Unraveling specifics of mental health symptoms in war survivors who fled versus stayed in the area of conflict using network analysis

•Given the high number of survivors of mass violence, understanding mental health specifics of war survivors is critical.•We used network analyses to examine mental health symptoms in different groups of war survivors.•We compared war survivors who stayed in the area of former conflict to refugees who had fled to Western European countries.•We also compared war survivors meeting diagnostic criteria for PTSD to war survivors not qualifying for this diagnosis.•Globally, networks were similar as reflected in high correlations between strength centrality and many consistent edges. War survivors often report symptoms of post-traumatic stress disorder (PTSD), depression, anxiety, and somatization. Hence, understanding symptom constellations among different populations of war survivors is critical. Using the network approach to psychopathology, we examined symptom centrality for these conditions in war survivors from Balkan countries who had stayed in the area of former conflict compared to those individuals from Balkan countries who had fled to Western European countries (N = 4,167) with the Impact of Events Scale-Revised and the Brief Symptom Inventory. We further compared networks for war survivors who met criteria for PTSD-diagnosis (assessed with the MINI-International Neuropsychiatric Interview) to those without PTSD-diagnosis. Globally, networks were similar across the groups, whereas specific differences emerged in symptom centrality. More consistencies were found between PTSD and Western country networks, which may be partially explained by a higher prevalence of PTSD in those who had fled to Western European than in those who had stayed in the Balkan countries. Given the cross-sectional nature of our data, the directionality of edges in our networks remains unclear. Further, higher levels of trauma exposure and symptom severity in Western country participants may have confounded results. The PTSD findings are in line with previous research on PTSD symptoms. They further provide novel insights into depressive, anxiety, and somatization symptoms in survivors of war. These findings need to be substantiated and call for future intervention studies that test the effects of targeting central symptoms we identified in our study.