A Functional Network Perspective on Posttraumatic Stress in Refugees: Implications for Theory, Classification, Assessment, and Intervention

Kim Yuval, Anna Aizik-Reebs, Ido Lurie, Dawit Demoz, Amit Bernstein

Research output: Contribution to journalArticlepeer-review


There is an important, long-standing debate regarding the universality vs. specificity of trauma-related mental health symptoms in socio-culturally and linguistically diverse population groups, such as refugees and asylum seekers. Network theory, an emerging development in the field of psychological science, provides a novel data analytic methodology to evaluate and empirically examine long-standing questions about the structure and function of posttraumatic stress symptoms. We sought to empirically model the functional network of posttraumatic stress symptoms among East African refugees who survived multiple potentially traumatic events. A sample of 148 Sudanese and Eritrean male asylum seekers (M(SD)age = 32.60(7.13) were recruited from the community in Israel. The nature and function(s) of posttraumatic symptoms (Harvard Trauma Questionnaire) were modeled using regularized partial correlation models to derive a network of symptoms. Spinglass and exploratory graph analysis walktrap algorithms were then used to identify functional “circuits of symptoms” or clusters of nodes within the network. Analyses revealed a functional symptom circuitry that shares features with the predominant western model of posttraumatic stress disorder; as well as unique functional clusters of symptoms inconsistent with nosology and symptomatology observed in studies of Western populations. Findings may have important implications for theory, classification, assessment, candidate mechanisms that may drive and maintain posttraumatic stress, and in turn may inform prevention or treatment for socio-culturally diverse forcibly displaced population groups.

Original languageEnglish
Pages (from-to)268-282
Number of pages15
JournalTranscultural Psychiatry
Issue number2
StatePublished - Apr 2021

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Part of the data collection was supported by Israel Science Foundation awarded to A. Bernstein and part of the data collection was supported by a European Commission – European Instrument for Democracy & Human Rights grant awarded to Physicians for Human Rights – Israel, with whom we partnered.

Publisher Copyright:
© The Author(s) 2020.


  • PTSD
  • asylum seekers
  • cross-cultural
  • global mental health
  • network analysis
  • posttraumatic stress
  • psychiatric classification
  • refugee
  • trauma

ASJC Scopus subject areas

  • Health(social science)
  • Psychiatry and Mental health


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