- Continuous traumatic stress acts as a transdiagnostic process linking PTSD, depression and anxiety symptoms among adolescents exposed to ongoing violence.
- Network analyses showed cross-domain CTS connections; Ukraine displayed tighter, more evenly distributed symptom networks, South Africa showed broader, diffuse patterns with stronger anxiety expression.
- Targeting central CTS bridge symptoms in interventions could reduce comorbidity and improve mental health outcomes in adolescents living under continuous threat.
Front Psychiatry. 2026 Oct 13;17:1888773. doi: 10.3389/fpsyt.2026.1888773. eCollection 2026.
ABSTRACT
BACKGROUND: Adolescents living under conditions of continuous traumatic stress (CTS) are exposed to ongoing, persistent, unpredictable threats that differ from past discrete traumatic events and are associated with high levels of CTS symptoms, posttraumatic stress disorder (PTSD), depression, and anxiety. Despite growing evidence that CTS functions as a risk factor for trauma-related disorders, little is known about how specific CTS symptoms are embedded within broader psychopathology networks across diverse contexts of chronic violence.
AIM: This study applied item-level network analysis to examine the structural role of individual CTS symptoms within PTSD, depression, and anxiety symptom networks among adolescents exposed to CTS in South Africa (n = 600) and Ukraine (n = 485).
METHOD: Adolescents (aged 12 to 18 years) completed standardised measures of CTS, PTSD, depression, and anxiety symptoms. Item-level network models were used to examine within- and cross-domain symptom associations, identify central and bridging CTS symptoms, assess their predictive value for overall symptom severity, and test network invariance across countries.
RESULTS: In both samples, strong within-domain clustering was observed alongside robust cross-domain connections linking CTS symptoms with PTSD, depression, and anxiety symptoms. In Ukraine, CTS symptoms were represented by symptoms reflecting loss of meaning, intense fear or horror, and episodes of rage, while in South Africa, CTS symptoms were represented by difficulty controlling emotions, feelings of betrayal, and perceived life threat. The findings also suggest that CTS symptoms were more tightly interconnected and more evenly distributed across PTSD, depression, and anxiety symptoms in the Ukrainian sample, whereas the South African sample demonstrated a broader and more diffuse symptom pattern, with anxiety-related symptoms appearing to be more prominently expressed.
CONCLUSION: Findings suggest that CTS symptoms may potentially operate as a transdiagnostic process – cutting across, and contributing to shared variance in PTSD, depression, and anxiety symptoms – among adolescents exposed to ongoing violence. Interventions targeting core CTS bridge symptoms may reduce comorbidity and improve mental health outcomes in chronically threatened youth across diverse conflict settings.
PMID:42948517 | PMC:PMC13711263 | DOI:10.3389/fpsyt.2026.1888773
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