Association between social networks and symptoms of post-traumatic stress during the pandemic: Cohort study in South Korea

Background: This study estimated the association between pre-pandemic social network properties and symptoms of posttraumatic stress during the coronavirus disease 2019 (COVID-19) pandemic in South Korea. Methods: We conducted four online mental health surveys during COVID-19 (from March 14, 2020, to December 11, 2021) among individuals enrolled in a community-based cohort study (previously recruited from 2013 to 2018). Among 4060 people interviewed at the pre-pandemic baseline, 2652 individuals (men = 951, women = 1701) who responded to at least one of the four surveys conducted were included. At baseline, each individual's social network, including size and average closeness, was measured in an egocentric way. Post Traumatic Stress Disorder Checklist for DSM-5 (PCL-5) was measured at each survey point. A generalized linear model and a generalized linear mixed model were used after stratified by sex. Results: Among men, network size was negatively associated with total PCL-5 score (b = −0.42, SE = 0.16, p = 0.002). The magnitude of the association increased over time and was maximal by the 4th survey (b = −0.65, SE = 0.31, p = 0.037). Among women, average closeness was negatively associated with the total PCL-5 score (b = −1.16, SE = 0.37, p = 0.002). In analyses disaggregated by symptom clusters, social networks were associated explicitly with symptoms of intrusion and mood but not with avoidance and arousal symptoms. Conclusion: In this cohort of adults followed for more than a year during the outbreak of COVID-19 in South Korea, social networks established before the onset of the COVID-19 pandemic had a protective association against developing symptoms of PTSD during the first two years of the pandemic.