
19 Feel disliked	0.46 (0.70)	0.52 (0.70)	0.56 (0.72)	0.50 (0.65)
20 Cannot get going	0.30 (0.60)	0.23 (0.55)	0.31 (0.62)	0.28 (0.57)

Notes: M and SD are used to represent mean and standard deviation, respectively. PDSC = Posttraumatic Diagnostic Scale-Chinese; CESD = Center for Epidemiological Studies-Depression. CESD 4, 8, 12 and 16 measuring positive affect are reverse coded and worded.

Figure 4. A directed acyclic graph (DAG) of PTSD and depression symptom change trajectories over time (N = 254).

Notes: (R) = reverse scored and worded. Bother = Feel bothered. PAppetite = Poor appetite. Blue = Feel blue. Good (R) = Lack feeling good. Mindless = Trouble keeping my mind. Depressed = Depressed mood. Effort = Effortful. Hope (R) = Hopelessness. Failure = Feel failure. Fear = Fearful. RestSleep = Restless sleep. Happy (R) = Lack happiness. TalkLess = Talk less. Lonely = Lonely. Unfriendly = Find people unfriendly. Enjoy (R) = Lack enjoyment. Cry = Crying. Sad = Sadness. Disliked = Feel disliked. NotGetGo = Cannot get going. ThIntrusive = Intrusive thought. Nightmare = Nightmare. Flashback = Flashback. EmoReact Emotional cue. PhyReact = Physiological cue. ThAvoid = Avoid thought. Upset = Upset. RemAvoid = Avoid reminder. LInterest = Loss of interest. Detach = Detachment. RestrictA = Restricted affect. FortFuture = Foreshortened future. DisSleep = Sleep disturbance. Irritate = Irritability/anger. DiffConcen = Difficulty concentrating. HVigilant = Hypervigilance. Startle = Exaggerated startle.

Data availability statement

Data used in the analyses are available through the following OSF link: https://osf.io/kbxtc.