A network analysis of ‘thinking a lot’: Connections to childhood trauma and post-traumatic stress disorder among men who have sex with men in Vietnam

Sexual minorities face an increased risk of being exposed to trauma and developing Post-Traumatic Stress Disorder (PTSD). PTSD symptoms can be exacerbated by ‘Thinking a Lot’ (TAL). The purpose of this study was to explore TAL and its associations with childhood trauma exposure and PTSD among young men who have sex with men (MSM) in Hanoi, Vietnam. Between June and October 2018, 198 participants completed the TAL Questionnaire, Childhood Trauma Questionnaire, and PTSD Symptom Scale. The network of associations among TAL, childhood trauma, and PTSD symptoms was estimated using the Ising model with l1 regularization, and a clustering algorithm was applied. Results indicated that childhood emotional abuse was connected to adult hyperarousal symptoms, but not to TAL-induced distress or other PTSD symptom clusters. PTSD symptom clusters were highly interconnected, and hyperarousal and avoidance symptom clusters specifically linked childhood trauma exposure to TAL-induced insomnia, irritability, and somatic distress. These findings underscored the complex local understanding of TAL and its role in the connection between childhood trauma and PTSD among MSM.