Evaluation of symptom network density as a predictor of treatment outcome of inpatient psychotherapy

Abstract

Objective:

The network approach implies that the persistence of a mental disorder is rooted in a dense causal interconnection of symptoms. This study attempts to replicate and generalize previous findings in support of the assumption that higher density predicts poorer outcomes. The study examines the predictive value of network density at admission for recovery after inpatient treatment.

Method:

N = 1375 adult patients with various forms of mental illness were classified as recovered (28%) versus not recovered (72%) after inpatient treatment. Recovery was defined as clinically significant improvement in impairment from admission to discharge. Networks of transdiagnostic symptoms at the time of admission were estimated. Network density, measured by global strength d, was compared between the recovered and not recovered groups using a permutation test.

Results:

Global strength at the time of admission tended to be higher in the No-Recovery group (d = 10.83) than the Recovery group (d = 7.53) but the association was not significant (p = .12). Similar results were found after controlling for group size and symptom severity.

Conclusion:

The predictive value of network density for treatment outcomes remains unclear. There might be structural differences between the groups that the current measure of network density does not adequately represent.

Keywords:

• Network analysis
• network density
• prediction
• treatment outcome
• recovery
• transdiagnostic

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Statement of Ethics

We confirm that the present study was conducted in adherence to the guidelines for research involving human participants and in ethical compliance with the World Medical Association Declaration of Helsinki of 1975, revised in 2013. We did not obtain ethical approval for the present study however because the data was collected as part of the routine quality assurance procedure of the involved clinics.

Informed Consent from Participants

All participants gave their informed written consent to participation and to data usage in further research. Participant data has been anonymized, which has not distorted the scholarly meaning.

Additional information

Funding

This study was supported by the funding of the German Federal Ministery of Education and Research (BMBF, Bundesministerium für Bildung und Forschung), and the European Union (16DKWN108).