Depicting the associations between different forms of psychopathology in trauma-exposed adolescents

  • Xing Cao
  • Li WangEmail author
  • Chengqi Cao
  • Ruojiao Fang
  • Chen Chen
  • Brian J. Hall
  • Jon D. Elhai
Original Contribution


Psychiatric comorbidity in traumatized youth is prevalent, but such associations between two disorders may be confounded with other comorbid conditions. Few studies have examined the unique relationships among multiple disorders. Which disorders maximally explain the relationships between others and whether such disorders differ by sex remain largely unknown. Using a construct-level network approach, this study characterized the independent associations among nine prevalent emotional and behavioral disorders/problems evaluated by the PTSD Checklist for DSM-5, the Revised Children’s Anxiety and Depression Scale, and the Youth Self-Report in a sample of 1181 disaster-exposed adolescents (53.9% girls; a mean age of 14.3 \(\pm \) 0.8 years). The associations were strong among the seven internalizing problems and between the two externalizing ones, but weaker between these two spectra of psychopathology. Major depressive disorder (MDD) was most strongly connected with others, maximally accounting for the associations, especially those between the two spectra. Overall and individual association strength and the connecting role of MDD were generally equivalent across sex. These findings highlight the necessity of MDD in linking comorbid forms of psychopathology in traumatized youth, and suggest MDD as a potential intervention priority in this population.


Comorbidity Trauma Sex Adolescence 



This study was funded by the External Cooperation Program of Chinese Academy of Sciences (153111KYSB20160036), the National Natural Science Foundation of China (31271099, 31471004), and the Key Project of Research Base of Humanities and Social Sciences of Ministry of Education (16JJD190006).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study has been approved by the Institutional Review Board of the Institute of Psychology, Chinese Academy of Sciences and has been performed in accordance with the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent/assent was obtained from all participants and their guardians.

Supplementary material

787_2019_1400_MOESM1_ESM.pdf (437 kb)
Supplementary file1 (PDF 436 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of PsychologyChinese Academy of SciencesBeijingChina
  2. 2.Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
  3. 3.Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social SciencesUniversity of MacauMacauChina
  4. 4.Department of Health, Behavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  5. 5.Department of PsychologyUniversity of ToledoToledoUSA
  6. 6.Department of PsychiatryUniversity of ToledoToledoUSA

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