The relationship between alexithymia, depression, anxiety, and stress in elderly with multiple chronic conditions in China: a network analysis

Highlights • A significant reduction in psychological impact 4 weeks after COVID outbreak. • The mean scores of respondents in both surveys were above PTSD cut-offs. • Female gender, physical symptoms associated with a higher psychological impact. • Hand hygiene, mask-wearing & confidence in doctors reduced psychological impact. • Online trauma-focused psychotherapy may be helpful to public during COVID-19.

The usage of psychological networks that conceptualize behavior as a complex interplay of psychological and other components has gained increasing popularity in various research fields. While prior publications have tackled the topics of estimating and interpreting such networks, little work has been conducted to check how accurate (i.e., prone to sampling variation) networks are estimated, and how stable (i.e., interpretation remains similar with less observations) inferences from the network structure (such as centrality indices) are. In this tutorial paper, we aim to introduce the reader to this field and tackle the problem of accuracy under sampling variation. We first introduce the current state-of-the-art of network estimation. Second, we provide a rationale why researchers should investigate the accuracy of psychological networks. Third, we describe how bootstrap routines can be used to (A) assess the accuracy of estimated network connections, (B) investigate the stability of centrality indices, and (C) test whether network connections and centrality estimates for different variables differ from each other. We introduce two novel statistical methods: for (B) the correlation stability coefficient, and for (C) the bootstrapped difference test for edge-weights and centrality indices. We conducted and present simulation studies to assess the performance of both methods. Finally, we developed the free R-package bootnet that allows for estimating psychological networks in a generalized framework in addition to the proposed bootstrap methods. We showcase bootnet in a tutorial, accompanied by R syntax, in which we analyze a dataset of 359 women with posttraumatic stress disorder available online. Electronic supplementary material The online version of this article (doi:10.3758/s13428-017-0862-1) contains supplementary material, which is available to authorized users.