Relationship between rumination and symptoms of posttraumatic stress disorder – a cross-sectional network analysis

Background Rumination is associated with the development and maintenance of PTSD. However, significant gaps remain in understanding how specific PTSD symptoms relate to rumination at a granular level, particularly when controlling for common comorbidities like depression and anxiety. This study used multi-level network analysis to examine these relationships in adult survivors of traumatic events. Methods Six hundred sixty-one adult survivors (median age 35 years, 29 to 45 years, 49.3% females) who had witnessed or experienced a car crash, a violent act, or the killing of someone participated in an online-based study. Participants completed the Posttraumatic Stress Disorder Checklist (PCL-5), the Repetitive Thinking Questionnaire (RTQ-10), the Generalized Anxiety Disorder (GAD-7), and the Patient Health Questionnaire (PHQ-9). Network analysis was conducted at both scale and item levels to examine associations while controlling for depression and anxiety. Results Network analysis revealed selective associations between rumination and symptoms of PTSD. At the cluster level, rumination was associated with re-experiencing and negative alterations in cognition and mood clusters, but not with avoidance or hyperarousal clusters. At the item level, complex patterns emerged including relevant associations between items assessing intrusive memories and persistent repetitive thoughts. Additionally, a negative association was observed between risk-taking behaviors and future-oriented wishful thinking. Conclusion Our findings reveal interconnected constructs, which might in part be due to content overlap among the questionnaires used. These findings highlight the importance of precise construct definition and measurement differentiation when investigating trauma-related cognitive processes and establish groundwork for future research examining temporal relationships and clinical applications.