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.

Translation and validation of the Chinese ICD-11 International Trauma Questionnaire (ITQ) for the Assessment of Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD)

Background: Two stress-related disorders have been proposed for inclusion in the revised ICD-11: Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). The International Trauma Questionnaire (ITQ) is a bespoke measure of PTSD and CPTSD and has been widely used in English-speaking countries. Objective: The primary aim of this study was to develop a Chinese version of the ITQ and assess its content, construct, and concurrent validity. Methods: Six mental health practitioners and experts rated the Chinese translated and back-translated items to assess content validity. A sample of 423 Chinese young adults completed the ITQ, the WHO Adverse Childhood Experiences International Questionnaire, and the Hospital Anxiety and Depression Scale. Among them, 31 participants also completed the English and Chinese versions of the ITQ administered in random order at retest. Four alternative confirmatory factor analysis models were tested using data from participants who reported at least one adverse childhood experience (ACE; N = 314). Results: The Chinese ITQ received excellent ratings on relevance and appropriateness. Test-retest reliability and semantic equivalence across English and Chinese versions were acceptable. The correlated first-order six-factor model and a second-order two-factor (PTSD and DSO) both provided an acceptable model fit. The six ITQ symptoms clusters were all significantly correlated with anxiety, depression, and the number of ACEs. Conclusions: The Chinese ITQ generates scores with acceptable psychometric properties and provides evidence for including PTSD and CPTSD as separate diagnoses in ICD-11.

Hyperactivation and hypoactivation affective dysregulation symptoms are integral in complex posttraumatic stress disorder: Results from a nonclinical Israeli sample

OBJECTIVES

The current study sought to further assess the nature of the affect dysregulation (AD) cluster of the International Classification of Diseases-11 (ICD-11) proposal for complex posttraumatic stress disorder (CPTSD) in a nonclinical sample.

METHODS

An online survey sample from Israel (n = 618) completed a disorder-specific measure (International Trauma Questionnaire) of PTSD and CPTSD along with the Life Events Checklist and the World Health Organization Well-Being Index.

RESULTS

Estimated prevalence rates of PTSD and CPTSD were 9.2% and 1.0%, respectively. Confirmatory factor analysis results indicated that AD symptoms are better conceived as two correlated dimensions of hyperactivation and hypoactivation symptoms. Latent class analysis results indicated that CPTSD was clearly distinguishable from PTSD. CPTSD class membership was associated with higher levels of traumatization and poorer psychological well-being scores.

CONCLUSIONS

Findings support the discriminant validity of the ICD-11 proposals for PTSD and CPTSD in a nonclinical sample using a disorder-specific measure. The results provide further evidence that the final symptom profile for CPTSD in ICD-11 should model the AD cluster using both hyperactivation and hypoactivation symptoms.

ICD-11 PTSD and complex PTSD amongst Syrian refugees in Lebanon: the factor structure and the clinical utility of the International Trauma Questionnaire

OBJECTIVE

Support for ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) is growing; however, few studies include refugees or examine the clinical utility of PTSD/CPTSD classifications. This study sought to provide the first evaluations of (i) the factor structure of ICD-11 PTSD/CPTSD amongst refugees in the Middle East; and (ii) the clinical utility of the International Trauma Questionnaire (ITQ) to identify PTSD/CPTSD in a humanitarian context.

METHOD

Participants were 112 treatment-seeking Syrian refugees living in Lebanon. Factorial validity was assessed using confirmatory factor analysis (CFA) based on responses to the ITQ. Clinical utility of the ITQ was assessed through semi-structured interviews with six Lebanese psychotherapists.

RESULTS

Complex PTSD (36.1%) was more common than PTSD (25.2%), and no sex or age differences were observed at the prevalence or symptomatic levels. CFA results supported a two-factor higher-order model consistent with ICD-11 PTSD/CPTSD. Qualitative findings indicated that the ITQ is generally positively regarded, with some limitations and suggested modifications noted.

CONCLUSION

This is the first study to support the ICD-11 PTSD/CPTSD amongst refugees in the Middle East and the clinical utility of the ITQ in a humanitarian context. Findings support the growing evidence for the cross-cultural applicability of ICD-11 PTSD/CPTSD.

The International Trauma Questionnaire: development of a self-report measure of ICD-11 PTSD and complex PTSD

OBJECTIVE

The purpose of this study was to finalize the development of the International Trauma Questionnaire (ITQ), a self-report diagnostic measure of post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD), as defined in the 11th version of the International Classification of Diseases (ICD-11).

METHOD

The optimal symptom indicators of PTSD and CPTSD were identified by applying item response theory (IRT) analysis to data from a trauma-exposed community sample (n = 1051) and a trauma-exposed clinical sample (n = 247) from the United Kingdom. The validity of the optimized 12-item ITQ was assessed with confirmatory factor analyses. Diagnostic rates were estimated and compared to previous validation studies.

RESULTS

The latent structure of the 12-item, optimized ITQ was consistent with prior findings, and diagnostic rates of PTSD and CPTSD were in line with previous estimates.

CONCLUSION

The ITQ is a brief, simply worded measure of the core features of PTSD and CPTSD. It is consistent with the organizing principles of the ICD-11 to maximize clinical utility and international applicability through a focus on a limited but central set of symptoms. The measure is freely available and can be found in the body of this paper.

Co-occurring internalizing and externalizing psychopathology in childhood and adolescence: a network approach

The network approach suggests that psychopathology arises from complex associations between symptoms and may offer insight into the mechanisms that underpin psychiatric comorbidities. The transition from childhood to adolescence is a key period in the development of psychopathology, yet has rarely been considered from a network perspective. As such, the present study examined the network structure of internalizing and externalizing psychopathology from middle childhood through adolescence using data from the Avon Longitudinal Study of Parents and Children (ALSPAC; n = 4405). Eight DSM-IV disorders were assessed using maternal reports when children were aged 7.5, 10.5 and 14 years. Weighted, undirected networks were estimated and the relative importance of each node was assessed using three common measures of node centrality; strength, betweenness, and closeness. A consistent network structure emerged at all three time points; nodes clustered together in two regions of space broadly reflecting the internalizing and externalizing spectra. Permutation tests supported structural invariance across this developmental period. These spectra were bridged by numerous disorder-level interactions, the most consistent of which was between depression and oppositional defiant disorder (ODD). Furthermore, inspection of the centrality indices indicated that generalised anxiety disorder and ODD were the most central disorders in the networks. These findings demonstrate that symptom/disorder-level interplay and reciprocal influence are plausible mechanisms for the association between internalizing and externalizing psychopathology in childhood/adolescence.

The complexity of trauma exposure and response: Profiling PTSD and CPTSD among a refugee sample

OBJECTIVE

This study investigated the latent dimensional and categorical structure of ICD-11 complex posttraumatic stress disorder (CPTSD) within a refugee sample.

METHOD

A subsample that identified as refugee (n = 308) was selected from the National Epidemiological Survey on Alcohol and Related Conditions. Factor mixture modeling (FMM) was employed to establish the dimensional structure of CPTSD symptomology and the categorical distribution of these dimensions. It was then evaluated whether trauma history could differentiate between the distribution of trauma response profiles.

RESULTS

A correlated 6-factor model with 5 latent classes was the best fitting model. Two classes were characterized by symptom profiles that were consistent with ICD-11 CPTSD and PTSD formulations. The remaining classes were characterized by nonspecific variation across dimensions. CPTSD class membership was predicted by traumas that were predominantly interpersonal in nature (serious neglect, physical assault, and sexual assault), whereas PTSD class membership was predicted by situational traumatic experiences (unarmed civilian in a conflict environment and a serious accident). A distinct dose-response effect was evident between cumulative traumatic exposure and CPTSD class membership.

CONCLUSION

FMM class profiles distinguished between PTSD and CPTSD symptom formulations. Moreover, class membership was determined by specific trauma-exposure histories. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Distress and worry as mediators in the relationship between psychosocial risks and upper body musculoskeletal complaints in highly automated manufacturing

As a result of changes in manufacturing including an upward trend in automation and the advent of the fourth industrial revolution, the requirement for supervisory monitoring and consequently, cognitive demand has increased in automated manufacturing. The incidence of musculoskeletal disorders has also increased in the manufacturing sector. A model was developed based on survey data to test if distress and worry mediate the relationship between psychosocial factors (job control, cognitive demand, social isolation and skill discretion), stress states and symptoms of upper body musculoskeletal disorders in highly automated manufacturing companies (n = 235). These constructs facilitated the development of a statistically significant model (RMSEA 0.057, TLI 0.924, CFI 0.935). Cognitive demand was shown to be related to higher distress in employees, and distress to a higher incidence of self-reported shoulder and lower back symptoms. The mediation model incorporating stress states (distress, worry) as mediators is a novel approach in linking psychosocial risks to musculoskeletal disorders. Practitioners' Summary With little requirement for physical work in many modern automated manufacturing workplaces, there is often minimal management focus on Work-Related Musculoskeletal Disorders (WRMSDs) as important occupational health problems. Our model provides evidence that psychosocial factors are important risk factors in symptoms of WRMSD and should be managed.

From child maltreatment to ICD-11 complex post-traumatic stress symptoms: The role of emotion regulation and re-victimisation

OBJECTIVE

Complex post-traumatic stress disorder (CPTSD) will be introduced in ICD-11 and comprises symptoms of PTSD and disturbances in self-organisation (DSO). The association of trauma with PTSD and DSO is not yet fully understood. We investigated the path from child maltreatment to PTSD and DSO and examined the mediating role of emotion regulation (ER) and adult interpersonal re-victimisation.

METHOD

Adult patients (N = 193) from a Scottish National Health Service clinic participated in the project. Participants completed measures of life events, ICD-11 PTSD and CPTSD, and ER. Path analysis was used to assess possible direct and indirect effects from childhood trauma on current post-traumatic psychopathology.

RESULTS

Overall results indicate that the path from child maltreatment to PTSD is a direct one, while the path to DSO is indirectly mediated by ER.

CONCLUSIONS

Future research should address the potentially beneficial effect of treatment protocols for CPTSD explicitly aiming at reducing ER difficulties.

Prevalence and predictors of antidepressant prescribing in Northern Ireland

BackgroundAntidepressant prescription rates in the United Kingdom (UK) are among the highest in Western Europe and prescription rates in Northern Ireland (NI) are significantly higher than the rest of the UK. Moreover, while prescription rates are climbing annually, rates of depression are not changing, and evidence suggests that a range of socio-economic and geographical factors may be responsible. ObjectivesThe primary aim was to calculate the rates of antidepressant prescribing for the Northern Ireland population for years 2011 to 2015 and identify significant socio-demographic predictors. Methods (including data)This Administrative Research Centre (Northern Ireland) study linked data from the 2011 census and prescribing records (Enhanced Prescribing Database). The British National Formulary codes was used to identify the four main antidepressant drug types. FindingsResults indicated high levels of antidepressant prescribing for years 2011 to 2015 and significant associations were found with demographic, health, and economic variables. ConclusionsNorthern Ireland has high levels of antidepressant prescribing compared to other parts of the UK and other European countries. This suggests that there is a need to extend the provision of social prescribing, where people can avail of local, non-clinical options to alleviate mental health problems.

Learning Disability and Northern Ireland: Achieving Proportionate Universalism through Administrative Data Research

BackgroundThe Department of Health, Social Services & Public Safety’s policy document ‘Fit and Well – Changing Lives (2012-2022)’ indicates that people with a learning disability (LD) represent one of the most vulnerable and disadvantaged groups in Northern Ireland (NI). Individuals with a LD are more likely to experience major illnesses, to develop them earlier, and die of them sooner, than the general population. Furthermore, the LD population is less likely to get some of the evidence-based annual health checks and treatments they need, and continue to face real barriers in accessing services. At present there is no central register detailing the actual number of individuals with LD in NI. Study aimsThe study is based on research funded by the ESRC SDAI (ES/P002293/1). It involves the analysis of Northern Ireland Mortality Study (NIMS) data to: Establish the socio-demographic characteristics of the LD population; Profile morbidity and comorbidity of health care problems among individuals with LD; and Explore the causes of death among the NI LD community. Results and ConclusionsPreliminary study findings will be available by June 2018. Findings will be of particular interest to a range of government departments, trusts and learning disability support groups.

Childhood Adversity and Traumatic Disorders: A self-report and Danish linkage study

BackgroundAccurate assessment of childhood adversity is fundamental in understanding risk and resilient factors that can inform appropriate intervention and prevention strategies. Different statistical and methodological approaches (e.g., prospective, selfreported data) have been used to assess pathways and outcomes associated with childhood adversity, however, each is limited in a number of ways. ObjectivesLinking administrative data to population-based studies provides a powerful tool to overcome some of the challenges in trauma research and permits the estimation of temporally ordered models of risk. The current study seeks to assess the effect of childhood adversity on a diagnosis of traumatic disorder (TD). MethodsData were collected from a Danish national study in 2008/2009. A sample of 4,718 young adults were randomly selected from the birth cohort of children born in 1984. Structured interviews were conducted on 2,980 participants. This data was then linked with parental data (including 4 years prior to birth of child) and a ICD 10 diagnosis of a TD using information from the Danish registries. FindingsHierarchical regression analysis was used to examine parental risk factors, self-reported child maltreatment, experiencing violence in young adulthood and risk of a TD diagnosis at age 28. Findings indicated the dominant factor associated with TD was self-reported PTSD symptoms at age 24 (OR =3.82); followed by a parental mental health diagnosis (OR = 2.80). Being of female gender (OR = 2.42) and experiencing violence in young adulthood (OR = 1.94) also increased risk of a TD diagnosis. ConclusionThis study highlights the benefits of incorporating administrative data with self-report data to provide a more nuanced understanding of childhood adversity across different developmental stages. These findings have important conceptual and methodological implications and may be useful in informing future trauma studies.

Distress, Impairment and the Extended Psychosis Phenotype: A Network Analysis of Psychotic Experiences in an US General Population Sample

It has been proposed that subclinical psychotic experiences (PEs) may causally impact on each other over time and engage with one another in patterns of mutual reinforcement and feedback. This subclinical network of experiences in turn may facilitate the onset of psychotic disorder. PEs, however, are not inherently distressing, nor do they inevitably lead to impairment. The question arises therefore, whether nondistressing PEs, distressing PEs, or both, meaningfully inform an extended psychosis phenotype. The current study first aimed to exploit valuable ordinal data that captured the absence, occurrence and associated impairment of PEs in the general population to construct a general population based severity network of PEs. The study then aimed to partition the available ordinal data into 2 sets of binary data to test whether an occurrence network comprised of PE data denoting absence (coded 0) and occurrence/impairment (coded 1) was comparable to an impairment network comprised of binary PE data denoting absence/occurrence (coded 0) and impairment (coded 1). Networks were constructed using state-of-the-art regularized pairwise Markov Random Fields (PMRF). The severity network revealed strong interconnectivity between PEs and nodes denoting paranoia were among the most central in the network. The binary PMRF impairment network structure was similar to the occurrence network, however, the impairment network was characterized by significantly stronger PE interconnectivity. The findings may help researchers and clinicians to consider and determine how, when, and why an individual might transition from experiences that are nondistressing to experiences that are more commonly characteristic of psychosis symptomology in clinical settings.

Sex differences in PTSD symptoms: A differential item functioning approach

OBJECTIVE

Evidence has suggested there are sex differences in posttraumatic stress disorder (PTSD) symptom expression; however, few studies have assessed whether these differences are due to measurement invariance. This study aimed to examine sex differences in PTSD symptoms based on the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) using differential item functioning (DIF).

METHOD

Confirmatory factor analysis was conducted on the DSM-5 model of PTSD, followed by a multiple indicators multiple causes (MIMIC) model to examine possible DIF using the PTSD Checklist for DSM-5. Data were analyzed from a Malaysian adolescent sample (n = 481) of which 61.7% were female, with a mean age of 17.03 years.

RESULTS

The results indicated the presence of DIF for 2 of 20 PTSD criteria. Females scored significantly higher on emotional cue reactivity (B4), and males reported significantly higher rates of reckless or self-destructive behavior (E2) while statistically controlling for the latent variables in the model. However, the magnitude of these item-level differences was small.

CONCLUSION

These findings indicate that despite the presence of DIF for 2 DSM-5 symptoms, this does not provide firm support for nonequivalence across sex. (PsycINFO Database Record (c) 2019 APA, all rights reserved).