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Social Psychiatry and Psychiatric Epidemiology

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Open Access 01-01-2017 | Invited Reviews

Mental disorders as networks of problems: a review of recent insights

Authors: Eiko I. Fried, Claudia D. van Borkulo, Angélique O. J. Cramer, Lynn Boschloo, Robert A. Schoevers, Denny Borsboom

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 1/2017

Abstract

Purpose

The network perspective on psychopathology understands mental disorders as complex networks of interacting symptoms. Despite its recent debut, with conceptual foundations in 2008 and empirical foundations in 2010, the framework has received considerable attention and recognition in the last years.

Methods

This paper provides a review of all empirical network studies published between 2010 and 2016 and discusses them according to three main themes: comorbidity, prediction, and clinical intervention.

Results

Pertaining to comorbidity, the network approach provides a powerful new framework to explain why certain disorders may co-occur more often than others. For prediction, studies have consistently found that symptom networks of people with mental disorders show different characteristics than that of healthy individuals, and preliminary evidence suggests that networks of healthy people show early warning signals before shifting into disordered states. For intervention, centrality—a metric that measures how connected and clinically relevant a symptom is in a network—is the most commonly studied topic, and numerous studies have suggested that targeting the most central symptoms may offer novel therapeutic strategies.

Conclusions

We sketch future directions for the network approach pertaining to both clinical and methodological research, and conclude that network analysis has yielded important insights and may provide an important inroad towards personalized medicine by investigating the network structures of individual patients.

Available only for authorised users

Note that this DSM network is not based on empirical data, but each node in the network is a symptom as listed in the DSM. Overlapping symptoms are depicted as one and the same node.

The network distance between symptoms of different disorders is based on the average shortest path length. This measure is calculated by averaging the number of steps (i.e., the number of connections) to travel from each symptom of one disorder to each symptom of the other disorder [24].

The simulation tool "vax" provides a beautiful explanation of centrality and shows how such treatment should work by targeting the most central nodes: http://vax.herokuapp.com/game.

Note that there are two further possibilities that can explain an undirected edge between A and B: an unmodeled influence of a (set of) latent variables C (A ← C → B); and conditioning on a common effect D such that A → D ← B. The latter can arise if D is a variable included in the network, but also when it is not, for instance when the investigated sample has been selected on (a function of) a common effect of the variables in the network.

For an ongoing study on this topic, see http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5707.

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Title: Mental disorders as networks of problems: a review of recent insights
Authors: Eiko I. Fried
Claudia D. van Borkulo
Angélique O. J. Cramer
Lynn Boschloo
Robert A. Schoevers
Denny Borsboom
Publication date: 01-01-2017
Publisher: Springer Berlin Heidelberg
Published in: Social Psychiatry and Psychiatric Epidemiology / Issue 1/2017
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI: https://doi.org/10.1007/s00127-016-1319-z

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Mental disorders as networks of problems: a review of recent insights

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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