title: Perceived causal relations between anxiety, posttraumatic stress and depression: extension to moderation, mediation, and network analysis.
abstract: BACKGROUND
  Previous research demonstrates that posttraumatic memory reexperiencing, depression, anxiety, and guilt-shame are frequently co-occurring problems that may be causally related.
  
  
  OBJECTIVE
  The present study utilized Perceived Causal Relations (PCR) scaling in order to assess participants' own attributions concerning whether and to what degree these co-occurring problems may be causally interrelated.
  
  
  METHODS
  288 young adults rated the frequency and respective PCR scores associating their symptoms of posttraumatic reexperiencing, depression, anxiety, and guilt-shame.
  
  
  RESULTS
  PCR scores were found to moderate associations between the frequency of posttraumatic memory reexperiencing, depression, anxiety, and guilt-shame. Network analyses showed that the number of feedback loops between PCR scores was positively associated with symptom frequencies.
  
  
  CONCLUSIONS
  Results tentatively support the interpretation of PCR scores as moderators of the association between different psychological problems, and lend support to the hypothesis that increased symptom frequencies are observed in the presence of an increased number of causal feedback loops between symptoms. Additionally, a perceived causal role for the reexperiencing of traumatic memories in exacerbating emotional disturbance was identified.
authors.affiliation: Department of Psychiatry and Psychology, Graduate Program in Neuroscience, Western University Canada, London, Ontario, Canada.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Frewen
authors.forename: Verena D
authors.initials: VD
authors.lastname: Schmittmann
authors.forename: Laura F
authors.initials: LF
authors.lastname: Bringmann
authors.forename: Denny
authors.initials: D
authors.lastname: Borsboom
keywords: Perceived causal relations; anxiety; assessment; comorbidity; depression; posttraumatic stress disorder (PTSD)