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Mekawi Y, Silverstein MW, Walker A, Ishiekwene M, Carter S, Michopoulos V, Stevens JS, Powers A. Examining the psychometric properties of the PCL-5 in a black community sample using item response theory. J Anxiety Disord 2022; 87:102555. [PMID: 35338915 PMCID: PMC9275184 DOI: 10.1016/j.janxdis.2022.102555] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 02/03/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
Black Americans are more likely to be exposed to certain types of traumatic events and experience posttraumatic stress disorder (PTSD) compared to other racial groups. Consequently, sound assessment of PTSD in this underserved and understudied population is necessary to develop and accurately answer research questions about etiology and intervention efficacy. However, the item-level psychometric properties of one of the most commonly used assessment tools, the PTSD Checklist for DSM-5 (PCL-5), has yet to be examined among Black Americans. To address this gap, we used item response theory (IRT) to assess item difficulty and discrimination in a sample of Black American adults (n = 307). We employed a graded response model with all 20 items of the PCL-5 loading on to a latent PTSD factor. At clinically significant levels of PTSD, the most discriminating items were flashbacks, inability to experience positive emotions, and nightmares and the least discriminating items were cued emotional distress, diminished interest, and hypervigilance. These results emphasize the importance of flashbacks, inability to experience positive emotions, and nightmares and deemphasize the importance of hypervigilance and sleep difficulties when assessing for clinically significant symptoms of PTSD in Black Americans. Treatment implications include a nuanced approach towards hypervigilance.
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Affiliation(s)
- Yara Mekawi
- University of Louisville, Department of Psychological and Brain Sciences, USA.
| | | | - Aisha Walker
- Georgia State University, Department of Psychology, USA
| | | | - Sierra Carter
- Georgia State University, Department of Psychology, USA
| | | | - Jennifer S Stevens
- Emory School of Medicine, Department of Psychiatry and Behavioral Sciences, USA
| | - Abigail Powers
- Emory School of Medicine, Department of Psychiatry and Behavioral Sciences, USA
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Nelson JD, Cuellar AE, Cheskin LJ, Fischer S. Eating Disorders and Posttraumatic Stress Disorder: A Network Analysis of the Comorbidity. Behav Ther 2022; 53:310-322. [PMID: 35227406 DOI: 10.1016/j.beth.2021.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/10/2021] [Accepted: 09/18/2021] [Indexed: 11/02/2022]
Abstract
Eating disorders (EDs) and posttraumatic stress disorder (PTSD) commonly co-occur, but the mechanisms driving this co-occurrence are not well understood. The current study explored the relationships between symptoms of ED and PTSD in a sample of male and female undergraduate students in order to identify pathways that may maintain the comorbidity. Network analysis was conducted in a sample of 344 first-year undergraduates to visualize partial correlations between each symptom in the comorbidity. Core symptoms, bridge symptoms, and direct pathways between ED and PTSD symptoms were identified. The PTSD symptoms negative emotions (strength = 1.13) and negative beliefs (strength = 1.11) were the strongest symptoms in the network. The strongest bridge nodes were the ED symptoms restriction (bridge strength = 3.32) and binge eating (bridge strength = 2.63). The strongest edges between ED and PTSD nodes were between binge eating and concentration (part r = .16), restriction and sleep (part r = .14), and binge eating and positive emotions (part r = .11). Findings suggest that PTSD symptoms related to negative alterations in cognitions and mood may be highly influential in the ED-PTSD network due to their relatedness to all other symptoms. The pathway between binge eating and inability to experience positive emotions suggest that the comorbidity may be partially maintained through an affect regulation function of binge eating.
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Rossi R, Socci V, Pacitti F, Carmassi C, Rossi A, Di Lorenzo G, Hyland P. The Italian Version of the International Trauma Questionnaire: Symptom and Network Structure of Post-Traumatic Stress Disorder and Complex Post-Traumatic Stress Disorder in a Sample of Late Adolescents Exposed to a Natural Disaster. Front Psychiatry 2022; 13:859877. [PMID: 35693953 PMCID: PMC9174511 DOI: 10.3389/fpsyt.2022.859877] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/06/2022] [Indexed: 11/27/2022] Open
Abstract
The 11th revision of the International Classification of Diseases has endorsed substantial changes in Post-Traumatic Stress Disorder (PTSD) and has introduced Complex PTSD (cPTSD). The objective of this study was to assess the symptom and network structure of PTSD and cPTSD using the International Trauma Questionnaire- Italian version (ITQ) and the prevalence of PTSD and cPTSD in a community sample of late adolescents enriched with exposure to a destructive earthquake. A 1,010 high school students participated to the study. Confirmatory Factor Analysis supports that a six first-order correlated factors was the best fitting model of ICD-11 PTSD/cPTSD. The network analysis supports a clear separation between core PTSD symptoms and disturbances in self-organization (DSO) symptoms, avoidance, and negative self-concept were the most central items. The prevalence of PTSD and cPTSD was 9.11 and 4.06%, respectively. Female participants reported higher rates of both PTSD and cPTSD. This is the first study to report on ICD-11 PTSD and cPTSD rates on an Italian adolescence community sample. Consistent with other community samples, we found higher rates of PTSD compared to cPTSD. The results confirmed the factorial validity of the ITQ. The network structure highlights the importance of negative self-concept in cPTSD and avoidance in PTSD.
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Affiliation(s)
- Rodolfo Rossi
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Valentina Socci
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesca Pacitti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Rossi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy.,IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Philip Hyland
- Department of Psychology, Maynooth University, Maynooth, Ireland
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Krüger-Gottschalk A, Ehring T, Knaevelsrud C, Dyer A, Schäfer I, Schellong J, Rau H, Köhler K. Confirmatory factor analysis of the Clinician-Administered PTSD Scale (CAPS-5) based on DSM-5 vs. ICD-11 criteria. Eur J Psychotraumatol 2022; 13:2010995. [PMID: 35070160 PMCID: PMC8774060 DOI: 10.1080/20008198.2021.2010995] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Many studies have investigated the latent structure of the DSM-5 criteria for posttraumatic stress disorder (PTSD). However, most research on this topic was based on self-report data. We aimed to investigate the latent structure of PTSD based on a clinical interview, the Clinician-Administered PTSD Scale (CAPS-5). METHOD A clinical sample of 345 participants took part in this multi-centre study. Participants were assessed with the CAPS-5 and the Posttraumatic Stress Disorder Checklist (PCL-5). We evaluated eight competing models of DSM-5 PTSD symptoms and three competing models of ICD-11 PTSD symptoms. RESULTS The internal consistency of the CAPS-5 was replicated. In CFAs, the Anhedonia model emerged as the best fitting model within all tested DSM-5 models. However, when compared with the Anhedonia model, the non-nested ICD-11 model as a less complex three-factor solution showed better model fit indices. DISCUSSION We discuss the findings in the context of earlier empirical findings as well as theoretical models of PTSD.
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Affiliation(s)
| | - Thomas Ehring
- Department of Psychology, LMU Munich, Munich, Germany
| | - Christine Knaevelsrud
- Department of Clinical Psychology and Psychotherapy, Free University Berlin, Berlin, Germany
| | - Anne Dyer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Ingo Schäfer
- Centre for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Schellong
- Department of Psychotherapy and Psychosomatic Medicine, Technical University Dresden, Dresden, Germany
| | - Heinrich Rau
- German Armed Forces Center for Military Mental Health, German Armed Forces Hospital Berlin, Berlin, Germany
| | - Kai Köhler
- German Armed Forces Center for Military Mental Health, German Armed Forces Hospital Berlin, Berlin, Germany
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Hermosilla S, Forthal S, Van Husen M, Metzler J, Ghimire D, Ager A. The Child PTSD Symptom Scale: Psychometric Properties among Earthquake Survivors. Child Psychiatry Hum Dev 2021; 52:1184-1193. [PMID: 33247347 PMCID: PMC8155094 DOI: 10.1007/s10578-020-01097-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
Evidence for a single underlying factor structure of posttraumatic stress disorder (PTSD) in children remains elusive. We assessed the underlying factor structure of the Child PTSD Symptom Scale through exploratory (EFA) and confirmatory factor analyses (CFA) in 570 survivors of the 2015 Gorkha earthquake in Nepal. The EFA suggests that the three-factor DSM-IV model fit these data best. The CFA suggests that while the DSM-IV model adequately fit these data, the four-factor King model fit them better. There was no evidence of differential item functioning by age or gender, and internal consistency of the scale was high. PTSD (overall or by factor) was not correlated with functional impairment. Inconsistent psychometric results across contexts and methodologies suggest that our current theoretical conceptualizations and empirical models of posttraumatic stress are lacking. Future studies must both document the instrument properties to assure internal validity and cross-study comparisons and, bolstered by increased psychometric data and analyses, rework theoretical models of PTSD with improved cross-cultural validity.
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Affiliation(s)
- Sabrina Hermosilla
- Institute for Social Research, University of Michigan, 426 Thompson Street, 1006E, Ann Arbor, MI, 48104, USA.
| | - Sarah Forthal
- Columbia-WHO Center for Global Mental Health, Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
| | - Madeline Van Husen
- Columbia-WHO Center for Global Mental Health, Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
| | - Janna Metzler
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, USA
| | - Dirgha Ghimire
- Institute for Social Research, University of Michigan, 426 Thompson Street, 1006E, Ann Arbor, MI, 48104, USA
| | - Alastair Ager
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, USA
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland, UK
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Tsur N, Bachem R, Zhou X, Levin Y, Abu-Raiya H, Maercker A. Cross-cultural investigation of COVID-19 related acute stress: A network analysis. J Psychiatr Res 2021; 143:309-316. [PMID: 34530342 PMCID: PMC8437796 DOI: 10.1016/j.jpsychires.2021.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/08/2021] [Accepted: 09/01/2021] [Indexed: 12/16/2022]
Abstract
The outbreak of the COVID-19 pandemic has confronted humanity with an ongoing biopsychosocial stressor, imposing multifaceted challenges to individuals and societies. Particularly, the pandemic reflects an ongoing, potentially life-threatening danger to self and others, which may instigate acute stress symptoms (ASS). This study utilized a network framework to assess cross-national ASS a short time following the initial COVID-19 outbreak. Three samples of adult participants from China, Israel, and Switzerland completed a self-report assessment of acute stress symptoms. Network analyses were utilized to uncover the phenotype and dynamics of different ASS in these three countries. The ASS network analyses revealed extensive connections in all networks and reflected the structure of ASS. The centrality indexes in all networks were from the hyperarousal cluster. "Feeling jumpy" was the node with the highest strength centrality in the Israeli sample and "physiological reactivity" was the item with the highest centrality in the Swiss sample. In the Chinese sample, the item with the highest centrality was "feeling alert to danger." The findings reveal that despite some variations, the overall clinical picture of ASS in response to the COVID-19 pandemic is universal. These findings highlight the centrality of hyperarousal symptoms, presumably reflecting its significance for clinical interventions.
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Affiliation(s)
- Noga Tsur
- Bob Shapell School of Social Work, Tel-Aviv University, P.O.B. 39040, Ramat Aviv, Tel-Aviv, 69978, Israel.
| | - Rahel Bachem
- Department of Psychology, University of Zurich, Binzmuehlestrasse 14/17, CH-8050 Zurich, Switzerland
| | - Xiao Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, China
| | - Yafit Levin
- Department of Education, Ariel University, Ariel, Israel.
| | - Hisham Abu-Raiya
- Bob Shapell School of Social Work, Tel-Aviv University, P.O.B. 39040, Ramat Aviv, Tel-Aviv, 69978, Israel
| | - Andreas Maercker
- Department of Psychology, University of Zurich, Binzmuehlestrasse 14/17, CH-8050 Zurich, Switzerland
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Weems CF. Commentary on the Special Issue on Network Analysis: Assessment, Intervention, Theory, and the Nature of Reality: Actualizing the Potential of Network Perspectives on Posttraumatic Stress Disorder. J Trauma Stress 2020; 33:116-125. [PMID: 32061111 DOI: 10.1002/jts.22482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 12/12/2022]
Abstract
This commentary on the Journal of Traumatic Stress special issue on network analysis explores the network perspective on posttraumatic stress disorder (PTSD), emphasizing the advances in research made in this collection of articles. The commentary is organized around the following themes related to actualizing the perspective's methodological, assessment, and intervention potential and the potential shift in the theoretical underpinnings of mental disorders that networks models imply. First, extant data using network analysis suggest that reactions to traumatic stress are more complicated than once thought but that this complexity does not mean efficient, relatively simple heuristics to aid assessment and intervention do not exist. Attention to methodological issues in symptom assessment may help move this aspect of the research forward. Second, the extant research is largely correlational and has not yet established causal linkages, although temporal associations underlying network models are being identified. Prospective and intervention studies employing network analysis are critical. Third, the network perspective of PTSD symptoms may advance research on the mechanisms of risk and resilience (e.g., neurodevelopmental, cognitive behavioral, emotional, and social models) by helping link symptoms to theoretical causal processes. A developmental framework that views the effect of traumatic stress in terms of temporal cascades of reactions with both negative and potentially positive cognitive, behavioral, social, and emotional outcomes fits the network analysis model. Fourth, network models call into question some of the fundamental assumptions underlying the conceptualization of mental disorders, leaving several ontological questions and implications currently unanswered; research examining the implications of the new assumptions is needed.
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Affiliation(s)
- Carl F Weems
- Department of Human Development and Family Studies, Iowa State University, Ames, Iowa, USA
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Frewen P, O'Donnell M, D'Andrea W. Introduction to the Special Issue: Network Analysis of Traumatic Stress. J Trauma Stress 2020; 33:5-9. [PMID: 32208542 DOI: 10.1002/jts.22486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/09/2020] [Indexed: 12/18/2022]
Abstract
Network analysis has emerged as a promising new statistical methodology for traumatic stress studies. The present special issue of the Journal of Traumatic Stress amalgamates the reports of 10 studies that employed network analysis to further the field's understanding of traumatic stress. The current issue includes reports of network analyses that sought to better understand the impact of different kinds of traumatic events, including childhood and gender-based trauma exposure, on PTSD symptomatology as defined under the DSM-5 and ICD-11, and examined the relation between PTSD symptoms and trauma-related dissociative experiences as well as the impact of psychological treatment on trauma recovery. A variety of research designs from a diverse group of international samples were employed, including concurrent, longitudinal, experience-sampling, and treatment outcome studies. Finally, a commentary on the articles included in this special issue was provided by Dr. Carl Weems.
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Affiliation(s)
- Paul Frewen
- Departments of Psychiatry and Psychology, Western University, London, Ontario, Canada
| | - Meaghan O'Donnell
- Phoenix Australia, Department Psychiatry, University of Melbourne, Melbourne, Australia
| | - Wendy D'Andrea
- Department of Psychology, The New School, New York, New York, USA
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