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Zhao YJ, Zhang C, Guo T, Sha S, Su Z, Cheung T, Jackson T, An FR, Xiang YT. Associations between post-traumatic stress symptoms and quality of life among psychiatric healthcare personnel in China during the COVID-19 pandemic: A network approach. Front Psychiatry 2023; 14:975443. [PMID: 36873200 PMCID: PMC9975756 DOI: 10.3389/fpsyt.2023.975443] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 01/10/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Post-traumatic stress symptoms (PTSS) are commonly reported by psychiatric healthcare personnel during the coronavirus disease 2019 (COVID-19) pandemic and negatively affect quality of life (QOL). However, associations between PTSS and QOL at symptom level are not clear. This study examined the network structure of PTSS and its connection with QOL in psychiatric healthcare personnel during the COVID-19 pandemic. METHODS This cross-sectional study was carried out between March 15 and March 20, 2020 based on convenience sampling. Self-report measures including the 17-item Post-Traumatic Stress Disorder Checklist - Civilian version (PCL-C) and World Health Organization Quality of Life Questionnaire - Brief Version (WHOQOL-BREF) were used to measure PTSS and global QOL, respectively. Network analysis was used to investigate the central symptoms of PTSS and pattern of connections between PTSS and QOL. An undirected network was constructed using an extended Bayesian Information Criterion (EBIC) model, while a directed network was established based on the Triangulated Maximally Filtered Graph (TMFG) method. RESULTS Altogether, 10,516 psychiatric healthcare personnel completed the assessment. "Avoidance of thoughts" (PTSS-6), "Avoidance of reminders" (PTSS-7), and "emotionally numb" (PTSS-11) were the most central symptoms in the PTSS community, all of which were in the Avoidance and Numbing domain. Key bridge symptoms connecting PTSS and QOL were "Sleep disturbances" (PTSS-13), "Irritability" (PTSS-14) and "Difficulty concentrating" (PTSS-15), all of which were within the Hyperarousal domain. CONCLUSION In this sample, the most prominent PTSS symptoms reflected avoidance while symptoms of hyper-arousal had the strongest links with QOL. As such, these symptom clusters are potentially useful targets for interventions to improve PTSS and QOL among healthcare personnel at work under pandemic conditions.
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Affiliation(s)
- Yan-Jie Zhao
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Cheng Zhang
- Yong Ding Lu Outpatient Department, Jingnan Medical Area, Chinese PLA General Hospital, Beijing, China
| | - Tong Guo
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Sha Sha
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Zhaohui Su
- School of Public Health, Southeast University, Nanjing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Todd Jackson
- Department of Psychology, University of Macau, Taipa, Macao SAR, China
| | - Feng-Rong An
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Taipa, Macao SAR, China
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DSM-5 Posttraumatic Stress Disorder Symptoms in Nonclinical Samples of Chinese and Pakistani Trauma-Exposed Adults: Factor Structure and Invariance Across Culture. J Nerv Ment Dis 2022; 210:439-445. [PMID: 35640065 DOI: 10.1097/nmd.0000000000001515] [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] [Indexed: 11/25/2022]
Abstract
The purpose of the current study was to examine the latent structure and cross-cultural measurement validity of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) posttraumatic stress disorder (PTSD) symptoms assessed by the PTSD Checklist for DSM-5. Participants comprised trauma-exposed Chinese and Pakistani undergraduate students (N = 495 and N = 186, respectively). Confirmatory factor analysis (CFA) indicated that a seven-factor hybrid model involving intrusion, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal factors provided good fit in both samples. This model fit significantly better than three alternative models including the DSM-5 four-factor model and six-factor anhedonia and externalizing behaviors models. The subsequent multigroup CFA showed that the best-fitting hybrid model demonstrated cross-cultural measurement invariance. Our findings provide further empirical support for the seven-factor PTSD hybrid model and its cross-cultural invariance, and have implications for understanding and application of DSM-5's PTSD symptoms.
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Chen W, Gao R, Yang T. Factor Structure and Psychometric Properties for the PTSD Checklist of Chinese Adolescents in the Closed Period after the COVID-19 Outbreak. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12245. [PMID: 34832000 PMCID: PMC8623554 DOI: 10.3390/ijerph182212245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022]
Abstract
After COVID-19 appeared in China in December 2019, the mental health of adolescents, as a vulnerable group in public health emergencies, was negatively affected by the epidemic and the unprecedented prevention and control measures. The purpose of this study was to investigate the factor structure and psychometric properties of the Posttraumatic Stress Disorder (PTSD) Checklist (PCL) among Chinese adolescents. A total of 915 participants completed the PTSD. Confirmatory factor analyses (CFAs) and multi-group CFAs were used to test the factor structure and psychometric properties of PTSD. The CFA results showed that five-factor PCL was the optimal fitting model with satisfactory reliability and validity; moreover, it was suggested that the properties of PCL were invariant across gender, PTSD and asymptomatic groups, early and late adolescents, as well as over time. In summary, PCL is applicable among Chinese adolescents and can be used for effective measurement of PTSD caused by epidemics and to conduct cross-group studies.
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Affiliation(s)
- Wei Chen
- School of Psychology, Guizhou Normal University, Guiyang 550025, China; (R.G.); (T.Y.)
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Li G, Wang L, Cao C, Fang R, Liu P, Luo S, Zhang J, Hall BJ, Elhai JD. DSM-5 posttraumatic stress symptom dimensions and health-related quality of life among Chinese earthquake survivors. Eur J Psychotraumatol 2018; 9:1468710. [PMID: 29736219 PMCID: PMC5933284 DOI: 10.1080/20008198.2018.1468710] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/01/2018] [Indexed: 01/06/2023] Open
Abstract
It has been well-documented that posttraumatic stress symptoms cause impairments in health-related quality of life (HRQoL). Until now we have little data on how DSM-5 PTSD symptom dimensions relate to different aspects of HRQoL. Clarifying this question would be informative to improve the quality of life of PTSD patients. This study aimed to investigate the effects of dimensions of a well-supported seven-factor model of DSM-5 PTSD symptoms on physical and psychosocial HRQoL. A total of 1063 adult survivors of the 2008 Wenchuan earthquake took part in this study nine years after the disaster. PTSD symptoms were measured by the PTSD Checklist for DSM-5 (PCL-5). HRQoL was measured by the Medical Outcomes Survey Short Form-36 (SF-36). The associations between PTSD symptom dimensions and HRQoL were examined using structural equation models. Dysphoric arousal symptoms were found to significantly relate to physical HRQoL. Other symptom dimensions were not associated with HRQoL. Our findings contribute to the relationship between DSM-5 PTSD and HRQoL, and carry implications for further clinical practice and research on trauma-exposed individuals.
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Affiliation(s)
- Gen Li
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Li Wang
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Chengqi Cao
- College of Psychology and Sociology, Shenzhen University, Shenzhen, China
| | - Ruojiao Fang
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Ping Liu
- Department of Psychosomatic Medicine, People's Hospital of Deyang City, Deyang, China
| | - Shu Luo
- Department of Psychosomatic Medicine, People's Hospital of Deyang City, Deyang, China
| | - Jianxin Zhang
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Brain J Hall
- Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, University of Macau, Taipa, Macau (SAR) China.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jon D Elhai
- Department of Psychology, University of Toledo, Toledo, OH, USA.,Department of Psychiatry, University of Toledo, Toledo, OH, USA
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5
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Reward deficiency and anti-reward in pain chronification. Neurosci Biobehav Rev 2016; 68:282-297. [DOI: 10.1016/j.neubiorev.2016.05.033] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 05/26/2016] [Accepted: 05/27/2016] [Indexed: 12/12/2022]
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Armour C, Műllerová J, Elhai JD. A systematic literature review of PTSD's latent structure in the Diagnostic and Statistical Manual of Mental Disorders: DSM-IV to DSM-5. Clin Psychol Rev 2015; 44:60-74. [PMID: 26761151 DOI: 10.1016/j.cpr.2015.12.003] [Citation(s) in RCA: 169] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 11/20/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
Abstract
The factor structure of posttraumatic stress disorder (PTSD) has been widely researched, but consensus regarding the exact number and nature of factors is yet to be reached. The aim of the current study was to systematically review the extant literature on PTSD's latent structure in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in order to identify the best-fitting model. One hundred and twelve research papers published after 1994 using confirmatory factor analysis and DSM-based measures of PTSD were included in the review. In the DSM-IV literature, four-factor models received substantial support, but the five-factor Dysphoric arousal model demonstrated the best fit, regardless of gender, measurement instrument or trauma type. The recently proposed DSM-5 PTSD model was found to be a good representation of PTSD's latent structure, but studies analysing the six- and seven-factor models suggest that the DSM-5 PTSD factor structure may need further alterations.
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Affiliation(s)
- Cherie Armour
- School of Psychology, Ulster University, Coleraine, Northern Ireland, UK.
| | - Jana Műllerová
- School of Psychology, Ulster University, Coleraine, Northern Ireland, UK
| | - Jon D Elhai
- Department of Psychology, University of Toledo, Toledo, OH, USA; Department of Psychiatry, University of Toledo, Toledo, OH, USA
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Zelazny K, Simms LJ. Confirmatory factor analyses of DSM-5 posttraumatic stress disorder symptoms in psychiatric samples differing in Criterion A status. J Anxiety Disord 2015; 34:15-23. [PMID: 26103594 DOI: 10.1016/j.janxdis.2015.05.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 04/22/2015] [Accepted: 05/15/2015] [Indexed: 11/27/2022]
Abstract
We examined the symptom structure of posttraumatic stress disorder (PTSD), as defined by American Psychiatric Association (2013. Diagnostic and statistical manual of mental disorders (DSM-5) (5th ed.). Washington, DC: Author). DSM-5 introduced notable changes to PTSD criteria, and the structural impact of these changes is unclear. We conducted confirmatory factor analyses comparing seven commonly investigated or recently proposed PTSD models in a large sample of interviewed psychiatric outpatients reporting a Criterion A trauma (n = 310) or a sub-threshold (non-Criterion A) stressful life event (n = 284). A novel six-factor dysphoria model and recently proposed seven-factor hybrid model outperformed other models and fit the data equally well in both groups. Our results suggest equal fit for both models, although the six-factor model is more parsimonious. These results have implications for research regarding the mechanisms underlying and the treatments targeting PTSD.
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Affiliation(s)
- Kerry Zelazny
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, NY 14260, USA.
| | - Leonard J Simms
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, NY 14260, USA
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Assessing Latent Level Associations Between PTSD and Dissociative Factors: Is Depersonalization and Derealization Related to PTSD Factors More So than Alternative Dissociative Factors? PSYCHOLOGICAL INJURY & LAW 2014. [DOI: 10.1007/s12207-014-9196-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Liu P, Wang L, Cao C, Wang R, Zhang J, Zhang B, Wu Q, Zhang H, Zhao Z, Fan G, Elhai JD. The underlying dimensions of DSM-5 posttraumatic stress disorder symptoms in an epidemiological sample of Chinese earthquake survivors. J Anxiety Disord 2014; 28:345-51. [PMID: 24792723 DOI: 10.1016/j.janxdis.2014.03.008] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/22/2014] [Accepted: 03/25/2014] [Indexed: 11/19/2022]
Abstract
The current study investigated the underlying dimensions of DSM-5 PTSD symptoms in an epidemiological sample of Chinese earthquake survivors. The sample consisted of 810 females and 386 males, with a mean age of 47.9 years (SD=10.0, range: 16-73). PTSD symptoms were assessed using the PTSD Checklist for DSM-5, and alternative models were evaluated with confirmatory factor analysis. Results indicated that a six-factor model comprised of intrusion, avoidance, negative affect, anhedonia, dysphoric arousal, and anxious arousal factors emerged as the best fitting model. The current findings add to limited literature on the latent structure of PTSD symptoms described in the recently released DSM-5, and carry implications for further trauma-related research and clinical practice.
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Affiliation(s)
- Ping Liu
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Graduate University of Chinese Academy of Sciences, Beijing, China; People's Hospital of Deyang City, Deyang, Sichuan, 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; Graduate University of Chinese Academy of Sciences, Beijing, China
| | - Richu Wang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Graduate University of Chinese Academy of Sciences, Beijing, China
| | - Jianxin Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Biao Zhang
- People's Hospital of Deyang City, Deyang, Sichuan, China
| | - Qi Wu
- People's Hospital of Deyang City, Deyang, Sichuan, China
| | - Hong Zhang
- People's Hospital of Deyang City, Deyang, Sichuan, China
| | - Zhihong Zhao
- Hanwang People's Hospital, Deyang, Sichuan, China
| | - Gaolin Fan
- Hanwang People's Hospital, Deyang, Sichuan, China
| | - Jon D Elhai
- Department of Psychology, University of Toledo, Toledo, USA; Department of Psychiatry, University of Toledo, Toledo, USA
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The dimensional structure of posttraumatic stress symptomatology in 323,903 U.S. veterans. J Psychiatr Res 2014; 49:31-6. [PMID: 24275548 DOI: 10.1016/j.jpsychires.2013.10.020] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 10/28/2013] [Accepted: 10/31/2013] [Indexed: 10/26/2022]
Abstract
There is ongoing debate regarding the optimal dimensional structure of posttraumatic stress disorder symptomatology. A better understanding of this structure has significant implications, as it can provide more refined phenotypic measures for use in studies of the etiology and neurobiology of PTSD, as well as for use as endpoints in treatment studies of this disorder. In this study we analyzed the dimensional structure of PTSD symptomatology, as assessed using the PTSD Symptom Checklist-Military Version in 323,903 Veterans. Confirmatory factor analyses were used to compare two 4-factor models and a newly proposed 5-factor model to the 3-factor DSM-IV model of PTSD symptom dimensionality. To evaluate the external validity of the best-fitting model, we then conducted a structural equation model examining how the symptom dimensions of this model related to diagnoses of depression, anxiety, and substance use disorder. Results indicated that a newly proposed 5-factor 'dysphoric arousal' model comprised of separate re-experiencing, avoidance, numbing, dysphoric arousal, and anxious arousal symptom clusters provided a significantly better fit to the data compared to the DSM-IV and the two alternative four-factor models. External validity analyses revealed that numbing symptoms were most strongly related to diagnoses of depression and substance use disorder, and that dysphoric arousal symptoms were most strongly related to a diagnosis of anxiety disorder. Thus the dimensional structure of PTSD may be best represented by five symptom dimensions. The clinical implications of these results and implications for further refinement of extant PTSD assessment instruments are discussed.
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Examining the relation between the serotonin transporter 5-HTTPLR genotype x trauma exposure interaction on a contemporary phenotypic model of posttraumatic stress symptomatology: a pilot study. J Affect Disord 2013; 148. [PMID: 23183127 PMCID: PMC3604029 DOI: 10.1016/j.jad.2012.11.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Little is known about the specificity of the interaction of serotonin transporter 5-HTTLPR genotype x trauma exposure in relation to contemporary structural models of PTSD symptomatology, which suggest that 4- or 5-factor models provide a better representation of the phenotypic expression of this disorder. METHODS One hundred forty-nine respondents of a representative sample of adults affected by Hurricane Ike were interviewed 2-5 months after this 2008 disaster. RESULTS After adjustment for age, sex, and ancestral proportion scores, the interaction of 5-HTTPLR genotype x trauma exposure was significantly associated with both severity (β=.40, p<.001) and probable diagnosis (Wald=4.55, p=.033; odds ratio=3.81, 95% CI=1.11-13.03) of Ike-related PTSD. Respondents with the low-expression variant of the 5-HTTPLR polymorphism (S allele carriers) who were highly exposed to Hurricane Ike reported significantly greater severity of PTSD symptoms and were more likely to screen positive for PTSD than respondents homozygous for the L allele who were highly exposed to Hurricane Ike. Confirmatory factor analyses revealed that a 5-factor model of intercorrelated re-experiencing, avoidance, numbing, dysphoric arousal, and anxious arousal symptoms provided the best structural representation of PTSD symptomatology. The 5-HTTPLR genotype x exposure interaction was significant only for anxious arousal (β=.44, p<.001) and re-experiencing (β=.35, p<.001) symptoms, but not avoidance, numbing, or dysphoric arousal symptoms (all βs≤.20, all ps>.13). LIMITATIONS The small sample size and employment of self-report measures may limit generalizability of these findings. CONCLUSIONS Results of this pilot study suggest that the low-expression variant of the 5-HTTLPR polymorphism modifies risk for PTSD, but that this effect may be specific to anxious arousal and re-experiencing symptoms.
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