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Miller ML, Laifer LM, Thomas EBK, Grekin R, O'Hara MW, Brock RL. From pregnancy to the postpartum: Unraveling the complexities of symptom profiles among trauma-exposed women. J Affect Disord 2024; 357:11-22. [PMID: 38663559 PMCID: PMC11149003 DOI: 10.1016/j.jad.2024.04.079] [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] [Received: 08/23/2023] [Revised: 03/18/2024] [Accepted: 04/21/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Many women experience new onset or worsening of existing posttraumatic stress disorder (PTSD) symptoms during pregnancy and the early postpartum period. However, perinatal PTSD symptom profiles and their predictors are not well understood. METHODS Participants (N = 614 community adults) completed self-report measures across three methodologically similar longitudinal studies. Mixture modeling was used to identify latent subgroups of trauma-exposed women with distinct patterns of symptoms at pregnancy, 1-month, and 3-month postpartum. RESULTS Mixture modeling demonstrated two classes of women with relatively homogenous profiles (i.e., low vs. high symptoms) during pregnancy (n = 237). At 1-month postpartum (n = 391), results suggested a five-class solution: low symptoms, PTSD only, depression with primary appetite loss, depression, and comorbid PTSD and depression. At 3-months postpartum (n = 488), three classes were identified: low symptoms, elevated symptoms, and primary PTSD. Greater degree of exposure to interpersonal trauma and reproductive trauma, younger age, and minoritized racial/ethnic identity were associated with increased risk for elevated symptoms across the perinatal period. LIMITATIONS Only a subset of potential predictors of PTSD symptoms were examined. Replication with a larger and more racially and ethnically diverse sample of pregnant women is needed. CONCLUSIONS Results highlight limitations of current perinatal mental health screening practices, which could overlook women with elevations in symptoms (e.g., intrusions) that are not routinely assessed relative to others (e.g., depressed mood), and identify important risk factors for perinatal PTSD symptoms to inform screening and referral.
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Affiliation(s)
- Michelle L Miller
- Indiana University School of Medicine, Department of Psychiatry, Goodman Hall/IU Health Neuroscience Center, Suite 2800, 355 W. 16th St., Indianapolis, IN 46202, United States of America; University of Iowa, Department of Psychological & Brain Sciences, G60 Psychological and Brain Sciences Building, Iowa City, IA 52242, United States of America.
| | - Lauren M Laifer
- University of Nebraska-Lincoln, Department of Psychology, 238 Burnett Hall, Lincoln, NE 68588, United States of America
| | - Emily B K Thomas
- University of Iowa, Department of Psychological & Brain Sciences, G60 Psychological and Brain Sciences Building, Iowa City, IA 52242, United States of America
| | - Rebecca Grekin
- University of Iowa, Department of Psychological & Brain Sciences, G60 Psychological and Brain Sciences Building, Iowa City, IA 52242, United States of America
| | - Michael W O'Hara
- University of Iowa, Department of Psychological & Brain Sciences, G60 Psychological and Brain Sciences Building, Iowa City, IA 52242, United States of America
| | - Rebecca L Brock
- University of Nebraska-Lincoln, Department of Psychology, 238 Burnett Hall, Lincoln, NE 68588, United States of America
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2
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Levin-Aspenson HF, Greene AL. Rethinking trauma-related psychopathology in the Hierarchical Taxonomy of Psychopathology (HiTOP). J Trauma Stress 2024; 37:361-371. [PMID: 38270594 DOI: 10.1002/jts.23014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/17/2023] [Accepted: 12/12/2023] [Indexed: 01/26/2024]
Abstract
Research on trauma exposure and its consequences has made tremendous progress in elucidating the role of traumatic life events in the development and maintenance of psychopathology as well as in evaluating interventions aimed at addressing the personal and public burden of trauma-related psychopathology. However, there is growing concern that problems with predominant definitions of posttraumatic syndrome (e.g., content coverage and scope, within-category heterogeneity, excessive diagnostic comorbidity) limit further efforts to fully conceptualize trauma-related psychopathology and deliver appropriate, personalized interventions. As demonstrated by an impressive body of research over the past several years, the Hierarchical Taxonomy of Psychopathology (HiTOP) presents a compelling alternative to traditional nosologies in terms of empirically based characterizations of psychopathology phenotypes, with evidence of strong utility for research and clinical applications. However, HiTOP's primary focus on descriptive psychopathology has resulted in an unacceptable gap regarding the conceptualization of trauma-related psychopathology from a dimensional, transdiagnostic perspective. We see an important opportunity to clarify what HiTOP can offer the field of traumatic stress research and articulate a future for trauma-related psychopathology within HiTOP. We argue for disaggregating psychopathology symptoms from their purported causes and, instead, developing a detailed taxonomy of traumatic events alongside an ever-evolving HiTOP model. Doing so will help identify empirically based phenotypes of trauma-related psychopathology that (a) go beyond the traditional PTSD criterion sets and (b) allow for the possibility that different features of traumatic experiences (e.g., type, duration, subjective meaning) may be associated with different symptom sequelae across different psychopathology spectra.
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Affiliation(s)
| | - Ashley L Greene
- VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
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3
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Scheeringa MS. Is factor analysis useful for revising diagnostic criteria for PTSD? A systematic review of five issues ten years after DSM-5. J Psychiatr Res 2024; 176:98-107. [PMID: 38850584 DOI: 10.1016/j.jpsychires.2024.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Based on factor analysis research, DSM-5 revised the diagnostic criteria for posttraumatic stress disorder (PTSD) by increasing symptom clusters from three to four. AIMS To question whether that is an appropriate use of factor analysis. METHODS Reviewed the literature on five issues of factor analysis relevant to diagnostic criteria: (1) discovery of factors identical to symptom clusters, (2) consensus about the number of factors in best-fitting models, (3) configural variance between subpopulations to explain inconsistent model results, (4) methods to externally validate factors after discovery, and (5) treatment response of symptom clusters to externally validate factors. Two hundred four articles using DSM-IV or DSM-5 symptoms were included. RESULTS Two of four DSM-5 clusters were discovered with exploratory factor analysis. Support for a best-fitting model was inconsistent. Models with the highest number of factors were the best mathematical fit 87% of the time. Subpopulations did not reveal a pattern of configural variance to explain inconsistent findings. External validation of factors relied entirely on questionnaires. A review of 143 randomized controlled trials did not reveal differential treatment response of any symptom cluster. CONCLUSION Findings did not support the usefulness of factor analysis because the findings are too disparate to be helpful.
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Affiliation(s)
- Michael S Scheeringa
- Adjunct, Tulane University School of Medicine, Department of Psychiatry and Behavioral Sciences, New Orleans, LA, USA.
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4
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Carpenter JK, Pineles SL, Griffin MG, Pandey S, Werner K, Kecala NM, Resick PA, Galovski TE. Heart rate reactivity during trauma recall as a predictor of treatment outcome in cognitive processing therapy for PTSD. Behav Res Ther 2024; 176:104519. [PMID: 38503205 PMCID: PMC10999335 DOI: 10.1016/j.brat.2024.104519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 03/21/2024]
Abstract
Emotional engagement when recollecting a trauma memory is considered a key element of effective trauma-focused therapy. Research has shown that reduced physiological reactivity during trauma recall is associated with worse treatment outcomes for posttraumatic stress disorder (PTSD), but this has yet to be examined in a cognitively oriented treatment. This study examined whether pretreatment heart rate (HR) reactivity during trauma recall predicts PTSD symptom improvement and treatment dropout during Cognitive Processing Therapy (CPT) for PTSD. Participants were 142 women with PTSD secondary to interpersonal violence enrolled in one of two clinicals trials. HR reactivity reflected the mean increase in HR after listening to two 30-s scripts of the trauma memory prior to treatment. Linear mixed-effects models showed the effect of HR reactivity on change in total PTSD symptoms was not significant, but lower HR reactivity predicted less improvement in reexperiencing and avoidance and was associated with increased dropout. Findings suggest pretreatment physiological reactivity to the trauma memory may be a prognostic indicator of some elements of treatment response in CPT. Results tentatively support the importance of emotional activation during trauma recall in cognitive treatment of PTSD, though more research is needed to clarify how low HR reactivity impacts treatment.
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Affiliation(s)
- Joseph K Carpenter
- National Center for PTSD, Women's Health Sciences Division, Boston, MA, USA; Veterans Affairs (VA) Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Suzanne L Pineles
- National Center for PTSD, Women's Health Sciences Division, Boston, MA, USA; Veterans Affairs (VA) Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Michael G Griffin
- Department of Psychological Sciences, University of Missouri, St. Louis, USA
| | - Shivani Pandey
- National Center for PTSD, Women's Health Sciences Division, Boston, MA, USA; Veterans Affairs (VA) Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Kimberly Werner
- Department of Psychological Sciences, University of Missouri, St. Louis, USA
| | - Natalia M Kecala
- Department of Psychological Sciences, University of Missouri, St. Louis, USA
| | - Patricia A Resick
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Tara E Galovski
- National Center for PTSD, Women's Health Sciences Division, Boston, MA, USA; Veterans Affairs (VA) Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Pimentel FU, Oliveira SESD. Personality functioning, positive outlook for the future, and simple and complex post-traumatic stress disorder. Acta Psychol (Amst) 2024; 244:104165. [PMID: 38335812 DOI: 10.1016/j.actpsy.2024.104165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/15/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Posttraumatic Stress Disorder (PTSD) and its complex form (C-PTSD) are psychopathological conditions that are related to several personality traits. In particular, the current study aims to investigate the associations of impairment of personality functioning (IPF) and positive outlook for the future (POF) with PTSD and C-PTSD. A sample of 304 Brazilian adults responded to an online survey. IPF was measured according to the alternative model for personality disorders, POF was operationalized using optimism and hope scales, and PTSD and C-PTSD were measured using the ICD-11 model. Data analysis included correlation, structural equation models, multivariate analysis of variance, and multinomial logistic regression. The results showed that IPF and POF were moderately correlated with PTSD and C-PTSD in positive and negative directions, respectively. IPF and POF were more strongly associated with C-PTSD than PTSD. From the categorical approach to psychopathology, IPF and POF were shown to be associated only with C-PTSD. This is the first study that provides empirical data on the association of IPF and POF with both forms of PTSD. Understanding the associations between pathological and resilient personality domains and PTSD and C-PTSD symptoms can support the development of effective interventions.
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Kremyar AJ, Ben-Porath YS, Sellbom M, Gervais RO. Assessing posttraumatic stress disorder symptom clusters with the Minnesota Multiphasic Personality Inventory-3 in a forensic disability sample. J Clin Psychol 2023; 79:2798-2822. [PMID: 37597252 DOI: 10.1002/jclp.23581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/17/2023] [Accepted: 08/08/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE Previous evidence indicates that scales from the Minnesota Multiphasic Personality Inventory (MMPI) family of instruments can measure self-reported posttraumatic stress disorder (PTSD) symptomology and differentiate symptom clusters, including in forensic disability assessments. However, limited research has examined assessment of PTSD symptoms with the MMPI-3, the most recent MMPI instrument. The goal of the current study was to identify the strongest MMPI-3 scale predictors of individual PTSD symptom clusters, measured via self-report. METHODS Using a sample of 716 disability claimants (54.2% men; Mage = 42.98, SD = 10.87; 81.8% White), correlation, regression, and dominance analyses were performed to examine associations between scores on MMPI-3 scales and latent PTSD symptom cluster factors derived using confirmatory factor analyses from items of the Detailed Assessment of Posttraumatic Stress (DAPS), and to identify the strongest predictor of each symptom cluster when MMPI-3 scales were concurrently considered. RESULTS Results indicate that conceptually expected MMPI-3 scale scores were meaningfully associated with PTSD symptom cluster factors, with the MMPI-3 Anxiety-Related Experiences (ARX) scale demonstrating the strongest and most consistent associations across symptom clusters. CONCLUSIONS Results of the current study largely converge with previous empirical studies of self-reported PTSD symptoms in disability claimant settings with the MMPI instruments. Interpretive implications for the MMPI-3, limitations, and future research directions are discussed.
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Affiliation(s)
- Andrew J Kremyar
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
| | - Yossef S Ben-Porath
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
| | - Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Roger O Gervais
- Neurobehavioural Associates Inc., Edmonton, Alberta, Canada
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
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Birkenæs V, Refsum Bakken N, Frei E, Jaholkowski P, Smeland OB, Tesfaye M, Agartz I, Susser E, Bresnahan M, Røysamb E, Nordbø Jørgensen K, Nesvåg R, Havdahl A, Andreassen OA, Elken Sønderby I. Psychometric Properties and Diagnostic Associations of the Short-Form Community Assessment of Psychic Experiences in a Population-Based Sample of 29 021 Adult Men. Schizophr Bull 2023; 49:1229-1238. [PMID: 37262330 PMCID: PMC10483447 DOI: 10.1093/schbul/sbad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND HYPOTHESIS Around 5%-7% of the adult population are estimated to have lifetime psychotic experiences (PEs), which are associated with psychosis risk. PEs assessed with Community Assessment of Psychic Experiences (CAPE) are associated with psychosis but also non-psychotic disorders, which could be partly explained by CAPE indirectly capturing emotional symptoms. We investigated the psychometric properties of a shorter version, CAPE-9, and whether CAPE-9 scores are associated with lifetime psychotic or non-psychotic mental disorders after controlling for current anxiety and depressive symptoms. DESIGN CAPE-9 questionnaire data were obtained from 29 021 men (42.4 ± 5.6 yrs.) from the Norwegian Mother, Father, and Child Cohort Study. We investigated CAPE-9 reliability and factor structure. Logistic regression was used to test effects of current anxiety and depressive symptoms (SCL-12) on associations between CAPE-9 scores and psychiatric diagnoses. RESULTS CAPE-9 fit a previously reported 3-factor structure and showed good reliability. Twenty-six percent reported at least one lifetime PE. CAPE-9 scores were significantly associated with most psychiatric disorders (schizophrenia, depression, bipolar disorder, substance abuse, anxiety, trauma-related disorders, and ADHD). After controlling for concurrent emotional symptoms, only associations with schizophrenia (OR = 1.29; 95% CI = 1.18-1.38) and trauma-related disorders (OR = 1.09; CI = 1.02-1.15) remained significant. CONCLUSIONS CAPE-9 showed good psychometric properties in this large population-based adult male sample, and PEs were more clearly associated with psychotic disorders after controlling for current emotional symptoms. These results support the use of the short CAPE-9 as a cost-effective tool for informing public health initiatives and advancing our understanding of the dimensionality of psychosis.
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Affiliation(s)
- Viktoria Birkenæs
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nora Refsum Bakken
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Evgeniia Frei
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Piotr Jaholkowski
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Olav B Smeland
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Markos Tesfaye
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Agartz
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
- Department of Psychiatric Research, Diakohjemmet Hospital, Oslo, Norway
| | - Ezra Susser
- Mailman School of Public Health, Department of Epidemiology and Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Michaeline Bresnahan
- Mailman School of Public Health, Department of Epidemiology and Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Espen Røysamb
- Faculty of Social Sciences, Department of Psychology, Oslo University Hospital, Oslo, Norway
| | - Kjetil Nordbø Jørgensen
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ragnar Nesvåg
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Alexandra Havdahl
- Center for Genetic Epidemiology and Mental Health, Norwegian Institute of Public Health, Oslo, Norway
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Ole A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Ida Elken Sønderby
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
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Galatzer-Levy IR, Onnela JP. Machine Learning and the Digital Measurement of Psychological Health. Annu Rev Clin Psychol 2023; 19:133-154. [PMID: 37159287 DOI: 10.1146/annurev-clinpsy-080921-073212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Since its inception, the discipline of psychology has utilized empirical epistemology and mathematical methodologies to infer psychological functioning from direct observation. As new challenges and technological opportunities emerge, scientists are once again challenged to define measurement paradigms for psychological health and illness that solve novel problems and capitalize on new technological opportunities. In this review, we discuss the theoretical foundations of and scientific advances in remote sensor technology and machine learning models as they are applied to quantify psychological functioning, draw clinical inferences, and chart new directions in treatment.
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Affiliation(s)
- Isaac R Galatzer-Levy
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA;
- Current affiliation: Google LLC, Mountain View, California, USA
| | - Jukka-Pekka Onnela
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Zhou D, Liu S, Zhou H, Liu J, Ma Y. The association among teacher-student relationship, subjective well-being, and academic achievement: Evidence from Chinese fourth graders and eighth graders. Front Psychol 2023; 14:1097094. [PMID: 36777196 PMCID: PMC9909438 DOI: 10.3389/fpsyg.2023.1097094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023] Open
Abstract
This study compared the teacher-student relationship, subjective well-being, and academic achievement between fourth graders and eighth graders, and examined whether and how subjective well-being played a mediating role concerning teacher-student relationship and academic achievement across the two grades. The participants included 19,845 fourth graders and 11,691 eighth graders from a city in central China. The findings indicated that (1) compared with eighth graders, fourth graders reported significantly higher mean scores in the teacher-student relationship, subjective well-being, and academic achievements; (2) a positive teacher-student relationship can promote students' academic achievement both directly and indirectly through subjective well-being across the two groups; (3) The mediating effect of subjective well-being accounted for 42.8% of the total effects between teacher-student relationship and academic achievement for fourth graders, which was higher than that for eighth graders (22.7%). Limitations and future directions are elaborated.
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Affiliation(s)
- Da Zhou
- Faculty of Education, Northeast Normal University, Changchun, China
| | - Shuting Liu
- Faculty of Education, Northeast Normal University, Changchun, China
| | - Hao Zhou
- Collaborative Innovation Center of Assessment for Basic Education Quality, Beijing Normal University, Beijing, China
| | - Jian Liu
- Collaborative Innovation Center of Assessment for Basic Education Quality, Beijing Normal University, Beijing, China
| | - Yue Ma
- School of Education, Shanghai Jiao Tong University, Shanghai, China,*Correspondence: Yue Ma,
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Ettore E, Müller P, Hinze J, Benoit M, Giordana B, Postin D, Lecomte A, Lindsay H, Robert P, König A. Digital Phenotyping for Differential Diagnosis of Major Depressive Episode: Narrative Review. JMIR Ment Health 2023; 10:e37225. [PMID: 36689265 PMCID: PMC9903183 DOI: 10.2196/37225] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 09/02/2022] [Accepted: 09/30/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Major depressive episode (MDE) is a common clinical syndrome. It can be found in different pathologies such as major depressive disorder (MDD), bipolar disorder (BD), posttraumatic stress disorder (PTSD), or even occur in the context of psychological trauma. However, only 1 syndrome is described in international classifications (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5]/International Classification of Diseases 11th Revision [ICD-11]), which do not take into account the underlying pathology at the origin of the MDE. Clinical interviews are currently the best source of information to obtain the etiological diagnosis of MDE. Nevertheless, it does not allow an early diagnosis and there are no objective measures of extracted clinical information. To remedy this, the use of digital tools and their correlation with clinical symptomatology could be useful. OBJECTIVE We aimed to review the current application of digital tools for MDE diagnosis while highlighting shortcomings for further research. In addition, our work was focused on digital devices easy to use during clinical interview and mental health issues where depression is common. METHODS We conducted a narrative review of the use of digital tools during clinical interviews for MDE by searching papers published in PubMed/MEDLINE, Web of Science, and Google Scholar databases since February 2010. The search was conducted from June to September 2021. Potentially relevant papers were then compared against a checklist for relevance and reviewed independently for inclusion, with focus on 4 allocated topics of (1) automated voice analysis, behavior analysis by (2) video and physiological measures, (3) heart rate variability (HRV), and (4) electrodermal activity (EDA). For this purpose, we were interested in 4 frequently found clinical conditions in which MDE can occur: (1) MDD, (2) BD, (3) PTSD, and (4) psychological trauma. RESULTS A total of 74 relevant papers on the subject were qualitatively analyzed and the information was synthesized. Thus, a digital phenotype of MDE seems to emerge consisting of modifications in speech features (namely, temporal, prosodic, spectral, source, and formants) and in speech content, modifications in nonverbal behavior (head, hand, body and eyes movement, facial expressivity, and gaze), and a decrease in physiological measurements (HRV and EDA). We not only found similarities but also differences when MDE occurs in MDD, BD, PTSD, or psychological trauma. However, comparative studies were rare in BD or PTSD conditions, which does not allow us to identify clear and distinct digital phenotypes. CONCLUSIONS Our search identified markers from several modalities that hold promise for helping with a more objective diagnosis of MDE. To validate their potential, further longitudinal and prospective studies are needed.
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Affiliation(s)
- Eric Ettore
- Department of Psychiatry and Memory Clinic, University Hospital of Nice, Nice, France
| | - Philipp Müller
- Research Department Cognitive Assistants, Deutsches Forschungszentrum für Künstliche Intelligenz GmbH, Saarbrücken, Germany
| | - Jonas Hinze
- Department of Psychiatry and Psychotherapy, Saarland University Medical Center, Hombourg, Germany
| | - Michel Benoit
- Department of Psychiatry, Hopital Pasteur, University Hospital of Nice, Nice, France
| | - Bruno Giordana
- Department of Psychiatry, Hopital Pasteur, University Hospital of Nice, Nice, France
| | - Danilo Postin
- Department of Psychiatry, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Bad Zwischenahn, Germany
| | - Amandine Lecomte
- Research Department Sémagramme Team, Institut national de recherche en informatique et en automatique, Nancy, France
| | - Hali Lindsay
- Research Department Cognitive Assistants, Deutsches Forschungszentrum für Künstliche Intelligenz GmbH, Saarbrücken, Germany
| | - Philippe Robert
- Research Department, Cognition-Behaviour-Technology Lab, University Côte d'Azur, Nice, France
| | - Alexandra König
- Research Department Stars Team, Institut national de recherche en informatique et en automatique, Sophia Antipolis - Valbonne, France
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Rudenstine S, Schulder T, Bhatt KJ, McNeal K, Ettman CK, Galea S. The capacity to adapt: Documenting the relationship between stressors and probable depression, anxiety, and posttraumatic stress at two time points during the COVID-19 pandemic. J Affect Disord 2022; 318:54-61. [PMID: 36049606 PMCID: PMC9424125 DOI: 10.1016/j.jad.2022.08.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/03/2022] [Accepted: 08/26/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Psychological adaptability, or the reduction of psychiatric symptoms in the context of ongoing stressors, is well-documented. The present study assessed relationships between COVID-19 related stressors and depression, anxiety, and post-traumatic stress (PTS) during April and July 2020. METHODS Prevalence of, and changes in, symptom severity levels in April vs. July were measured with ANOVA F-tests. Logistic regressions were used to assess the odds of probable diagnosis. RESULTS Symptom distributions skewed lower in July, as compared to April for all three diagnostic categories. From April to July, prevalence of probable anxiety and depression decreased across all levels of stress, prevalence of PTS increased for high stress, and decreased for medium and low stress levels. In July, only high stress related to higher odds of probable diagnoses, as compared to April when both medium and high stress did. LIMITATIONS Due to use of cross-sectional self-report data, the present findings could not establish causality between variables, and provide probable, rather than clinical, diagnoses. CONCLUSION Findings emphasize adaptability phenomena during COVID-19 and highlight the nuanced impact of ongoing stress.
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Affiliation(s)
- Sasha Rudenstine
- Department of Psychology, City College of New York, 160 Convent Avenue, New York, NY 10031, United States.
| | - Talia Schulder
- Department of Psychology, City College of New York, 160 Convent Avenue, New York, NY 10031, United States
| | - Krish J Bhatt
- Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, United States
| | - Kat McNeal
- Department of Psychology, City College of New York, 160 Convent Avenue, New York, NY 10031, United States
| | - Catherine K Ettman
- School of Public Health, Boston University, 715 Albany St, Boston, MA 02118, United States
| | - Sandro Galea
- School of Public Health, Boston University, 715 Albany St, Boston, MA 02118, United States
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Relationships among Problematic Smartphone Use, Mathematics Achievement, Teacher–Student Relationships, and Subjective Well-Being: Results from a Large-Scale Survey in China. Behav Sci (Basel) 2022; 12:bs12110454. [DOI: 10.3390/bs12110454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/28/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
This study examined the mediating role of mathematics performance and the moderating role of teacher–student relationships on the effects of problematic smartphone use on students’ subjective well-being. Through probability proportionate to size sampling (PPS), a total of 20,321 fourth graders from a city in central China were invited to complete a paper-based mathematics achievement test and an online questionnaire survey, including demographic information, problematic smartphone use, subjective well-being, and teacher–student relationship scales. The results showed that: after controlling for SES and gender, (1) problematic smartphone use had a direct and negative effect on students’ subjective well-being; (2) mathematics performance partially mediated the effects of problematic smartphone use on students’ subjective well-being; (3) teacher–student relationships moderated the effects of problematic smartphone use on mathematics performance/students’ subjective well-being; (4) with the increase in problematic smartphone use, high teacher–student relationships produced a lower rate of the positive moderating effect than low teacher–student relationships. The implications of this study and suggestions for future research are discussed.
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13
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Du J, Diao H, Zhou X, Zhang C, Chen Y, Gao Y, Wang Y. Post-traumatic stress disorder: a psychiatric disorder requiring urgent attention. MEDICAL REVIEW (BERLIN, GERMANY) 2022; 2:219-243. [PMID: 37724188 PMCID: PMC10388753 DOI: 10.1515/mr-2022-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/21/2022] [Indexed: 09/20/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a severe and heterogenous psychiatric disorder that was first defined as a mental disorder in 1980. Currently, the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) and the International Classification of Diseases 11th Edition (ICD-11) offer the most widely accepted diagnostic guidelines for PTSD. In both diagnostic categories, experiencing a traumatic event (TE) is the necessary criterion for diagnosing PTSD. The TEs described in the DSM-5 include actual or threatened death, serious injury, sexual violence, and other extreme stressors, either directly or indirectly. More than 70% of adults worldwide are exposed to a TE at least once in their lifetime, and approximately 10% of individuals develop PTSD after experiencing a TE. The important features of PTSD are intrusion or re-experiencing fear memories, pervasive sense of threat, active avoidance, hyperarousal symptoms, and negative alterations of cognition and mood. Individuals with PTSD have high comorbidities with other psychiatric diseases, including major depressive disorder, generalized anxiety disorder, and substance use disorder. Multiple lines of evidence suggest that the pathophysiology of PTSD is complex, involving abnormal neural circuits, molecular mechanisms, and genetic mechanisms. A combination of both psychotherapy and pharmacotherapy is used to treat PTSD, but has limited efficacy in patients with refractory PTSD. Because of the high prevalence, heavy burden, and limited treatments, PTSD is a psychiatric disorder that requires urgent attention. In this review, we summarize and discuss the diagnosis, prevalence, TEs, pathophysiology, and treatments of PTSD and draw attention to its prevention.
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Affiliation(s)
- Jun Du
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Huapeng Diao
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Xiaojuan Zhou
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Chunkui Zhang
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Yifei Chen
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Yan Gao
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Yizheng Wang
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
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14
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Wang N, Chung MC, Liu F, Wang Y. Posttraumatic stress on Chinese adolescents’ posttraumatic growth: The role of trauma centrality and emotion regulation. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03131-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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15
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Confirmatory Factor Analysis of Comorbidity between Depression and Aggression in a Child-Adolescent Community Sample: Nosological, Prognosis and Etiological Implications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084424. [PMID: 35457292 PMCID: PMC9030933 DOI: 10.3390/ijerph19084424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/28/2022] [Accepted: 04/06/2022] [Indexed: 12/07/2022]
Abstract
Comorbidity between depression and aggression in the child-adolescent population remains a controversial phenomenon. To our knowledge, no longitudinal study using structural equation modeling (SEM) has confirmed whether the relationship between depression and aggression is due to the fact that they share internalizing and externalizing supraordinal factors at the level of the syndrome or is due to the fact that they share common characteristics in relation to an underlying factor at the level of symptoms. We examined longitudinal comorbid relationships in a community sample (N = 251) at three waves ages from 10 to 13 years. The SEM showed that longitudinally, the comorbidity between depression and aggression is due to the fact that they share characteristics of the same underlying factor at the symptom level. These results have implications for the classification, diagnosis, and treatment of comorbidity between depression and aggression in a child-adolescent population.
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16
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Qi J, Sun R, Zhou X. Network analysis of comorbid posttraumatic stress disorder and depression in adolescents across COVID-19 epidemic and Typhoon Lekima. J Affect Disord 2021; 295:594-603. [PMID: 34509075 DOI: 10.1016/j.jad.2021.08.080] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 07/30/2021] [Accepted: 08/25/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Network analytic studies indicate that posttraumatic stress disorder (PTSD) may be comorbid with depression at the symptom level, but it remains unclear whether these findings are replicable and generalizable across trauma types. OBJECTIVE This study aim was to examine and compare PTSD-depression comorbidity networks of two types of trauma related to Typhoon Lekima and COVID-19 epidemic. METHODS Participants were 1605 and 601 adolescents recruited following Typhoon Lekima and the COVID-19 outbreak, respectively. RESULTS COVID-19 and Lekima PTSD-depression networks had considerable similarities, including adequate stability and accuracy, connected symptoms of PTSD and depression, symptoms with high centralities, and bridge symptoms. PTSD-depression comorbid symptoms were more complicated in the COVID-19 network but may show more persistence in the Lekima network. Distinct bridge symptoms contributed to the heterogeneity of PTSD-depression comorbidity characteristics between the two networks. Specifically, restricted affect and felt down and unhappy were two important bridge symptoms with high centrality unique to the COVID-19 network. CONCLUSIONS PTSD-depression comorbidity network has considerable replicability across trauma types, but specific symptom-level associations and some bridge symptoms may vary across trauma types. These findings also highlight the importance of negative emotions to comorbid PTSD and depression in adolescents following the COVID-19 outbreak compared with Typhoon Lekima.
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Affiliation(s)
- Junjun Qi
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou 310028, China
| | - Rui Sun
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou 310028, China
| | - Xiao Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou 310028, China.
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17
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Tang D, Fan W, Zou Y, George RA, Arbona C, Olvera NE. Self-efficacy and achievement emotions as mediators between learning climate and learning persistence in college calculus: A sequential mediation analysis. LEARNING AND INDIVIDUAL DIFFERENCES 2021. [DOI: 10.1016/j.lindif.2021.102094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Maples-Keller JL, Hyatt CS, Sleep CE, Stevens JS, Fenlon EE, Jovanovic T, Rothbaum BO, Ressler KJ, Carter S, Bradley B, Fani N, Powers A, Michopoulos V. DSM-5 alternative model for personality disorders trait domains and PTSD symptoms in a sample of highly traumatized African American women and a prospective sample of trauma center patients. Personal Disord 2021; 12:491-502. [PMID: 33444034 PMCID: PMC8277882 DOI: 10.1037/per0000477] [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] [Indexed: 11/08/2022]
Abstract
Posttraumatic stress disorder (PTSD) has a specified precipitant (i.e., trauma), and thus, is particularly well-suited to examine risk and maintenance factors for the development of the disorder. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) alternative model of personality disorder (AMPD) is based, in part, on a dimensional trait model; previous research suggests that personality traits are related to PTSD symptoms. To date, there is little research examining this model with regard to PTSD symptoms, and such research could elucidate new strategies for identification and prevention. The present study investigates associations between AMPD traits and PTSD symptoms in a cross-sectional high-risk sample (N = 490; 100% female; 97.8% African American) and in a prospective, longitudinal sample of Level 1 trauma center patients (N = 185; 46.8% female; 72.5% African American). The Personality Inventory for DSM-5 Brief Form domains were significantly associated with PTSD total symptom severity and symptom clusters across both self-report and clinical interview measures. Personality Inventory for DSM-5 Negative Affectivity and Psychoticism emerged as significant predictors of concurrent PTSD. When prospectively predicting PTSD symptoms in the longitudinal cohort, Negative Affectivity and Psychoticism were significant predictors of PTSD symptom severity. These findings indicate how the DSM-5 AMPD pathological traits are associated with risk for stress-related disorders cross-sectionally and prospectively. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Emily E. Fenlon
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Barbara O. Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Kerry J. Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
- Department of Psychiatry, Mclean Hospital, Harvard Medical School
| | - Sierra Carter
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
- Department of Psychology, Georgia State University
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
- Yerkes National Primate Research Center, Atlanta, Georgia, United States
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19
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Meng J, Tang C, Xiao X, Välimäki M, Wang H. Co-occurrence Pattern of Posttraumatic Stress Disorder and Depression in People Living With HIV: A Latent Profile Analysis. Front Psychol 2021; 12:666766. [PMID: 34025528 PMCID: PMC8131520 DOI: 10.3389/fpsyg.2021.666766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The comorbidity of posttraumatic stress disorder (PTSD) and depression is common among people living with the HIV (PLWH). Given the high prevalence and serious clinical consequences of the comorbidity of these two disorders, we conducted a latent profile analysis to examine the co-occurrence pattern of PTSD and depression in PLWH. Methods: The data for this cross-sectional study of PLWH were collected from 602 patients with HIV in China. A secondary analysis using latent profile analysis was conducted to examine HIV-related PTSD and depression symptoms. Results: A four-class solution fits the data best, with the four classes characterized as asymptomatic (42.9%), mild symptoms (33.9%), low to moderate symptoms (19.8%), and high to moderate symptoms (3.4%). The severity of PTSD and depression symptoms was comparable in this solution, and no group was dominated by PTSD or depression. Conclusion: The absence of a distinct subcluster of PLWH with only PTSD or depression symptoms supports that PTSD and depression in PLWH are psychopathological manifestations after traumatic exposures. Health care staff should pay more attention to the existence of comorbid symptoms of individuals, develop integrated interventions for the symptoms cluster, and evaluate their effectiveness in clinical practice.
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Affiliation(s)
- Jingjing Meng
- Xiangya Nursing School of Central South University, Changsha, China
| | - Chulei Tang
- Xiangya Nursing School of Central South University, Changsha, China
| | - Xueling Xiao
- Xiangya Nursing School of Central South University, Changsha, China
| | - Maritta Välimäki
- Xiangya Nursing School of Central South University, Changsha, China.,Department of Nursing Science, University of Turku, Turku, Finland
| | - Honghong Wang
- Xiangya Nursing School of Central South University, Changsha, China
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20
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Levin-Aspenson HF, Watson D, Ellickson-Larew S, Stanton K, Stasik-O'Brien SM. Beyond Distress and Fear: Differential Psychopathology Correlates of PTSD Symptom Clusters. J Affect Disord 2021; 284:9-17. [PMID: 33581490 DOI: 10.1016/j.jad.2021.01.090] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/12/2021] [Accepted: 01/31/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Research suggests that re-experiencing and avoidance are "core" PTSD symptoms, but there has been little research explicating their unique connections to psychopathology other than internalizing conditions such as depression and anxiety. We aim to unpack symptom heterogeneity within PTSD by exploring associations between re-experiencing and avoidance clusters and major psychopathology domains in a dimensional metastructural framework (e.g., the Hierarchical Taxonomy of Psychopathology, or HiTOP). METHOD We used a trauma-exposed community sample (n = 233, 66.1% female, mean age = 45 years) to compare re-experiencing and avoidance's associations with factor-analytically derived dimensions generally corresponding to HiTOP structure: Distress, Fear, Detachment, Antagonism, Disinhibition, Thought Disorder, and Compulsivity. RESULTS Both re-experiencing and avoidance were robustly related to Fear. Re-experiencing was particularly related to Distress and Thought Disorder, whereas avoidance was related to domains involving overinhibition (e.g., Compulsivity). Relative to avoidance, re-experiencing had broader and more substantial associations with psychopathology, partly as a function of its greater saturation with dysphoria. LIMITATIONS Coverage of PTSD symptoms was limited to questionnaire measurement of re-experiencing and avoidance clusters. Results need to be replicated in samples selected for posttraumatic psychopathology. CONCLUSION Although they are strongly intercorrelated and both are robustly related to Fear, re-experiencing and avoidance differ substantially in their unique relations with other forms of psychopathology, and re-experiencing may be less specific to PTSD than previously thought. These differences can be used to understand the etiology and phenomenology of re-experiencing and avoidance in greater depth to inform more targeted and effective interventions for posttraumatic psychopathology.
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21
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Mordeno IG, Gallemit IMJS, Ferolino MAL, Sinday JV. DSM-5-Based ASD Models: Assessing the Latent Structural Relations with Functionality in War-Exposed Individuals. Psychiatr Q 2021; 92:347-362. [PMID: 32748123 DOI: 10.1007/s11126-020-09804-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There is a dearth of studies investigating the latent structure of Acute Stress Disorder (ASD) following the changes in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5). To date, there is no consensus on the best representation of ASD. This study addressed this gap by examining four latent ASD models in a sample of war-exposed individuals (N = 424). Investigation on the relationship of the best-fitting model to functionality in the latent level was also conducted. The five-factor model, composed of intrusion, avoidance, numbing, dysphoric arousal, and anxious arousal factors, yielded the best-fitting model. Latent associations between the factors of the model and functionality suggest that symptoms of functionality do not significantly affect the factor structure of ASD. These findings have implications for understanding the underlying mechanism of ASD and can inform the development of more nuanced trauma-related interventions, particularly addressing ASD symptoms and functionality separately.
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Affiliation(s)
- Imelu G Mordeno
- Department of Professional Education, Mindanao State University - Iligan Institute of Technology, Andres Bonifacio Ave., Tibanga, 9200, Iligan City, Philippines.
| | - I Marie Joy S Gallemit
- School of Graduate Studies, College of Education, Mindanao State University - Iligan Institute of Technology, Iligan City, Philippines
| | - Michelle Anne L Ferolino
- School of Graduate Studies, College of Education, Mindanao State University - Iligan Institute of Technology, Iligan City, Philippines
| | - Jonahliza V Sinday
- School of Graduate Studies, College of Education, Mindanao State University - Iligan Institute of Technology, Iligan City, Philippines
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22
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Manzanero AL, Crespo M, Barón S, Scott T, El-Astal S, Hemaid F. Traumatic Events Exposure and Psychological Trauma in Children Victims of War in the Gaza Strip. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:1568-1587. [PMID: 29294997 DOI: 10.1177/0886260517742911] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The present article studies war-related trauma and its effects on children living in the Gaza Strip, 6 months after the attack launched by the Israeli army on July 8, 2014, which lasted for 51 days. The objective was twofold: (a) to identify the prevalence of exposure to traumatic events and (b) to examine the symptoms of traumatic stress in children as described by their parents or tutors using the Harvard Trauma Questionnaire (HTQ). Data from 1,850 male and female children aged between 6 and 15 years living in the Gaza Strip were collected throughout the months of February and April 2015, that is 6 months after the attack. Results showed that the majority of the children were exposed to bombardments and residential area destruction (83.51%), were confined at home unable to go outside (72.92%), were witness to the profanation of mosques (70.38%), were exposed to combat situations (66.65%), and saw corpses (59.95%). A sample of 275 males (28.3%) and 232 females (26.5%) showed diagnoses of posttraumatic stress disorder (PTSD). Gender and age were independent of PTSD. The presence of this pathology was positively related to the number of trauma events experienced. The type of traumatic experience was hardly related to age and gender. A greater protection on behalf of the families against exposure to traumatic events could explain these differences.
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Affiliation(s)
| | | | | | | | | | - Fairouz Hemaid
- United Nations Relief and Works Agency for Palestine Refugees, Palestine
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23
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Zhou D, Liu J, Liu J. On the different effects of teacher–student rapport on urban and rural students' math learning in China: An empirical study. PSYCHOLOGY IN THE SCHOOLS 2020. [DOI: 10.1002/pits.22446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Da Zhou
- Collaborative Innovation Center of Assessment for Basic Education Quality, Beijing Normal University Beijing China
| | - Jinqing Liu
- Department of Curriculum and Instruction Indiana University Bloomington Indiana USA
| | - Jian Liu
- Collaborative Innovation Center of Assessment for Basic Education Quality, Beijing Normal University Beijing China
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24
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Roze M, Melchior M, Vuillermoz C, Rezzoug D, Baubet T, Vandentorren S. Post-Traumatic Stress Disorder in Homeless Migrant Mothers of the Paris Region Shelters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134908. [PMID: 32646029 PMCID: PMC7370032 DOI: 10.3390/ijerph17134908] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 11/17/2022]
Abstract
Migrant women are disproportionately more likely to experience traumatic events in their country of origin, during migration and after arriving in the host country. Homeless women are more likely to be exposed to multiple victimizations in childhood (emotional or physical maltreatment) and in adulthood (sexual abuse, street victimization). This study’s objective was to describe the factors associated with the likelihood of post-traumatic stress disorder (PTSD) among homeless migrant mothers in the Paris region. Face-to-face interviews were conducted by bilingual psychologists and interviewers in a representative sample of homeless families in the Paris region. PTSD was ascertained using the Mini International Neuropsychiatric Interview (MINI) (n = 691 mothers). We studied PTSD in mothers using weighted Poisson regression. Homeless migrant mothers had high levels of PTSD (18.9%) in the 12 months preceding the study. In multivariate analysis, PTSD was associated with departure from the country of origin because of violence (PR = 1.45 95% CI 1.03; 2.04), depression in the preceding 12 months (PR = 1.82 95% CI 1.20; 2.76), and residential instability (PR = 1.93 95% CI 1.27; 2.93). Homeless migrant mothers have high levels of traumatic events and PTSD. Improvements in screening for depression and PTSD and access to appropriate medical care are essential for this vulnerable group.
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Affiliation(s)
- Mathilde Roze
- INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F75012 Paris, France; (M.R.); (M.M.); (C.V.)
| | - Maria Melchior
- INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F75012 Paris, France; (M.R.); (M.M.); (C.V.)
| | - Cécile Vuillermoz
- INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F75012 Paris, France; (M.R.); (M.M.); (C.V.)
| | - Dalila Rezzoug
- CESP Inserm 1178, Université Paris 13, APHP Hôpital Avicenne, 93000 Bobigny, France; (D.R.); (T.B.)
- Centre National de Ressources et Résilience, 59800 Lille, France
| | - Thierry Baubet
- CESP Inserm 1178, Université Paris 13, APHP Hôpital Avicenne, 93000 Bobigny, France; (D.R.); (T.B.)
- Centre National de Ressources et Résilience, 59800 Lille, France
| | - Stéphanie Vandentorren
- INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F75012 Paris, France; (M.R.); (M.M.); (C.V.)
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
- Correspondence:
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25
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Noor N, Pao C, Dragomir-Davis M, Tran J, Arbona C. PTSD symptoms and suicidal ideation in US female firefighters. Occup Med (Lond) 2020; 69:577-585. [PMID: 31064010 DOI: 10.1093/occmed/kqz057] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Little is known regarding the mental health of women firefighters. AIMS To identify demographic, work-related and mental health characteristics associated with post-traumatic stress disorder (PTSD) symptoms and lifetime suicidal ideation in female firefighters compared with male colleagues. METHODS Participants were firefighters (75 women and 2564 men) employed in a large urban fire department in the USA. Chi-square, correlations, t-tests and analyses of variance were conducted to examine the predictors of PTSD symptoms and lifetime suicide ideation in men and women. RESULTS Approximately 20% of women scored positively for PTSD and 30% reported lifetime suicidal ideation. Women with PTSD symptoms were more likely to be in their mid-career years (11-20) than in their first 10 years (87% versus 44%; χ2 = 8.77, P < 0.05) and to have received counselling (53% versus 14%; χ2 = 8.11, P < 0.01). Being single (73% versus 58%; χ2 = 6.02, P < 0.05), having a second job (68% versus 38%; χ2 = 5.79, P < 0.05) and having received counselling (41% versus 11%; χ2 = 8.51, P < 0.01) predicted suicide ideation. Depression and general stress positively predicted PTSD symptoms and suicide ideation. PTSD also predicted suicide ideation. CONCLUSIONS Compared to male firefighters, women were at high risk for PTSD symptoms and suicide ideation. Particularly for women, few socio-demographic and work-related variables were associated with these outcomes. Mental health variables predicted depression and suicide ideation for both gender groups. Therefore, in screening and intervention efforts, it may be most fruitful to focus on mental health risk correlates of PTSD and suicide ideation.
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Affiliation(s)
- N Noor
- The Menninger Clinic, Houston, TX, USA
| | - C Pao
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
| | - M Dragomir-Davis
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
| | - J Tran
- Firefighter Support Network, Houston Fire Department, Houston, TX, USA
| | - C Arbona
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
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26
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Distress Variance and Specificity of Symptom Dimensions in Posttraumatic Stress Disorder: a Quadripartite Perspective. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2020. [DOI: 10.1007/s10862-019-09772-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Silverstein MW, Petri JM, Kramer LB, Weathers FW. An item response theory analysis of the PTSD checklist for DSM-5: Implications for DSM-5 and ICD-11. J Anxiety Disord 2020; 70:102190. [PMID: 32106024 DOI: 10.1016/j.janxdis.2020.102190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 12/05/2019] [Accepted: 01/15/2020] [Indexed: 01/05/2023]
Abstract
The PTSD Checklist (PCL) is a widely used, extensively validated questionnaire for posttraumatic stress disorder (PTSD). The PCL was revised for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5; Friedman, 2013), and the updated version, the PCL-5, has continued the strong psychometric performance of the original version. To further explore the PCL-5's psychometric properties, we used item response theory (IRT) to examine item difficulty and discrimination parameters in separate samples of trauma-exposed undergraduates (N = 1213) and community members (N = 367). Considering item difficulty, nightmares, flashbacks, and reckless or self-destructive behavior emerged among the most difficult items across samples and internal avoidance emerged as the least difficult items across samples. In terms of item discrimination, inability to experience positive emotions, detachment from others, diminished interest, and negative emotions emerged as highly discriminating items in both samples, and traumatic amnesia and reckless or self-destructive behavior emerged as the least discriminating items in both samples. These results have implications for the divergent conceptualizations of PTSD in DSM-5 versus International Classification of Diseases, 11th Edition (ICD-11; WHO, 2018). Future research should employ IRT in a clinical population.
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Zhang WJ, Yan C, Shum D, Deng CP. Responses to academic stress mediate the association between sleep difficulties and depressive/anxiety symptoms in Chinese adolescents. J Affect Disord 2020; 263:89-98. [PMID: 31818801 DOI: 10.1016/j.jad.2019.11.157] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/23/2019] [Accepted: 11/30/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Sleep difficulties are pervasive in Chinese adolescents, which exert aversive influence on their emotional health. However, the underlying mechanisms of this effect remain unclear. This study addressed whether stress responses mediate the concurrent and prospective relationship between sleep difficulties and depressive/anxiety symptoms in Chinese adolescents. METHOD 17,946 adolescents (14-18 years-old) were administrated the Pittsburgh Sleep Quality Index, the Center for Epidemiologic Studies Depression Scale, Revised Children's Manifest Anxiety Scale and the Responses to Stress Questionnaire. Further, 710 of them finished the one-year follow-up assessments. Structural equation models were conducted to determine the concurrent and prospective mediation effects of stress responses and the moderated effect of gender and age. RESULTS Involuntary engagement and disengagement responses, as well as engagement coping, significantly mediated the cross-sectional relationship between sleep difficulties and depressive/anxiety symptoms. Moreover, sleep difficulties at baseline predicted enhanced involuntary engagement responses but reduced the use of engagement coping strategies one year later, resulting in an elevated level of depressive/anxiety symptoms. Finally, females and younger adolescents with greater sleep difficulties were more likely to generate maladaptive stress responses. LIMITATIONS First, sleep difficulties were only measured using self-reported approaches. Second, potential confounding variables (e.g., socioeconomic status) were not adjusted for. Third, our study only focused on typically-developing youth samples rather than clinical samples. CONCLUSIONS Our findings highlight the important role of stress responses in the relationship between sleep difficulties and depressive/anxiety symptoms. The findings might also shed some light on the psychological intervention of sleep difficulties and mood disorder in adolescent populations.
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Affiliation(s)
- Wen-Jun Zhang
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Shanghai Changning-ECNU Mental Health Center, School of Psychology and Cognitive Science, East China Normal University, 3663 North Zhongshan Road, Shanghai, China
| | - Chao Yan
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Shanghai Changning-ECNU Mental Health Center, School of Psychology and Cognitive Science, East China Normal University, 3663 North Zhongshan Road, Shanghai, China.
| | - David Shum
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University; Hong Kong Special Administrative Region, China; Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Neuropsychology and Applied Cognitive Neuroscience Lab, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.
| | - Ci-Ping Deng
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Shanghai Changning-ECNU Mental Health Center, School of Psychology and Cognitive Science, East China Normal University, 3663 North Zhongshan Road, Shanghai, China.
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Doric A, Stevanovic D, Stupar D, Vostanis P, Atilola O, Moreira P, Dodig-Curkovic K, Franic T, Davidovic V, Avicenna M, Noor M, Nussbaum L, Thabet A, Ubalde D, Petrov P, Deljkovic A, Antonio ML, Ribas A, Oliveira J, Knez R. UCLA PTSD reaction index for DSM-5 (PTSD-RI-5): a psychometric study of adolescents sampled from communities in eleven countries. Eur J Psychotraumatol 2019; 10:1605282. [PMID: 31105904 PMCID: PMC6507911 DOI: 10.1080/20008198.2019.1605282] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/22/2019] [Accepted: 03/28/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Children and adolescents are often exposed to traumatic events, which may lead to the development of posttraumatic stress disorder (PTSD). It is therefore important for clinicians to screen for potential symptoms that can be signs of PTSD onset. PTSD in youth is a worldwide problem, thus congruent screening tools in various languages are needed. Objective: The aim of this study was to test the general psychometric properties of the Traumatic Stress Disorder Reaction Index for children and adolescents (UCLA PTSD) Reaction Index for DSM-5 (PTSD-RI-5) in adolescents, a self-report instrument intended to screen for trauma exposure and assess PTSD symptoms. Method: Data was collected from 4201 adolescents in communities within eleven countries worldwide (i.e. Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, Palestine-Gaza, Philippines, Portugal, Romania, and Serbia). Internal consistency, discriminant validity, and a confirmatory factor analysis of a four-factor model representing the main DSM-5 symptoms of the PTSD-RI-5 were evaluated. Results: The PTSD-RI-5 total score for the entire sample shows very good reliability (α = .92) as well as across all countries included (α ranged from .90 to .94). The correlations between anxiety/depressive symptoms and the PTSD-RI-5 scores were below .70 indicating on good discriminant validity. The four-factor structure of the scale was confirmed for the total sample and data from six countries. The standardized regression weights for all items varied markedly across the countries. The lack of a common acceptable model across all countries prevented us from direct testing of cross-cultural measurement invariance. Conclusions: The four-factor structure of the PTSD-RI-5 likely represents the core PTSD symptoms as proposed by the DSM-5 criteria, but there could be items interpreted in a conceptually different manner by adolescents from different cultural/regional backgrounds and future cross-cultural evaluations need to consider this finding.
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Affiliation(s)
- Ana Doric
- Department of Psychology (Center for Applied Psychology), Faculty of Humanities and Social Sciences, University of Rijeka, Rijeka, Croatia
| | - Dejan Stevanovic
- Child Psychiatry, Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
| | - Dusko Stupar
- Child Psychiatry, Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
| | - Panos Vostanis
- School of Psychology, Leicester University, Leicester, UK
| | - Olayinka Atilola
- Department of Behavioural Medicine, Lagos State University College of Medicine Ikeja, Lagos, Nigeria
| | | | - Katarina Dodig-Curkovic
- Medical Faculty Osijek, Faculty for Dental Medicine and Health, University Health Center Osijek, Osijek, Croatia
| | - Tomislav Franic
- Child and Adolescent Psychiatry, School of Medicine, University of Split, Split, Croatia
| | - Vrljicak Davidovic
- Department of Psychiatry, Clinical Hospital Centre Split, Split, Croatia
| | - Mohamad Avicenna
- Faculty of Psychology, State Islamic University Syarif Hidayatullah, Jakarta, Indonesia
| | - Multazam Noor
- Psychiatry department, Dr Soeharto Heerdjan Mental Hospital Jakarta, Jakarta, Indonesia
| | - Laura Nussbaum
- Department of Child and Adolescent Psychiatry, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Abdelaziz Thabet
- School of Public Health, Al Quds University, Gaza Branch, Palestine
| | - Dino Ubalde
- Department of Psychology, St. Dominic College of Asia, City of Bacoor, Philippines
| | - Petar Petrov
- Department of Child and Adolescent Psychiatry, University Hospital St. Marina, Varna, Bulgaria
| | | | | | - Adriana Ribas
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Rajna Knez
- Department of Women´s and Children´s health, Skaraborgs Hospital, Skövde, Sweden.,Department of Psychiatry and Psychological Medicine, Medical School, University of Rijeka, Rijeka, Croatia.,University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Göteborg, Sweden
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30
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Contractor AA, Greene T, Dolan M, Elhai JD. Relations between PTSD and depression symptom clusters in samples differentiated by PTSD diagnostic status. J Anxiety Disord 2018; 59:17-26. [PMID: 30142474 DOI: 10.1016/j.janxdis.2018.08.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 08/04/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Abstract
Co-occurring posttraumatic stress disorder (PTSD) and depression following traumatic experiences are cumulatively associated with functional impairment. To examine mechanisms for the PTSD-depression comorbidity, we investigated their cluster-level associations. Using data obtained from Amazon's Mechanical Turk platform, 368 trauma-exposed participants were split into two subsamples: those with (n = 163) and without (n = 185) probable PTSD. In both subsamples, confirmatory factor analyses indicated an optimal seven-factor PTSD Hybrid Model. Results of Wald tests of parameter constraints indicated that, in both subsamples, PTSD's dysphoric arousal cluster strongly related to somatic depression compared to all/most other PTSD Hybrid Model clusters. Additionally, in both subsamples, PTSD's negative affect, externalizing behaviors, and anhedonia clusters each strongly related to non-somatic depression compared to PTSD's anxious arousal cluster. Our results indicated that PTSD's dysphoric arousal symptoms mainly accounted for PTSD's shared variance with somatic depression, while the negative alterations in cognitions and mood (NACM)/dysphoria and arousal symptoms (primarily externalizing behaviours) mainly accounted for PTSD's shared variance with non-somatic depression. Our findings have implications for the discussion on PTSD's specific/non-specific clusters tied to diagnostic modifications, for understanding mechanisms underlying PTSD-depression comorbidity, and for the use of transdiagnostic and multi-component treatment protocols for PTSD-depression symptoms.
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Affiliation(s)
| | - Talya Greene
- Department of Community Mental Health, University of Haifa, Israel
| | - Megan Dolan
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Jon D Elhai
- Department of Psychology and Department of Psychiatry, University of Toledo, Toledo, OH, USA
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Confirmatory Factor Analysis of the Nepean Dysphoria Scale in a Clinical Sample. Psychiatr Q 2018; 89:621-629. [PMID: 29404831 DOI: 10.1007/s11126-018-9564-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The construct of dysphoria has been described inconsistently across a broad range of psychopathology. The term has been used to refer to an irritable state of discontent, but is also thought to incorporate anger, resentment and nonspecific symptoms associated with anxiety and depression, such as tension and unhappiness. The Nepean Dysphoria Scale has been developed to allow assessment of dysphoria, but its factor structure has not yet been investigated in clinical samples. We aimed to determine the latent structure of dysphoria as reflected by the Nepean Dysphoria Scale, using a clinical sample. Adults (N = 206) seeking treatment at a range of mental health services were administered the Nepean Dysphoria Scale. Four putative factor structures were investigated using confirmatory factor analysis: a single-factor model, a hierarchical model, a bifactor model and a four-factor model as identified in previous studies. No model fit the data except for a four-factor model when a revised 22-item version of the original 24-item scale was investigated. A four-factor structure similar to that identified in non-clinical samples was supported, albeit following the removal of two items. The Nepean Dysphoria Scale appears to have utility for the assessment of dysphoria in routine clinical settings.
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32
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Zhen R, Quan L, Zhou X. Co-occurring patterns of post-traumatic stress disorder and depression among flood victims: A latent profile analysis. J Health Psychol 2018; 25:1543-1555. [PMID: 29558825 DOI: 10.1177/1359105318763505] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study examined the co-occurring patterns of post-traumatic stress disorder and depression. A sample of 187 victims completed self-report questionnaires after a major flood disaster. Results indicated four classes: low symptoms group (49.7%), mild comorbid symptoms group (24.1%), serious comorbid symptoms group (3.2%), and medium comorbid symptoms group (23.0%). Male victims were less likely and older victims were more likely to belong to the medium comorbid symptoms group; victims with more serious trauma exposure and those using more maladaptive cognition emotional regulation strategies were more likely to belong to both the mild and medium comorbid symptoms groups.
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Affiliation(s)
- Rui Zhen
- Beijing Normal University, China
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33
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Hurlocker MC, Vidaurri DN, Cuccurullo LAJ, Maieritsch K, Franklin CL. Examining the latent structure mechanisms for comorbid posttraumatic stress disorder and major depressive disorder. J Affect Disord 2018; 229:477-482. [PMID: 29334642 DOI: 10.1016/j.jad.2017.12.076] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 12/27/2017] [Accepted: 12/31/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a complex psychiatric illness that can be difficult to diagnose, due in part to its comorbidity with major depressive disorder (MDD). Given that researchers have found no difference in prevalence rates of PTSD and MDD after accounting for overlapping symptoms, the latent structures of PTSD and MDD may account for the high comorbidity. In particular, the PTSD Negative Alterations in Cognition and Mood (NACM) and Hyperarousal factors have been characterized as non-specific to PTSD. Therefore, we compared the factor structures of the Diagnostic and Statistical Manual of Mental Disorders, 5thedition (DSM-5) PTSD and MDD and examined the mediating role of the PTSD NACM and Hyperarousal factors on the relationship between MDD and PTSD symptom severity. METHODS Participants included 598 trauma-exposed veterans (Mage = 48.39, 89% male) who completed symptom self-report measures of DSM-5 PTSD and MDD. RESULTS Confirmatory factor analyses indicated an adequate-fitting four-factor DSM-5 PTSD model and two-factor MDD model. Compared to other PTSD factors, the PTSD NACM factor had the strongest relationship with the MDD Affective factor, and the PTSD NACM and Hyperarousal factors had the strongest association with the MDD Somatic factor. Further, the PTSD NACM factor explained the relationship between MDD factors and PTSD symptom severity. More Affective and Somatic depression was related to more NACM symptoms, which in turn were related to increased severity of PTSD. LIMITATIONS Limitations include the reliance on self-report measures and the use of a treatment-seeking, trauma-exposed veteran sample which may not generalize to other populations. CONCLUSIONS Implications concerning the shared somatic complaints and psychological distress in the comorbidity of PTSD and MDD are discussed.
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Affiliation(s)
- Margo C Hurlocker
- Southeast Louisiana Veterans Health Care System, 2400 Canal St., New Orleans, LA 70119, USA
| | - Desirae N Vidaurri
- Southeast Louisiana Veterans Health Care System, 2400 Canal St., New Orleans, LA 70119, USA
| | - Lisa-Ann J Cuccurullo
- Southeast Louisiana Veterans Health Care System, 2400 Canal St., New Orleans, LA 70119, USA; South Central VA Healthcare Network Mental Illness Research, Education, and Clinical Center (MIRECC), 2400 Canal Street., New Orleans, LA 70119, USA; Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112, USA
| | - Kelly Maieritsch
- Edward Hines Jr. VA Hospital, 5000 South 5th Avenue, Hines, IL 60141, USA
| | - C Laurel Franklin
- Southeast Louisiana Veterans Health Care System, 2400 Canal St., New Orleans, LA 70119, USA; South Central VA Healthcare Network Mental Illness Research, Education, and Clinical Center (MIRECC), 2400 Canal Street., New Orleans, LA 70119, USA; Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112, USA.
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34
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Quan L, Zhen R, Yao B, Zhou X, Yu D. The Role of Perceived Severity of Disaster, Rumination, and Trait Resilience in the Relationship Between Rainstorm-related Experiences and PTSD Amongst Chinese Adolescents Following Rainstorm Disasters. Arch Psychiatr Nurs 2017; 31:507-515. [PMID: 28927516 DOI: 10.1016/j.apnu.2017.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 03/27/2017] [Accepted: 06/01/2017] [Indexed: 11/27/2022]
Abstract
This study examined the mediating role of perceived severity of trauma and rumination in the relationship between traumatic experiences and PTSD, and assessed the moderated role of resilience in this mediating process. Nine hundred and fifty-one adolescents were selected to complete a self-report questionnaire involving rainstorm-related experiences, perceived severity of trauma, rumination, resilience, and PTSD. The results found that rainstorm-related experiences had a positive effect on PTSD by perceived severity of disaster, or by rumination via perceived severity of disaster. Resilience buffered the relationship between rainstorm-related experiences and PTSD, but did not buffer the relation of rainstorm-related experiences to perceived severity of disaster and rumination. These findings indicated that rainstorm-related experiences may have an indirect effect on PTSD via cognitive activities, and these indirect paths were not buffered by resilience. A buffering effect only occurred in the direct paths from rainstorm-related experiences to PTSD.
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Affiliation(s)
- Lijuan Quan
- College of Educational Science, Anhui Normal University, Anhui, Wuhu 241000, China
| | - Rui Zhen
- Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, Beijing 100875, China
| | - Benxian Yao
- College of Educational Science, Anhui Normal University, Anhui, Wuhu 241000, China
| | - Xiao Zhou
- I-Core Research Center for Mass Trauma, School of Social Work, Tel Aviv University, Tel Aviv 69978, Israel.
| | - Dapeng Yu
- Department of Geography, Loughborough University, Loughborough, Leicestershire, UK
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35
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Brewin CR, Cloitre M, Hyland P, Shevlin M, Maercker A, Bryant RA, Humayun A, Jones LM, Kagee A, Rousseau C, Somasundaram D, Suzuki Y, Wessely S, van Ommeren M, Reed GM. A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clin Psychol Rev 2017; 58:1-15. [PMID: 29029837 DOI: 10.1016/j.cpr.2017.09.001] [Citation(s) in RCA: 323] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/18/2017] [Accepted: 09/05/2017] [Indexed: 11/27/2022]
Abstract
The World Health Organization's proposals for posttraumatic stress disorder (PTSD) in the 11th edition of the International Classification of Diseases, scheduled for release in 2018, involve a very brief set of symptoms and a distinction between two sibling disorders, PTSD and Complex PTSD. This review of studies conducted to test the validity and implications of the diagnostic proposals generally supports the proposed 3-factor structure of PTSD symptoms, the 6-factor structure of Complex PTSD symptoms, and the distinction between PTSD and Complex PTSD. Estimates derived from DSM-based items suggest the likely prevalence of ICD-11 PTSD in adults is lower than ICD-10 PTSD and lower than DSM-IV or DSM-5 PTSD, but this may change with the development of items that directly measure the ICD-11 re-experiencing requirement. Preliminary evidence suggests the prevalence of ICD-11 PTSD in community samples of children and adolescents is similar to DSM-IV and DSM-5. ICD-11 PTSD detects some individuals with significant impairment who would not receive a diagnosis under DSM-IV or DSM-5. ICD-11 CPTSD identifies a distinct group who have more often experienced multiple and sustained traumas and have greater functional impairment than those with PTSD.
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Affiliation(s)
- Chris R Brewin
- Department of Clinical, Educational and Health Psychology, University College London, London, UK.
| | - Marylène Cloitre
- Division of Dissemination and Training, National Center for PTSD, Menlo Park, CA, USA
| | - Philip Hyland
- School of Business, National College of Ireland, Dublin, Ireland
| | - Mark Shevlin
- School of Psychology, University of Ulster, Coleraine, North Ireland
| | - Andreas Maercker
- Department of Psychology, Division of Psychopathology, University of Zurich, Switzerland
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | | | - Lynne M Jones
- FXB Center for Health and Human Rights, Harvard School of Public Health, Harvard University, Cambridge, MA, USA
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Cécile Rousseau
- Department of Psychiatry, McGill University Health Center, Montreal, Canada
| | | | - Yuriko Suzuki
- National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | | | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Geoffrey M Reed
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland; Global Mental Health Program, Columbia University Medical Center, New York, NY, USA
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36
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Zhou X, Wu X, Zhen R. Assessing the latent structure of DSM-5 PTSD among Chinese adolescents after the Ya'an earthquake. Psychiatry Res 2017; 254:33-39. [PMID: 28441585 DOI: 10.1016/j.psychres.2017.04.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 03/18/2017] [Accepted: 04/18/2017] [Indexed: 11/27/2022]
Abstract
To examine the underlying substructure of DSM-5 PTSD in an adolescent sample, this study used a confirmatory factor analysis alternative model approach to assess 813 adolescents two and a half years after the Ya'an earthquake. Participants completed the PTSD Checklist for DSM-5, the Center for Epidemiologic Studies Depression Scale for Children, and the Screen for Child Anxiety Related Emotional Disorders. The results found that the seven-factor hybrid PTSD model entailing intrusion, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal had significantly better fit indices than other alternative models. Depression and anxiety displayed high correlations with the seven-factor model. The findings suggested that the seven-factor model was more applicable to adolescents following the earthquake, and may carry important implications for further clinical practice and research on posttraumatic stress symptomatology.
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Affiliation(s)
- Xiao Zhou
- Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, Beijing 100875, China; I-Core Research Center for Mass Trauma; Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Xinchun Wu
- Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, Beijing 100875, China.
| | - Rui Zhen
- Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, Beijing 100875, China
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Arbona C, Fan W, Schwartz J, Pao C, Tran JK, Buser S. Measurement and Structural Invariance of Posttraumatic Stress Disorder Symptoms in Hispanic and Caucasian Firefighters: A Bias-Corrected Bootstrap Confidence Intervals Approach. Assessment 2017; 26:209-222. [DOI: 10.1177/1073191116685805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study compared across Hispanic and Caucasian firefighters the relative fit of the four-factor Emotional Numbing and Dysphoria posttraumatic stress disorder models to the more recently proposed Dysphoric Arousal five-factor model. As hypothesized, the Dysphoric Arousal five-factor model emerged as the best fitting model within each ethnic group and it also showed measurement invariance between groups (configural invariance). Results of multigroup confirmatory factor analyses and a bias-corrected bootstrap confidence intervals analytic approach indicated that the five factor model also demonstrated invariance in factor loadings (metric invariance) and item-level intercepts (scalar invariance) across the two ethnic groups. Results indicate that the Dysphoric Arousal five factor model captures similar psychological constructs across Caucasian and English-speaking Hispanic firefighters. Therefore, observed factor scores are comparable across ethnic groups and can be combined when examining predictors of posttraumatic stress disorder severity.
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Affiliation(s)
| | | | | | | | - Jana K. Tran
- Firefighter Support Network, Houston Fire Department, Houston, TX, USA
| | - Sam Buser
- Firefighter Support Network, Houston Fire Department, Houston, TX, USA
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38
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Zhou X, Wu X, Chen Q, Zhen R. Why did adolescents have sleep problems after earthquakes? Understanding the role of traumatic exposure, fear, and PTSD. Scand J Psychol 2017; 58:221-227. [PMID: 28543322 DOI: 10.1111/sjop.12366] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 03/17/2017] [Indexed: 12/17/2022]
Abstract
To examine the relationships between trauma exposure, fear, post-traumatic stress disorder, and sleep problems in adolescents, 746 adolescent survivors of the 2008 Wenchuan earthquake in China were assessed at 1 year (T1) and 1.5 years (T2) after the earthquake using a trauma exposure questionnaire, a fear questionnaire, a child posttraumatic stress disorder symptom scale, and a subscale on child sleep problems. The results showed that T1 trauma exposure were not directly associated with sleep problems at T1 and T2, but played a positive role in sleep problems at both T1 and T2 indirectly through T1 posttraumatic stress disorder and T1 fear. T1 trauma exposure was also positively and indirectly associated with T2 sleep problems through T1 posttraumatic stress disorder via T1 sleep problems, or through T1 fear via the path from T1 posttraumatic stress disorder to T1 sleep problems. These findings indicated that fear and posttraumatic stress disorder 1 year after the earthquake played a mediating role in the relationship between trauma exposure at 1 year after the earthquake, and sleep problems at both 1 year and 1.5 years after the earthquake, respectively. In particular, posttraumatic stress disorder also had a multiple mediating effect in the path from trauma exposure to sleep problems via fear. Furthermore, the findings indicated that sleep problems were relatively stable between 1 and 1.5 years after an earthquake.
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Affiliation(s)
- Xiao Zhou
- School of Psychology, Beijing Normal University, Beijing, China
| | - Xinchun Wu
- School of Psychology, Beijing Normal University, Beijing, China
| | - Qiuyan Chen
- School of Sociology and Psychology, Southwest University for Nationalities, Chengdu, China
| | - Rui Zhen
- School of Psychology, Beijing Normal University, Beijing, China
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39
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Afzali MH, Sunderland M, Teesson M, Carragher N, Mills K, Slade T. A network approach to the comorbidity between posttraumatic stress disorder and major depressive disorder: The role of overlapping symptoms. J Affect Disord 2017; 208:490-496. [PMID: 27810269 DOI: 10.1016/j.jad.2016.10.037] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/12/2016] [Accepted: 10/23/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The role of symptom overlap between major depressive disorder and posttraumatic stress disorder in comorbidity between two disorders is unclear. The current study applied network analysis to map the structure of symptom associations between these disorders. METHODS Data comes from a sample of 909 Australian adults with a lifetime history of trauma and depressive symptoms. Data analysis consisted of the construction of two comorbidity networks of PTSD/MDD with and without overlapping symptoms, identification of the bridging symptoms, and computation of the centrality measures. RESULTS The prominent bridging role of four overlapping symptoms (i.e., sleep problems, irritability, concentration problems, and loss of interest) and five non-overlapping symptoms (i.e., feeling sad, feelings of guilt, psychomotor retardation, foreshortened future, and experiencing flashbacks) is highlighted. LIMITATIONS The current study uses DSM-IV criteria for PTSD and does not take into consideration significant changes made to PTSD criteria in DSM-5. Moreover, due to cross-sectional nature of the data, network estimates do not provide information on whether a symptom actively triggers other symptoms or whether a symptom mostly is triggered by other symptoms. CONCLUSION The results support the role of dysphoria-related symptoms in PTSD/MDD comorbidity. Moreover, Identification of central symptoms and bridge symptoms will provide useful targets for interventions that seek to intervene early in the development of comorbidity.
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Affiliation(s)
- Mohammad H Afzali
- NHMRC Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia.
| | - Matthew Sunderland
- NHMRC Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| | - Maree Teesson
- NHMRC Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| | - Natacha Carragher
- Office of Medical Education, Faulty of Medicine, UNSW, Sydney, Australia
| | - Katherine Mills
- NHMRC Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| | - Tim Slade
- NHMRC Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
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Cook JW, Baker TB, Beckham JC, McFall M. Smoking-induced affect modulation in nonwithdrawn smokers with posttraumatic stress disorder, depression, and in those with no psychiatric disorder. JOURNAL OF ABNORMAL PSYCHOLOGY 2016; 126:184-198. [PMID: 28004948 DOI: 10.1037/abn0000247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This research sought to determine whether smoking influences affect by means other than withdrawal reduction. Little previous evidence suggests such an effect. We surmised that such an effect would be especially apparent in posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), 2 disorders that are frequently comorbid with smoking and that involve dysregulated affect. Participants were U.S. veterans who were regular smokers (N = 159): 52 with PTSD (58% with comorbid MDD), 51 with MDD, and 56 controls with no psychiatric disorder. During 3 positive and 3 negative mood induction trials (scheduled over 2 sessions), nonwithdrawn participants smoked either a nicotine-containing cigarette (NIC+), a nicotine-free cigarette (NIC-), or held a pen. Positive and negative affect were each measured before and after mood induction. Results showed a significant 2-way interaction of Smoking Condition × Time on negative affect during the negative mood induction (F(6, 576) = 2.41, p = .03) in those with PTSD and controls. In these groups, both NIC+ and NIC-, relative to pen, produced lower negative affect ratings after the negative mood induction. There was also a 2-way interaction of Smoking Condition × Time on positive affect response to the positive mood induction among those with PTSD and controls (F(6, 564) = 3.17, p = .005) and among MDD and controls (F(6, 564) = 2.27, p = .036). Among all smokers, NIC+ enhanced the magnitude and duration of positive affect more than did NIC-. Results revealed affect modulation outside the context of withdrawal relief; such effects may motivate smoking among those with psychiatric diagnoses, and among smokers in general. (PsycINFO Database Record
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Affiliation(s)
- Jessica W Cook
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health
| | - Timothy B Baker
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health
| | | | - Miles McFall
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Public Health
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Solberg Ø, Birkeland MS, Blix I, Hansen MB, Heir T. Towards an exposure-dependent model of post-traumatic stress: longitudinal course of post-traumatic stress symptomatology and functional impairment after the 2011 Oslo bombing. Psychol Med 2016; 46:3241-3254. [PMID: 27609412 DOI: 10.1017/s0033291716001860] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Our understanding of the dynamics of post-traumatic stress symptomatology and its link to functional impairment over time is limited. METHOD Post-traumatic stress symptomatology (Post-traumatic Checklist, PCL) was assessed three times in 1-year increments (T1, T2, T3) following the Oslo bombing of 22 July, 2011, in directly (n = 257) and indirectly exposed (n = 2223) government employees, together with demographics, measures of exposure and work and social adjustment. The dynamics of post-traumatic stress disorder symptom cluster interplay were examined within a structural equation modelling framework using a cross-lagged autoregressive panel model. RESULTS Intrusions at T1 played a prominent role in predicting all symptom clusters at T2 for the directly exposed group, exhibiting especially strong cross-lagged relationships with avoidance and anxious arousal. For the indirectly exposed group, dysphoric arousal at T1 played the most prominent role in predicting all symptom clusters at T2, exhibiting a strong relationship with emotional numbing. Emotional numbing seemed to be the main driver behind prolonged stress at T3 for both groups. Functional impairment was predominately associated with dysphoric arousal and emotional numbing in both groups. CONCLUSIONS For directly exposed individuals, memories of the traumatic incident and the following intrusions seem to drive their post-traumatic stress symptomatology. However, as these memories lose their potency over time, a sequela of dysphoric arousal and emotional numbing similar to the one reported by the indirectly exposed individuals seems to be the main driver for prolonged post-traumatic stress and functional impairment. Findings are discussed using contemporary models within an exposure-dependent perspective of post-traumatic stress.
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Affiliation(s)
- Ø Solberg
- Norwegian Centre for Violence and Traumatic Stress Studies,Oslo,Norway
| | - M S Birkeland
- Norwegian Centre for Violence and Traumatic Stress Studies,Oslo,Norway
| | - I Blix
- Norwegian Centre for Violence and Traumatic Stress Studies,Oslo,Norway
| | - M B Hansen
- Norwegian Centre for Violence and Traumatic Stress Studies,Oslo,Norway
| | - T Heir
- Norwegian Centre for Violence and Traumatic Stress Studies,Oslo,Norway
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Arbona C, Fan W, Noor N. Factor structure and external correlates of posttraumatic stress disorder symptoms among African American firefighters. Psychol Res Behav Manag 2016; 9:201-9. [PMID: 27563263 PMCID: PMC4986676 DOI: 10.2147/prbm.s113615] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study compared the relative goodness of fit of three well-established factorial models of posttraumatic stress disorder (PTSD) symptoms among 477 African American male firefighters in a large city in the US. The compared models were the two four-factor emotional numbing and dysphoria models and a five-factor dysphoric arousal model. The study also examined the convergent and discriminant validity of PTSD symptom clusters in relation to depression and alcohol dependence symptoms. Both the emotional numbing and dysphoric arousal PTSD models provided a superior fit to the data compared to the dysphoria model. Findings also indicated a good fit for factor models that included PTSD, depression, and alcohol dependence latent factors, which provides support for the specificity of PTSD symptom clusters. Depression symptoms were more strongly correlated with PTSD symptom clusters than alcohol dependence. In the dysphoric arousal model, depression and alcohol dependence were equally related to the emotional numbing and dysphoric arousal clusters; however, both depression and alcohol dependence were more highly correlated with dysphoric arousal than with anxious arousal. Even though the emotional numbing and dysphoric arousal models demonstrated a superior fit to the data, the four-factor dysphoria model may provide a more parsimonious representation of PTSD's latent structure than the five-factor dysphoric arousal model. In conclusion, this study extends support for the well-established PTSD symptom factor models among African Americans, a population with whom these models had not been examined earlier.
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Affiliation(s)
- Consuelo Arbona
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
| | - Weihua Fan
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
| | - Nausheen Noor
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
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43
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Arbona C, Schwartz JP. Posttraumatic Stress Disorder Symptom Clusters, Depression, Alcohol Abuse, and General Stress Among Hispanic Male Firefighters. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2016. [DOI: 10.1177/0739986316661328] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined the association of the four posttraumatic stress disorder (PTSD) symptom clusters (re-experiencing, avoidance, dysphoria, and hyperarousal) included in the Dysphoria factor model to depression, substance abuse, and general stress among 551 male, Hispanic firefighters in a large metropolitan city in the United States. Approximately 11% of the participants demonstrated elevated PTSD compared with a 7% PTSD prevalence rate in the U.S. Hispanic population. Results of bivariate correlations and regression analyses indicated that, as expected, the dysphoria cluster captured a general distress dimension common to other affective disorders, whereas re-experiencing, avoidance, and hyperarousal symptoms demonstrated stronger specificity to depression than to substance abuse or general stress. Findings suggest that treatment approaches to PTSD with Hispanics should include interventions such as behavioral activation, which are designed to address non-specific distress.
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Keeley JW, Reed GM, Roberts MC, Evans SC, Robles R, Matsumoto C, Brewin CR, Cloitre M, Perkonigg A, Rousseau C, Gureje O, Lovell AM, Sharan P, Maercker A. Disorders specifically associated with stress: A case-controlled field study for ICD-11 mental and behavioural disorders. Int J Clin Health Psychol 2016; 16:109-127. [PMID: 30487855 PMCID: PMC6225017 DOI: 10.1016/j.ijchp.2015.09.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/22/2015] [Indexed: 11/16/2022] Open
Abstract
As part of the development of the Eleventh Revision of International Classification of Diseases and Related Health Problems (ICD-11), the World Health Organization Department of Mental Health and Substance Abuse is conducting a series of case-controlled field studies using a new and powerful method to test the application by clinicians of the proposed ICD-11 diagnostic guidelines for mental and behavioural disorders. This article describes the case-controlled field study for Disorders Specifically Associated with Stress. Using a vignette-based experimental methodology, 1,738 international mental health professionals diagnosed standardized cases designed to test key differences between the proposed diagnostic guidelines for ICD-11 and corresponding guidelines for ICD-10. Across eight comparisons, several proposed changes for ICD-11, including the addition of Complex PTSD and Prolonged Grief Disorder, produced significantly improved diagnostic decisions and clearer application of diagnostic guidelines compared to ICD-10. However, several key areas were also identified, such as the description of the diagnostic requirement of re-experiencing in PTSD, in which the guidelines were not consistently applied as intended. These results informed specific revisions to improve the clarity of the proposed ICD-11 diagnostic guidelines. The next step will be to further test these guidelines in clinic-based studies using real patients in relevant settings.
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Affiliation(s)
| | - Geoffrey M. Reed
- World Health Organization, Switzerland
- Universidad Autónoma de México (UNAM), Mexico
- Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñiz”, Mexico
| | | | | | - Rebeca Robles
- Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñiz”, Mexico
| | | | | | - Marylène Cloitre
- National Center for PTSD, USA
- New York University Langone Medical Center, USA
| | | | | | | | - Anne M. Lovell
- National Institute of Health and Medical Research (INSERM), France
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45
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Increased anticipatory contingent negative variation in posttraumatic stress disorder. Biol Psychol 2016; 117:80-88. [DOI: 10.1016/j.biopsycho.2016.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 03/03/2016] [Accepted: 03/04/2016] [Indexed: 02/04/2023]
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46
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Kramer MD, Arbisi PA, Thuras PD, Krueger RF, Erbes CR, Polusny MA. The class-dimensional structure of PTSD before and after deployment to Iraq: Evidence from direct comparison of dimensional, categorical, and hybrid models. J Anxiety Disord 2016; 39:1-9. [PMID: 26896605 DOI: 10.1016/j.janxdis.2016.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 12/16/2015] [Accepted: 02/06/2016] [Indexed: 10/22/2022]
Abstract
The assumption of specific etiology in posttraumatic stress disorder (PTSD) differentiates the disorder from most other psychiatric conditions. A 'risky test' of the assumption of specific etiology and resultant trauma-related symptom dimensions was conducted through structural modeling of PTSD symptoms in soldiers before (N=522) and after (n=423) a combat deployment to Iraq. If PTSD represents a discrete diagnostic entity that emerges after trauma exposure, we hypothesized either the number of latent classes should increase from pre- to post-deployment or symptom dimensions should qualitatively distinguish affected from unaffected classes following trauma exposure. Comparison of latent structural models revealed best fitting hybrid models for PTSD and depression with strong invariance of symptom dimensions across classes both before and after deployment and only quantitative (i.e., severity) differences between classes. These findings suggest PTSD is generally well-conceptualized as a dimensional syndrome worsened but not necessarily elicited by trauma exposure.
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Affiliation(s)
- Mark D Kramer
- Center for Chronic Disease Outcome Research, Minneapolis VA Healthcare System, B9-152, One Veterans Drive, Minneapolis, MN 55417, USA; Minneapolis VA Healthcare System, B68-2, One Veterans Drive, Minneapolis, MN 55417, USA; University of Minnesota-Department of Psychiatry, F282/2A West, 2450 Riverside Ave S, Minneapolis, MN 55454, USA.
| | - Paul A Arbisi
- Minneapolis VA Healthcare System, B68-2, One Veterans Drive, Minneapolis, MN 55417, USA; University of Minnesota-Department of Psychiatry, F282/2A West, 2450 Riverside Ave S, Minneapolis, MN 55454, USA; University of Minnesota-Department of Psychology, N218 Elliott Hall, 75 E River Rd, Minneapolis, MN 55417, USA.
| | - Paul D Thuras
- Minneapolis VA Healthcare System, B68-2, One Veterans Drive, Minneapolis, MN 55417, USA; University of Minnesota-Department of Psychiatry, F282/2A West, 2450 Riverside Ave S, Minneapolis, MN 55454, USA.
| | - Robert F Krueger
- University of Minnesota-Department of Psychology, N218 Elliott Hall, 75 E River Rd, Minneapolis, MN 55417, USA.
| | - Christopher R Erbes
- Center for Chronic Disease Outcome Research, Minneapolis VA Healthcare System, B9-152, One Veterans Drive, Minneapolis, MN 55417, USA; Minneapolis VA Healthcare System, B68-2, One Veterans Drive, Minneapolis, MN 55417, USA; University of Minnesota-Department of Psychiatry, F282/2A West, 2450 Riverside Ave S, Minneapolis, MN 55454, USA.
| | - Melissa A Polusny
- Center for Chronic Disease Outcome Research, Minneapolis VA Healthcare System, B9-152, One Veterans Drive, Minneapolis, MN 55417, USA; Minneapolis VA Healthcare System, B68-2, One Veterans Drive, Minneapolis, MN 55417, USA; University of Minnesota-Department of Psychiatry, F282/2A West, 2450 Riverside Ave S, Minneapolis, MN 55454, USA.
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Contractor AA, Presseau C, Capone C, Reddy MK, Shea MT. The moderating role of dysphoria in the relationship between intrusions and alcohol use. Addict Behav 2016; 55:5-14. [PMID: 26735913 DOI: 10.1016/j.addbeh.2015.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/20/2015] [Accepted: 12/14/2015] [Indexed: 11/24/2022]
Abstract
Posttraumatic Stress Disorder (PTSD) is frequently comorbid with alcohol use disorders (AUD; Calabrese et al., 2011; McFall, Mackay, & Donovan, 1992). Among several explanations for this comorbidity, the most empirically supported is the self-medication theory which postulates that substances are used to medicate PTSD-related distress (Keane & Wolfe, 1990; Khantzian, 1985; Stewart, 1996). The current study examines the effects of trauma-related distress on alcohol use (total drinking days, drinks per drinking day, heavy drinking days) in a sample of 127 trauma-exposed Veterans following deployment to Iraq or Afghanistan. The dysphoria symptoms of PTSD were used as an indicator of distress, and examined as a moderator in the relationship between intrusion symptoms of PTSD and alcohol use. The proposed moderation model was tested using cross-sectional data from the first month following return from deployment, and at 6 months and at 12 months post-deployment. Results showed that dysphoria symptoms significantly moderated relations between intrusions and total drinking days and heavy drinking days at one month post-deployment; however, a significant pattern was not demonstrated at 6 months and 12 months. Further, dysphoria did not moderate the relation between intrusion symptoms and drinks per drinking day at the three time points. Theoretical and clinical implications are subsequently discussed.
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48
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Zhou X, Wu X. The relationship between rumination, posttraumatic stress disorder, and posttraumatic growth among Chinese adolescents after earthquake: A longitudinal study. J Affect Disord 2016; 193:242-8. [PMID: 26773915 DOI: 10.1016/j.jad.2015.12.076] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/09/2015] [Accepted: 12/30/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) can coexist in individuals following traumatic experiences, and cognitive pathways to PTSD and PTG can be different. Nevertheless, to date, no study using the longitudinal-design has examine the cognitive process of PTSD and PTG, nor has the specific causal relation between cognitive factors and PTSD/PTG been clarified in the aftermath of disaster. Therefore, the aim of this study was to extend previous study from a longitudinal perspective, and further examine the possible cognitive mechanism of PTSD and PTG in a long-time frame after earthquake. METHODS 310 middle school students in Lushan County were assessed using the Event-Related Rumination Inventory, the Post-Traumatic Growth Inventory and the Child PTSD Symptom Scale at 6 months (T1), 12 months (T2) and 18 months (T3) after the Ya'an earthquake. RESULTS Intrusive rumination at T2 partly mediated the relationship of intrusive rumination at T1 to PTSD but not PTG at T3. Deliberate rumination at T2 did not mediate the relationship of intrusive rumination at T1 and PTG/PTSD at T3 but completely mediated the relation of intrusive rumination at T2 and PTSD/PTG at T3. LIMITATIONS All variables were measured by self-report scales. CONCLUSIONS Intrusive rumination at T1 had an effect on PTSD but not PTG at T3 through intrusive rumination at T2, and it could affect PTSD and PTG at T3 through deliberate rumination at T2. These results suggest that PTSD and PTG are influenced by different mechanisms and that intrusive rumination leads to PTSD, whereas deliberate rumination elicits PTG in a long time after trauma.
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Affiliation(s)
- Xiao Zhou
- Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, No. 19 Xinjiekouwai Street, Beijing 100875, China
| | - Xinchun Wu
- Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, No. 19 Xinjiekouwai Street, Beijing 100875, China.
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Latent dimensions of posttraumatic stress disorder and their relations with alcohol use disorder. Soc Psychiatry Psychiatr Epidemiol 2016; 51:421-9. [PMID: 26520448 DOI: 10.1007/s00127-015-1135-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 10/13/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The objective of this study was to evaluate the relationship between factors of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) using confirmatory factor analysis (CFA) in order to further our understanding of the substantial comorbidity between these two disorders. METHODS CFA was used to examine which factors of PTSD's dysphoria model were most related to AUD in a military sample. Ohio National Guard soldiers with a history of overseas deployment participated in the survey (n = 1215). Participants completed the PTSD Checklist and a 12-item survey from the National Survey on Drug Use used to diagnosis AUD. RESULTS The results of the CFA indicated that a combined model of PTSD's four factors and a single AUD factor fit the data very well. Correlations between PTSD's factors and a latent AUD factor ranged from correlation coefficients of 0.258-0.285, with PTSD's dysphoria factor demonstrating the strongest correlation. However, Wald tests of parameter constraints revealed that AUD was not more correlated with PTSD's dysphoria than other PTSD factors. CONCLUSIONS All four factors of PTSD's dysphoria model demonstrate comparable correlations with AUD. The role of dysphoria to the construct of PTSD is discussed.
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50
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Liu L, Wang L, Cao C, Qing Y, Armour C. Testing the dimensional structure of DSM-5 posttraumatic stress disorder symptoms in a nonclinical trauma-exposed adolescent sample. J Child Psychol Psychiatry 2016; 57:204-12. [PMID: 26358088 DOI: 10.1111/jcpp.12462] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The current study investigated the underlying dimensionality of DSM-5 posttraumatic stress disorder (PTSD) symptoms in a trauma-exposed Chinese adolescent sample using a confirmatory factor analytic (CFA) alternative model approach. METHODS The sample consisted of 559 students (242 females and 314 males) ranging in age from 12 to 18 years (M = 15.8, SD = 1.3). Participants completed the PTSD Checklist for DSM-5, the Major Depression Disorder and Panic Disorder subscales of the Revised Children's Anxiety and Depression Scale, and the Aggressive Behavior subscale of the Youth Self-Report. RESULTS Confirmatory factor analytic results indicated that a seven-factor model comprised of intrusion, avoidance, negative affect, anhedonia, externalizing behavior, anxious arousal, and dysphoric arousal factors emerged as the best-fitting model. Further analyses showed that the external measures of psychopathological variables including major depressive disorder, panic disorder, and aggressive behavior were differentially associated with the resultant factors. CONCLUSIONS These findings support and extend previous findings for the newly refined seven-factor hybrid model, and carry clinical and research implications for trauma-related psychopathology.
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Affiliation(s)
- Liyong Liu
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China.,Center for Disease Control and Prevention of Shijingshan District, Beijing, China
| | - Li Wang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Chengqi Cao
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Yulan Qing
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Cherie Armour
- Psychology Research Institute, Ulster University, Coleraine, UK
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