A longitudinal study of ICD-11 PTSD and complex PTSD in the general population of Israel

The ICD-11 includes two trauma disorders: Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). CPTSD is a disorder comprised of PTSD and Disturbance in Self-Organization (DSO) symptoms. Evidence supports the construct validity of PTSD and CPTSD, however, the temporal stability of these constructs has rarely been tested. This study examined the diagnostic stability of PTSD and CPTSD, and the temporal associations between PTSD and DSO symptoms over a period of one-year. Data were collected from a nationally representative sample of Israeli adults (n = 1,003) and one year later a random half of this sample were reassessed (n = 543). There were no statistically significant changes in rates of PTSD (6.7%, 5.3%) and CPTSD (4.9%, 3.7%) over time. Latent variable cross-lagged analysis indicated that PTSD and DSO symptoms were stable over time and that DSO symptoms predicted subsequent PTSD symptoms. Results suggest that ICD-11 PTSD and CPTSD are stable constructs in the general population over a period of one year. We discuss the possibility that these findings are influenced by the specific cultural context of Israel. Additionally, given the stability and influence of DSO symptoms we discuss the potential value of psychological therapies that directly address these symptoms.

Child Maltreatment Typologies and Intimate Partner Violence: Findings From a Danish National Study of Young Adults

The association between exposure to childhood maltreatment and subsequent intimate partner violence (IPV) has been well documented. Recently, there has been increased attention to IPV in adolescence and young adulthood, with studies demonstrating that IPV peaks in young adulthood. Data were collected from a Danish national study conducted by The Danish National Centre for Social Research in 2008 and 2009. A sample of 4,718 young adults (aged 24) was randomly selected using the total birth cohort of children born in 1984. Structured interviews were conducted with 2,980 participants equating to a response rate of 63%. Childhood maltreatment including emotional, sexual, and multiple abuse experiences and being female and a young parent were used to test the association with experiencing IPV victimization. Bivariate associations showed that all variables were significantly associated with experiencing IPV. When the variables were entered into a multivariate binary logistic regression analysis, being female indicated the strongest association (odds ratio [OR] = 13.96), followed by experiencing childhood sexual abuse (OR = 10.90) and experiencing multiple types of abuse (OR = 6.49). Results suggest that among the child maltreatment typologies, sexual abuse is the dominant factor associated with IPV. The current study extends the literature conducted on a young adult population by demonstrating that early adverse experiences and being female and a parent are associated with IPV in young adulthood. These findings suggest prevention programs should be targeted in early adolescence to support young people to establish and maintain positive and healthy relationships that promote safe conflict resolution strategies.

Profiling and predicting help-seeking behaviour among trauma-exposed UK firefighters

Background: Firefighters often do not avail of psychological support services within fire services. Hence, investigating help-seeking behaviour is crucial to determine viable support options. Objective: This study attempted to characterize help-seeking behaviour among UK firefighters by profiling and identifying patterns of help-seeking. Methods: An online survey was administered to 1282 UK firefighters who were asked which help-seeking options they availed of within and outside professional settings. The analysis was conducted in two linked phases. First, latent class analysis was used to identify the fewest profiles that most accurately described help-seeking behaviour. Second, multinomial logistic regression analysis was employed to describe class composition using demographic and years in service variables, while ANOVA was employed to identify variation in alcohol consumption and openness to discussing emotions across help-seeking classes. Results: Five distinct help-seeking classes were identified. Class 1 (9.2%) represented firefighters who availed of all forms of support. Class 2, the smallest class (6.9%) represented firefighters who independently sought External Professional Psychological Support. Class 3 (12.2%) represented those who mainly sought Friends Support. Class 4, the largest class (48.7%) represented those who mainly sought Spousal Support. Class 5 (23%) represented firefighters who sought all avenues of Social Support. Regression analyses indicated that the External Psychological Support class was more likely to be single with fewer years in service. Firefighters longest in service were less likely to seek Social Support, and those who relied on Spousal support had the lowest alcohol consumption. Conclusion: Variations in help-seeking behaviour among UK firefighters were found. Firefighters who sought spousal support had the lowest alcohol consumption rates, indicating a protected profile. Firefighters who only sought friends and informal colleagues' support had the highest alcohol consumption rates and the most difficulty in discussing feelings, indicating a potential at-risk profile. Recognizing these differences in help-seeking patterns is important for targeting interventions.

The relationship between ICD-11 PTSD, complex PTSD and dissociative experiences

Debate exists in the trauma literature regarding the role of dissociation in traumatic stress disorders. With the release of the new ICD-11 diagnostic guideline for posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD), this issue warrants further attention. In the current study, we provide a preliminary assessment of the associations between ICD-11 CPTSD and dissociative experiences. This study is based on a sample (N = 106) of highly traumatized clinical patients from the United Kingdom who completed measures of traumatic stress and dissociative experiences. The majority of participants met the diagnostic criteria for CPTSD (69.1%, n = 67), with few patients qualifying for a diagnosis of PTSD (9.3%, n = 9). Those with CPTSD had significantly higher levels of dissociative experiences compared to those with PTSD (Cohen's d = 1.04) and those with no diagnosis (Cohen's d = 1.44). Three CPTSD symptom clusters were multivariately associated with dissociation: Affective Dysregulation (β = .33), Re-experiencing in the here and now (β = .24), and Disturbed Relationships (β = .22). These findings indicate that dissociative experiences are particularly relevant for clinical patients with CPTSD. Future longitudinal work will be needed to determine if dissociation is a risk factor for, or outcome of, CPTSD.

Secondary traumatisation, burn-out and functional impairment: findings from a study of Danish child protection workers

Background: Child-protection workers are at elevated risk for secondary traumatization. However, research in the area of secondary traumatization has been hampered by two major obstacles: the use of measures that have unclear or inadequate psychometric properties and equivocal findings on the degree of associated functional impairment. Objective: To assess the relationship between secondary traumatization and burnout using exploratory structural equation modelling (ESEM) and to assess the relationship between secondary traumatization and functional impairment. Methods: A survey of Danish child-protection workers was conducted through the Danish Children Centres (N = 667). Secondary traumatization was measured using the Professional Quality of Life-5 (ProQoL-5) and burnout using the Oldenburg Burnout Inventory. Results: A three-factor ESEM model provided the best fit to the data, reflecting factors consistent with the structure of secondary traumatization and burnout. The factors were differentially related to trauma-related and organizational variables in ways consistent with existing evidence. All factors were significantly related to functional impairment. Conclusion: The findings supported the discriminant validity of secondary traumatization and burnout while highlighting methodological issues around the current use of sum-score approaches to investigating secondary traumatization. The current study supported the clinical relevance of secondary traumatization by linking it explicitly to social and cognitive functional impairment.

The validity of ICD-11 PTSD and Complex PTSD in East Asian cultures: findings with young adults from China, Hong Kong, Japan, and Taiwan

Background: The ICD-11 classifies posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as two distinct diagnoses. Few studies have tested the validity of ICD-11 CPTSD in non-Western settings, particularly in Asia. Objective: This study assessed the factorial, concurrent, and discriminant validity of CPTSD symptoms with four samples of young adults from mainland China, Hong Kong, Japan, and Taiwan. Method: Young adults aged 18-24 years were recruited by convenience sampling and provided their data anonymously online. Study measures included the International Trauma Questionnaire (ITQ) to measure PTSD and CPTSD, and measures of childhood adversity, depression, anxiety, age, and sex. Confirmatory factor analysis (CFA) was performed for each sample to evaluate the validity of two CPTSD measurement models. Structural equation modelling (SEM) was used to determine the multivariate associations between study variables for the full sample. Results: A total of 1,346 young adults completed the survey. CFA showed both models of CPTSD examined fit the data well across all four samples. SEM findings showed that number of childhood adversities significantly associated with both PTSD and CPTSD factors; depression significantly associated with CPTSD factors but not PTSD, whereas anxiety significantly associated with both. Conclusions: Study findings provide evidence for PTSD and CPTSD as separate and valid diagnoses in Asia. More cross-cultural comparisons are needed to understand whether risks for either condition differ by geographical or sociocultural norms.

A cross-country psychiatric screening of ICD-11 disorders specifically associated with stress in Kenya, Nigeria and Ghana

Background: The Global Forum for Health Research, with the support of the World Health Organization, highlighted the need to prioritize mental health research in Africa. The introduction of revised descriptions of Posttraumatic Stress Disorder (PTSD) and Adjustment Disorder, along with new diagnoses of Complex PTSD and Prolonged Grief Disorder, in the ICD-11 creates a need for additional national-level epidemiological studies on the prevalence of stress-related disorders. Methods: The prevalence rates of these four ICD-11 stress disorders were assessed in three African countries including Nigeria (N = 1006), Kenya (N = 1018), and Ghana (N = 500). Participants completed disorder-specific measures for each disorder. Findings: Across the entire sample, the current prevalence rate of probable Adjustment Disorder was 8.4% (95% C.I. = 7.4%, 9.6%), probable PTSD was 18.6% (95% C.I. = 17.2, 20.2%), probable Complex PTSD was 15.9% (95% C.I. = 14.5%, 17.4%) and probable Prolonged Grief Disorder was 3.7% (95% C.I. = 3.1%, 4.5%). Interpretation: The results are applicable primarily to well-educated urban and suburban adults in these African countries. Results indicated that Adjustment Disorder, PTSD, and CPTSD are highly prevalent in these three African countries. There is now a pressing need to develop culturally sensitive interventions to enable recovery from these conditions.

Examining the Discriminant Validity of Complex Posttraumatic Stress Disorder and Borderline Personality Disorder Symptoms: Results From a United Kingdom Population Sample

Complex posttraumatic stress disorder (CPTSD) was added to the diagnostic nomenclature in the 11th revision of the International Classification of Diseases (ICD-11). Although considerable evidence exists supporting the construct validity of CPTSD, the distinguishability of CPTSD symptoms from those of borderline personality disorder (BPD) has been questioned. The present study examined the discriminant validity of CPTSD and BPD symptoms among a trauma-exposed population sample from the United Kingdom (N = 546). Participants completed self-report measures of CPTSD and BPD symptoms, and their latent structure was assessed using exploratory structural equation modeling (ESEM). A three-factor model with latent variables reflecting PTSD, disturbances in self-organization (DSO), and BPD symptoms provided the best fit of the data, χ² (399, N = 546) = 1,650, p < .001; CFI = .944; TLI = .930; RMSEA = .077, 90% CI [.073, .081]. We identified multiple symptoms distinctive to individual constructs (e.g., disturbed relationships and suicidality) as well as symptoms shared across the constructs (e.g., affective dysregulation). The PTSD, β = .24; DSO, β = .23; and BPD, β = .27, latent variables were positively and significantly associated with childhood interpersonal trauma. The current findings support the discriminant validity of CPTSD and BPD symptoms and highlight various phenomenological signatures of each construct as well as demonstrate how these constructs share important similarities in symptom composition and exogenous correlates.

Modeling Patterns of Polyvictimiztion and Their Associations with Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder in the Israeli Population

Although evidence is accumulating for the conceptual validity of the ICD-11 proposal for posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD), our understanding of the specificity of trauma-related predictors is still evolving. Specifically, studies utilizing advanced statistical methods to model the association between trauma exposure and ICD-11 proposals of traumatic stress and differences in profiles of trauma exposure are lacking. Additionally, time since trauma and a clear memory of the trauma are yet to be examined as predictors of PTSD and CPTSD. We analyzed trauma exposure as reported by a general population sample of Israeli adults (N = 834), using latent class analysis, and the resultant classes were used in regression models to predict PTSD and CPTSD operationalized both dimensionally and categorically. Four distinct groups were identified: child and adult interpersonal victimization, community victimization-male, community victimization-female, and adult victimization. These groups were differentially related to PTSD and CPTSD, with only child and adult interpersonal victimization consistently predicting CPTSD and disturbances in self-organization. When modeled dimensionally, PTSD was associated with the child and adult interpersonal victimization and adult victimization groups, whereas only the child and adult interpersonal victimization group was predictive of PTSD when operationalized categorically. The roles of time since trauma and a clear memory of the trauma differed across PTSD and CPTSD. These findings support the use of trauma typologies for predicting PTSD and CPTSD and provide important insight into the distribution of trauma exposure in the Israeli population.

ICD-11 Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder in the United States: A Population-Based Study

The primary aim of this study was to provide an assessment of the current prevalence rates of International Classification of Diseases (11th rev.) posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) among the adult population of the United States and to identify characteristics and correlates associated with each disorder. A total of 7.2% of the sample met criteria for either PTSD or CPTSD, and the prevalence rates were 3.4% for PTSD and 3.8% for CPTSD. Women were more likely than men to meet criteria for both PTSD and CPTSD. Cumulative adulthood trauma was associated with both PTSD and CPTSD; however, cumulative childhood trauma was more strongly associated with CPTSD than PTSD. Among traumatic stressors occurring in childhood, sexual and physical abuse by caregivers were identified as events associated with risk for CPTSD, whereas sexual assault by noncaregivers and abduction were risk factors for PTSD. Adverse childhood events were associated with both PTSD and CPTSD, and equally so. Individuals with CPTSD reported substantially higher psychiatric burden and lower levels of psychological well-being compared to those with PTSD and those with neither diagnosis.

Modelling changes in anxiety and depression during low-intensity cognitive behavioural therapy: An application of growth mixture models

OBJECTIVES

Research largely supports the clinical effectiveness of low-intensity cognitive behavioural therapy (LICBT) for mild-to-moderate anxiety and depression, delivered by psychological well-being practitioners (PWPs). Knowledge regarding the predictors of treatment response, however, is relatively limited. The primary aim of this study was to model the heterogeneity in longitudinal changes in anxiety and depression throughout LICBT provided by PWPs in Northern Ireland (NI), and to explore associations between pre-treatment variables and differences in treatment response.

METHODS

Growth mixture modelling (GMM) techniques were employed to examine changes in psychological status in clients (N = 253) over the first six sessions of treatment, to identify divergent early response trajectories. A series of pre-treatment variables were used to predict class membership using chi-square tests and binary logistic regression models.

RESULTS

There was one class representing improvement and one representing no improvement for both anxiety and depression. Class membership was predictive of treatment outcome. Pre-treatment variables associated with less improvement included unemployment, risk of suicide, neglect of self or others, using medication, receiving previous or concurrent treatments, a longer duration of difficulties, and comorbidities.

CONCLUSIONS

Findings indicate most of the sample populated an 'improvers' class for both depression and anxiety. Pre-treatment variables identified as predictive of poor treatment response may need to be considered by practitioners in potential triage referral decision policies, supporting cost-effective and efficient services. Further research around predictors of clinical outcome is recommended.

PRACTITIONER POINTS

Most of the sample belonged to an 'improvers' class. Several pre-treatment variables predicted poor treatment response (unemployment, suicide risk, neglect, medication, previous or concurrent treatments, longer duration of difficulties, and comorbidities). Few studies have utilized GMM to determine predictors of outcome following LICBT Regarding pre-treatment variables, the possibility of self-report bias cannot be excluded. The time period was relatively short, although represented the optimum number of sessions recommended for LICBT. The lack of a control group and random allocation were the main limitations.

Negative self-evaluation and the genesis of internal threat: beyond a continuum of suicidal thought and behaviour

BACKGROUND

Death by suicide is often preceded by attempted suicide, suicidal ideation and non-suicidal self-injury. These extreme thoughts and behaviours have been considered in terms of a continuum of suicidality. Little known research, however, has considered a suicide continuum that extends beyond these extreme thoughts and behaviours and incorporates a much wider array of phenomena that may vary in severity and may constitute a broader negative self-evaluation (NSE) continuum.

METHOD

Harvesting key indicators of NSE from a British epidemiological survey (N = 8580), the current study used exploratory factor analysis, confirmatory factor analysis and factor mixture modelling to (i) identify the dimensional structure of NSE in the general population and (ii) profile the distribution of the resultant NSE dimensions. Multinomial logistic regression was then used to differentiate between classes using an array of risk variables, psychopathology outcome variables and a suicide attempt indicator.

RESULTS

A 4-factor model that reflected graded levels of NSE was identified; (F1) Low self-worth & subordination (F2) depression, (F3) suicidal thoughts, (F4) self-harm (SH). Seven classes suggested a clear pattern of NSE severity. Classes characterised by higher levels across the dimensions exhibited greater risk and poorer outcomes. The greatest risk for suicide attempt was associated with a class characterised by engagement in SH behaviour.

CONCLUSIONS

Low self-worth, subordination and depression, while representative of distinct groups in the population are also highly prevalent in those who entertain suicidal thoughts and engage in SH behaviour. The findings promote further investigation into the genesis and evolution of suicidality and internal threat.

Childhood adversity and psychosis in detained inpatients from medium to high secured units: Results from the Scottish census survey

BACKGROUND

There is limited data available regarding the most common forms of psychiatric illness, the occurrence of childhood adversity, and the link between childhood adversity and criminal and psychiatric outcomes amongst forensic inpatients.

AIMS

Using census data for all Scottish forensic inpatients, we investigated the most common primary psychiatric diagnoses in forensic settings, the occurrence of childhood adversity amongst forensic inpatients, and whether childhood adversity experiences significantly predict a range of criminal and psychiatric outcomes.

METHOD

Data for the current study were drawn from 'The Scottish Forensic Network Inpatient Census' (N = 422). The Responsible Medical Officers and other members of the clinical team collected all data from official patient records. All forensic inpatients across high, medium, and low security sites were surveyed.

RESULTS

The majority of patients had a psychotic disorder as their primary diagnosis (86.4%), with schizophrenia being the most common (70.0%). Childhood adversity was highly prevalent (79.2%), with physical abuse being the most common adverse experience (40.1%). Increased levels of childhood adversity were significantly associated with an increased risk of criminal convictions, self-reported abuse of animals, suicidal and self-injurious behaviour, and problematic use of drugs or alcohol.

CONCLUSIONS

Considering the association between adversity and psychosis, trauma informed care is essential for the mental health and forensic needs of this population.

Risk factors and comorbidity of ICD-11 PTSD and complex PTSD: Findings from a trauma-exposed population based sample of adults in the United Kingdom

BACKGROUND

Following the recently published 11th version of the WHO International Classification of Diseases (ICD-11), we sought to examine the risk factors and comorbidities associated with posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD).

METHOD

Cross-sectional and retrospective design. The sample consisted of 1,051 trauma-exposed participants from a nationally representative panel of the UK adult population.

RESULTS

A total of 5.3% (95% confidence interval [CI] = 4.0-6.7%) met the diagnostic criteria for PTSD and 12.9% (95% CI = 10.9-15.0%) for CPTSD. Diagnosis of PTSD was independently associated with being female, being in a relationship, and the recency of traumatic exposure. CPTSD was independently associated with younger age, interpersonal trauma in childhood, and interpersonal trauma in adulthood. Growing up in an urban environment was associated with the diagnosis of PTSD and CPTSD. High rates of physical and mental health comorbidity were observed for PTSD and CPTSD. Those with CPTSD were more likely to endorse symptoms reflecting major depressive disorder (odds ratio [OR] = 21.85, 95 CI = 12.51-38.04) and generalized anxiety disorder (OR = 24.63, 95 CI = 14.77-41.07). Presence of PTSD (OR = 3.13, 95 CI = 1.81-5.41) and CPTSD (OR = 3.43, 95 CI = 2.37-4.70) increased the likelihood of suicidality by more than three times. Nearly half the participants with PTSD and CPTSD reported the presence of a chronic illness.

CONCLUSIONS

CPTSD is a more common, comorbid, debilitating condition compared to PTSD. Further research is now required to identify effective interventions for its treatment.

Quality not quantity: loneliness subtypes, psychological trauma, and mental health in the US adult population

PURPOSE

Loneliness is a recognised public-health concern that is traditionally regarded as a unidimensional construct. Theories of loneliness predict the existence of subtypes of loneliness. In this study, latent class analysis (LCA) was used to test for the presence of loneliness subtypes and to examine their association with multiple mental health variables.

METHODS

A nationally representative sample of US adults (N = 1839) completed the De Jong Gierveld Loneliness Scale, along with self-report measures of childhood and adulthood trauma, psychological wellbeing, major depression, and generalized anxiety.

RESULTS

When treated as a unidimensional construct, 17.1% of US adults aged 18-70 were classified as lonely. However, the LCA results identified four loneliness classes which varied quantitatively and qualitatively: 'low' (52.8%), 'social' (8.2%), 'emotional' (26.6%), and 'social and emotional' (12.4%) loneliness. The 'social and emotional' class were characterised by the highest levels of psychological distress, followed by the 'emotional' class. The 'social' loneliness class had similar mental health scores as the 'low' loneliness class. Childhood and adulthood trauma were independently related to the most distressed loneliness classes.

CONCLUSIONS

Current findings provide support for the presence of subtypes of loneliness and show that they have unique associations with mental health status. Recognition of these subtypes of loneliness revealed that the number of US adults aged 18-70 experiencing loneliness was twice as high as what was estimated when loneliness was conceptualized as a unidimensional construct. The perceived quality, not the quantity, of interpersonal connections was associated with poor mental health.

Psychological interventions for ICD-11 complex PTSD symptoms: systematic review and meta-analysis

BACKGROUND

The 11th revision to the WHO International Classification of Diseases (ICD-11) identified complex post-traumatic stress disorder (CPTSD) as a new condition. There is a pressing need to identify effective CPTSD interventions.

METHODS

We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of psychological interventions for post-traumatic stress disorder (PTSD), where participants were likely to have clinically significant baseline levels of one or more CPTSD symptom clusters (affect dysregulation, negative self-concept and/or disturbed relationships). We searched MEDLINE, PsycINFO, EMBASE and PILOTS databases (January 2018), and examined study and outcome quality.

RESULTS

Fifty-one RCTs met inclusion criteria. Cognitive behavioural therapy (CBT), exposure alone (EA) and eye movement desensitisation and reprocessing (EMDR) were superior to usual care for PTSD symptoms, with effects ranging from g = -0.90 (CBT; k = 27, 95% CI -1.11 to -0.68; moderate quality) to g = -1.26 (EMDR; k = 4, 95% CI -2.01 to -0.51; low quality). CBT and EA each had moderate-large or large effects on negative self-concept, but only one trial of EMDR provided useable data. CBT, EA and EMDR each had moderate or moderate-large effects on disturbed relationships. Few RCTs reported affect dysregulation data. The benefits of all interventions were smaller when compared with non-specific interventions (e.g. befriending). Multivariate meta-regression suggested childhood-onset trauma was associated with a poorer outcome.

CONCLUSIONS

The development of effective interventions for CPTSD can build upon the success of PTSD interventions. Further research should assess the benefits of flexibility in intervention selection, sequencing and delivery, based on clinical need and patient preferences.

Differentiating symptom profiles of ICD-11 PTSD, complex PTSD, and borderline personality disorder: A latent class analysis in a multiply traumatized sample

Complex posttraumatic stress disorder (CPTSD) has been included as a diagnostic category in the International Classification of Diseases, 11th Edition, consisting of six symptom clusters: the three PTSD criteria of reexperiencing, avoidance, and hypervigilance, in addition to three disturbances of self-organization (DSO) symptoms defined as emotional dysregulation, interpersonal difficulties, and negative self-concept. As borderline personality disorder (BPD) shares similar features to DSO presentations and is commonly associated with PTSD, there is debate as to whether and how CPTSD is distinct from PTSD comorbid with BPD. This article aimed to identify groups with distinct profiles of self-reported CPTSD and BPD symptoms and associated trauma history characteristics. A latent class analysis (LCA) using CPTSD and BPD symptom variables was conducted on a sample of 195 treatment-seeking adults at a specialist trauma service. The classes were then compared on demographic and clinical characteristics using a series of analysis of variance and χ2 tests. The latent class analysis determined three distinct classes: a CPTSD/High BPD class characterized by high symptom endorsement across both conditions, a CPTSD/Moderate BPD class characterized by high PTSD and DSO symptom endorsement and moderate BPD, and a PTSD/Low BPD class characterized by PTSD symptoms and low DSO and BPD symptom endorsement. The two CPTSD classes were associated with greater exposure to multiple, interpersonal traumas earlier in life and exhibited higher functional impairment. Findings support the construct of a CPTSD diagnosis as a separate entity although BPD features seem to overlap greatly with CPTSD symptoms in this highly traumatized clinical sample. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The CSS-12: Development and Validation of a Short-Form Version of the Cyberchondria Severity Scale

Cyberchondria is defined as an increase in anxiety about one's health status as a result of excessive online searches. McElroy and Shevlin (2014) developed the first multidimensional, self-report measure of this construct-the Cyberchondria Severity Scale (CSS). The CSS consists of 33 items which can be summed to form a total score, and/or 5 subscale scores. The aim of the present study was to develop a short-form version of the CSS, removing the "Mistrust" subscale. Participants were undergraduate students from two UK universities (N = 661, 73% female, M_age = 22.19 years, SD = 5.88). Students completed the CSS, Short Health Anxiety Inventory (SHAI) and Generalized Anxiety Disorder Assessment (GAD-7). Twelve items were chosen for retention in the short form based on an exploratory factor analysis. These items corresponded to the four factors previously identified in the 33-item scale (minus the "Mistrust" subscale). Confirmatory factor analysis was used to validate the structure of the CSS-12. Confirmatory bifactor modeling indicated that the majority of item covariance was accounted for by a general cyberchondria factor. Construct validity was assessed by examining associations with the SHAI and GAD-7, with stronger correlations observed between the CSS-12 and the SHAI (compared with the GAD-7). The CSS-12 is a brief, reliable, and valid measure of worry/anxiety attributable to excessive online health research.

Where are all the males? Gender-specific typologies of childhood adversity based on a large community sample

BACKGROUND

Methodological issues have been identified when quantifying exposure to adversity and abuse. To address a single type may obscure covarying effects. To sum multiple exposures gives equal weight to each. Latent class analysis (LCA) addresses this by identifying homogenous subpopulations. Most studies using LCA have pooled gender data in spite of evidence that the nature and frequency of exposure differs by gender. Males report more interpersonal abuse, females report more of other exposures, particularly sexual.

OBJECTIVE

This study aimed to identify if stratifying data by gender resulted in different profiles of adversity/abuse Participants and setting: The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) wave II, a large community-based survey, nationally representative of the US population.

METHOD

This study used 14 indicators of childhood adversity as the basis for LCA.

RESULTS

The number and nature of classes differed by gender. The best solution for females was 4-class: a low risk class; a class at higher risk of sexual abuse; a class at higher risk of physical abuse; a class at higher risk of combined physical and sexual abuse. The best solution for males had only 3-classes; a low risk class, a class at higher risk of sexual abuse; a class at higher risk of physical abuse. The combined dataset resulted in a solution similar to the female solution.

CONCLUSION

The importance of developing models for males and females separately was evidenced by the male and female classes being differentially associated with mental health variables.

Complex posttraumatic stress disorder (CPTSD) following captivity: a 24-year longitudinal study

Background: The World Health Organization(WHO) International Classification of Diseases, 11th version (ICD-11), has proposed a new trauma-related diagnosis of complex posttraumatic stress disorder (CPTSD), separate and distinct from posttraumatic stress disorder (PTSD). However, to date, no study has examined CPTSD over time. Objectives: This prospective study aimed to examine predictors and outcomes of latent classes of PTSD and CPTSD following war captivity. Method: A sample of 183 Israeli former prisoners of the 1973 Yom Kippur War (ex-POWs) participated in a 24-year longitudinal study with three waves of measurements (T1: 1991, T2: 2008, and T3: 2015). Participants completed validated self-report measures, and their cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA). Results: Estimated rates of PTSD and CPTSD were high at all waves, with PTSD rates higher than CPTSD. A Latent Class Analysis (LCA) identified three main classes at T2: (1) a small class with low probability to meet PTSD and CPTSD clusters criteria (15.26%); (2) a class high only in PTSD symptoms (42.37%) and (3) a class high only in CPTSD symptoms (42.37%). Importantly, higher levels of psychological suffering in captivity at T1 were associated with higher odds of being in the CPTSD class at T2. In addition, CPTSD at T2 was more strongly associated with low self-rated health, functional impairment, and cognitive performance at T3, compared to the PTSD only class. Conclusions: Adulthood prolonged trauma of severe interpersonal intensity such as war captivity is related to CPTSD, years after the end of the war. Exposure to psychological suffering in captivity is a risk factor for future endorsement of CPTSD symptoms. CPTSD among ex-POWs is a marker for future dire mental health and functional consequences.