We analyzed the network structure of DSM-IV PTSD symptoms among 2,792 help-seeking Central and East African refugees in Kenya exposed to multiple, severe traumatic events and on-going stressors. To some extent, our results reproduced structures identified among clinical populations in Europe, including strong links within traditional symptom clusters, such as between avoidance of thoughts and situations, and hypervigilance and startling. However, we found substantial differences in most central symptoms, with detachment and disinterest far less and emotional numbing and concentration problems more central in our analyses. Our networks did not reproduce the common finding of particularly low centrality of amnesia. We further noted substantive similarities in network structure, but also differences, between refugees living in an urban environment and in refugee camps. Concentration problems were most central among mainly Somali refugees at a refugee camp, and associated with amnesia and sense of foreshortened future, while emotional numbing was the most central symptom among majority Congolese refugees in Nairobi. Our findings highlight the importance of contextual and cultural factors for PTSD symptomatology, and are informative for assessment and treatment among help-seeking refugees.

我们分析了在肯尼亚的2792名寻求帮助的中部和东非难民的DSM-IV PTSD症状的网络结构，这些难民遭受了多次严重的创伤事件和持续的压力。在某种程度上，我们的结果重现了欧洲临床人群中确定的结构，包括传统症状群内的紧密联系，例如在避免思想和处境之间以及警惕和惊吓之间。但是，在我们的分析中，我们发现大多数中央症状都存在实质性差异，超脱和无兴趣的情况要少得多，而情绪麻木和注意力集中的问题则更为重要。我们的网络并未重现失忆症中心性特别低的常见发现。我们还注意到了网络结构的实质性相似之处，也存在差异，居住在城市环境中和难民营中的难民之间的关系。在主要集中在难民营中的索马里难民中，集中问题最为严重，并与健忘症和前途渺茫有关，而情绪麻木是在内罗毕大多数刚果难民中最主要的症状。我们的研究结果突出了上下文和文化因素对PTSD症状的重要性，并为寻求帮助的难民进行评估和治疗提供了信息。