ORIGINAL RESEARCH article
Front. Psychiatry
Sec. Anxiety and Stress Disorders
Relationship between Rumination and Symptoms of Posttraumatic Stress Disorder – a Cross-sectional Network Analysis
Olena Zhabenko 1,2
Ziv Ben-Zion 3,4
Paul Raffelhüschen 5,2
Achim Burrer 2,5
Erich Seifritz 2,1
Stefan Jost 6
Kathrin Preller 6,7
Or Duek 4,8
Megan Paterson 3
Robert H Pietrzak 3,4,9
Jutta Joormann 10
Tobias R. Spiller 5,2,3
Ilan Harpaz-Rotem 3,4,10
1. Psychiatric University Hospital Zurich, Zurich, Switzerland
2. Universitat Zurich, Zürich, Switzerland
3. Yale School of Medicine, New Haven, United States
4. VA Connecticut Healthcare System West Haven VA Medical Center, West Haven, United States
5. Psychiatrische Universitatsklinik Zurich, Zürich, Switzerland
6. Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
7. Boehringer Ingelheim Pharma, Basel, Switzerland
8. Ben-Gurion University of the Negev, Be'er Sheva, Israel
9. Yale School of Public Health, New Haven, United States
10. Yale University, New Haven, United States
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Abstract
ABSTRACT Background: Rumination is associated with the development and maintenance of PTSD. However, significant gaps remain in understanding how specific PTSD symptoms relate to rumination at a granular level, particularly when controlling for common comorbidities like depression and anxiety. This study used multi-level network analysis to examine these relationships in adult survivors of traumatic events. Methods: Six hundred sixty-one adult survivors (median age 35 years, 29 to 45 years, 49.3% females) who had witnessed or experienced a car crash, a violent act, or the killing of someone participated in an online-based study. Participants completed the Posttraumatic Stress Disorder Checklist (PCL-5), the Repetitive Thinking Questionnaire (RTQ-10), the Generalized Anxiety Disorder (GAD-7), and the Patient Health Questionnaire (PHQ-9). Network analysis was conducted at both scale and item levels to examine associations while controlling for depression and anxiety. Results: Network analysis revealed selective associations between rumination and symptoms of PTSD. At the cluster level, rumination was associated with re-experiencing and negative alterations in cognition and mood clusters, but not with avoidance or hyperarousal clusters. At the item level, complex patterns emerged including relevant associations between items assessing intrusive memories and persistent repetitive thoughts. Additionally, a negative association was observed between risk-taking behaviors and future-oriented wishful thinking. Conclusion: Our findings reveal interconnected constructs, which might in part be due to content overlap among the questionnaires used. These findings highlight the importance of precise construct definition and measurement differentiation when investigating trauma-related
Summary
Keywords
Anxiety, Depression, Network analysis, PTSD, rumination
Received
13 January 2026
Accepted
20 February 2026
Copyright
© 2026 Zhabenko, Ben-Zion, Raffelhüschen, Burrer, Seifritz, Jost, Preller, Duek, Paterson, Pietrzak, Joormann, Spiller and Harpaz-Rotem. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Olena Zhabenko
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