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Puhalla A, Sullivan C, Chard K, Dickstein B, Hoge CW. An examination of the potential core symptoms of posttraumatic stress disorder: What is integral after removing general psychopathology & distress? J Psychiatr Res 2024; 174:46-53. [PMID: 38613942 DOI: 10.1016/j.jpsychires.2024.04.015] [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] [Received: 12/16/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/15/2024]
Abstract
Many confirmatory factor analyses (CFA) have examined the structure of posttraumatic stress disorder (PTSD) with some suggesting increased complexity (i.e., 6+ factors), while others suggesting a more refined structure (i.e., 2-factors). These competing PTSD structures may be due to conflation of non-trauma specific symptoms that have been added overtime. However, none of these studies examined if all symptoms being examined are specific to PTSD or potentially more related to general distress and psychopathology. The current study re-evaluated the structure of PTSD using bifactor exploratory factor analysis (EFA) to identify the construct's core symptoms. Data for EFA models were taken from a sample of Veterans (N = 694) attending outpatient therapy for PTSD and were cross-validated using CFA in a sample of 297 Veterans attending residential treatment. Clinician Administered PTSD Scale for DSM-5 (CAPS-5) at pre-treatment was used across sample. Factor analyses resulted in a 2-factor, bifactor model comprised of eight total items. Model fit was robust, RMSEA = 0 [0.000, 0.036]; robust CFI = 1; robust TLI = 1.017. The bifactor analytic approach captured what might be the core structure of PTSD, which were pathognomonic symptoms of PTSD (Factor one). A distinct second factor related to depression was also found. In identifying this structure, the model eliminates redundancies and lesser performing items and differentiates depressive reactions as potentially distinct and separate. Overall, these findings may assist in future research of PTSD by determining the unique elements of the construct within a veteran sample versus associated features, general psychological distress, and comorbid psychopathology.
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Affiliation(s)
- Alexander Puhalla
- Department of Education & Research, Coatesville VA Medical Center, Coatesville, PA, USA.
| | - Connor Sullivan
- Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| | - Kathleen Chard
- Trauma Recovery Center Cincinnati VA Medical Center, Cincinnati, OH, USA; University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Benjamin Dickstein
- Trauma Recovery Center Cincinnati VA Medical Center, Cincinnati, OH, USA
| | - Charles W Hoge
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
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2
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Eilers R, Ertl V, Kasparik B, Kost A, Rosner R. [Posttraumatic stress disorder in children and adolescents: results of a cross-sectional study on the effects of the newly formulated PTSD and CPTSD diagnoses in the ICD-11]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:409-418. [PMID: 38498186 PMCID: PMC10995073 DOI: 10.1007/s00103-024-03860-2] [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: 10/03/2023] [Accepted: 02/27/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND ICD-11 presents narrowed criteria for posttraumatic stress disorder (PTSD) and introduces complex PTSD (CPTSD) with additional difficulties in self-organization (DSO). These changes can have significant effects on the frequency of the diagnosis. The aim of this study was to investigate which ICD-11 symptom clusters cause children and adolescents to miss the diagnosis and whether caregivers are more likely to attribute changes in DSO to developmental level or to the traumatic event, and how these attributions are in turn related to symptom severity. METHODS N = 88 German-speaking children and adolescents (age: 7-17 years) after traumatic events and N = 79 caregivers participated between September 2019 and November 2020 in a survey on PTSD symptom severity (CATS-2) and attribution of DSO symptoms (caregiver questionnaire). RESULTS The ICD-11 criteria (CATS‑2 and a developmentally adapted version) showed lower frequency rates for PTSD as compared to DSM‑5 and ICD-10. The ICD-11 clusters re-experiencing and hyperarousal were met the least often. Changes in DSO symptoms were predominantly rated as event-related. This attribution was associated with higher PTSD and DSO symptom severity in caregiver reports. The age-related attribution was associated with higher DSO-symptom severity, but not PTSD symptom severity in caregiver reports. DISCUSSION In the context of the diagnostic process and the revision of diagnostic instruments for ICD-11 (C)PTSD, development-specific symptoms should be taken into account. The trauma-related differentiation of DSO symptom changes as compared to development-related fluctuations is challenging and therefore requires several sources of information.
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Affiliation(s)
- Rebekka Eilers
- Institut für Psychologie, Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Deutschland
| | - Verena Ertl
- Institut für Psychologie, Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Deutschland.
- Katholische Universität Eichstätt-Ingolstadt, Ostenstr. 25, 85072, Eichstätt, Deutschland.
| | - Barbara Kasparik
- Institut für Psychologie, Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Deutschland
| | - Anne Kost
- Altonaer Kinderkrankenhaus, Kinder- und Jugendsomatik, Hamburg, Deutschland
| | - Rita Rosner
- Institut für Psychologie, Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Deutschland
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3
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Wang L, Fang R, Chen C, Cao C. A comparison of ICD-11 and DSM-5 criteria of PTSD among Chinese trauma-exposed adolescent samples. Front Psychiatry 2023; 14:1186138. [PMID: 37383620 PMCID: PMC10293836 DOI: 10.3389/fpsyt.2023.1186138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/23/2023] [Indexed: 06/30/2023] Open
Abstract
This study aimed at comparing the prevalence and comorbidity differences of PTSD according to ICD-11 and DSM-5 definitions across two Chinese adolescent trauma-exposed samples. A total of 1,201 students exposed to earthquake and 559 students from vocational schools exposed to potentially traumatic events were included in this study. The PTSD Checklist for DSM-5 was used to measure PTSD symptoms. The MDD and GAD subscales of the Revised Children's Anxiety and Depression Scale were used to measure major depression disorder (MDD) and generalized anxiety disorder (GAD) symptoms. No significant PTSD prevalence differences between ICD-11 and DSM-5 were found across the two samples. The differences regarding comorbidities between ICD-11 and DSM-5 definitions were not significant among these two samples. The results revealed that the ICD-11 and DSM-5 provided similar prevalence of PTSD and comorbidity rates with MDD and GAD in Chinese trauma-exposed adolescent samples. This study contributes to the current understanding of the similarities and differences using different PTSD criteria and informs the organization and application of these two globally applied PTSD criteria.
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Affiliation(s)
- 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
| | - 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
| | - Chen Chen
- 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
- 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
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Fien S, Lawes JC, Ledger J, Drummond M, Simon P, Joseph N, Daw S, Best T, Stanton R, de Terte I. A preliminary study investigating the neglected domain of mental health in Australian lifesavers and lifeguards. BMC Public Health 2023; 23:1036. [PMID: 37259042 DOI: 10.1186/s12889-023-15741-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/24/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Surf lifesavers and lifeguards have provided essential education, preventative, and rescue services to the Australian community for over 110 years. In this first responder role, surf lifesavers and lifeguards are inadvertently exposed to high risk and trauma related experiences, which may negatively impact mental well-being. To date however, there has been limited research into the mental health of surf lifesavers and lifeguards, and no studies at all on the mental health of adolescent surf lifesavers. The preliminary study aimed to measure the exposure of potentially traumatic events (PTEs), post-traumatic stress symptoms (PTSS), self-efficacy, social support, and attitudes towards mental health problems in Surf Life Saving (SLS) members. METHODS An anonymous, online survey was developed (adolescent and adult versions) and created to measure the domain of mental health in surf lifesavers and lifeguards. Pearson's correlations investigated relationships between PTEs, PTSS, self-efficacy, social support, attitudes towards mental health problems, age, years as a SLS member, and years patrolling. Spearman's Rank was used for violations of normality. RESULTS A total of 57 surf lifesavers/lifeguards aged 13-59 years were included in the final analysis. There was a significant positive relationship between exposure to direct trauma and PTSS, which in turn, were associated with greater negative attitudes towards mental health problems towards the mental health of others, and lower levels of self-efficacy. Male and female adults with PTSS reported lower social support, whereas for adolescent males, a positive relationship between direct trauma and PTSS was observed. CONCLUSION This research is the first to explore the mental health of Australian surf lifesavers and lifeguards. The results highlight the potential risks to mental health and well-being associated with this first responder role. More research to protect the vulnerability of this population is warranted.
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Affiliation(s)
- Samantha Fien
- School of Health, Medical and Applied Sciences, Central Queensland University, Mackay, QLD, Australia.
- Research Cluster for Resilience and Wellbeing, Appleton Institute, Wayville, South, Australia.
- School of Health, Medical and Applied Sciences, Central Queensland University, Building 4, Room G.33, Mackay City Campus, Sydney Street, Mackay, Mackay, QLD, 4740 P +61 7, 4940 3430E, Australia.
| | - Jasmin C Lawes
- Surf Life Saving Australia, Bondi Beach, Sydney, NSW, Australia
| | - Jessica Ledger
- Surf Life Saving Australia, Bondi Beach, Sydney, NSW, Australia
| | - Murray Drummond
- College of Education, Psychology and Social Work, SHAPE Research Centre, Flinders University, Adelaide, Health, Australia
| | - Pamela Simon
- Surf Life Saving Australia, Bondi Beach, Sydney, NSW, Australia
| | - Nancy Joseph
- Surf Life Saving Australia, Bondi Beach, Sydney, NSW, Australia
| | - Shane Daw
- Surf Life Saving Australia, Bondi Beach, Sydney, NSW, Australia
| | - Talitha Best
- Research Cluster for Resilience and Wellbeing, Appleton Institute, Wayville, South, Australia
- School of Health, Medical and Applied Sciences, NeuroHealth Lab, Appleton Institute, Central Queensland University, Brisbane, QLD, Australia
| | - Robert Stanton
- Research Cluster for Resilience and Wellbeing, Appleton Institute, Wayville, South, Australia
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Ian de Terte
- School of Psychology, Massey University, Wellington, New Zealand
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5
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Unaccompanied foreign minors and mental health: Implementation and evaluation of the RHS-15 screening procedure for unaccompanied foreign minors. J Migr Health 2023; 7:100177. [PMID: 36968561 PMCID: PMC10033743 DOI: 10.1016/j.jmh.2023.100177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/01/2023] [Accepted: 03/08/2023] [Indexed: 03/19/2023] Open
Abstract
Background and objective The recent notable increase in refugees' flows, with refugee children and adolescents relocating worldwide, posed severe challenges to the different national healthcare systems. Social groups such as refugees fleeing from their countries because of persecution, wars and violence are considered at high risk of developing mental health-related problems. Despite international and national policies legally regulating the reception process and protecting health-related rights, including the mental well-being of refugee migrants, there is a theoretical and applied need for evidence-based instruments and procedures to support mental health within this population. Recent evidence refers to the Refugee Health Screener-15 (RHS-15) as a reliable and valid instrument for the early detection of trauma-related mental health problems. In this scenario, this study aimed to test the RHS screening process within a multidisciplinary first intervention reception context for unaccompanied refugee minors. Design The RHS-15 was administered with the support of cultural-linguistic mediators to 81 unaccompanied minor residents in a first intervention facility in Milan, Italy. This study aimed to assess psychometric characteristics, such as reliability, sensitivity and specificity feasibility and its implementation within a first intervention reception process. Results The analysis resulted in the validation of the RHS in its 13-item format. The results highlighted and confirmed an efficient delivery, excellent reliability and a positive predictive and convergent validity of the 13-item version. Further analysis showed an excellent ability to avoid false negatives, although there was a clear tendency to identify false positives. Conclusions The early identification of vulnerabilities among refugee minors is recommended to promote their long-term overall well-being. Integrating the screening results with additional observational elements and more specific diagnostic tools is recommended to gain a comprehensive perspective of the minors' well-being.
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Newnham EA, Gao X, Guragain B, Jiao F, Nathan E, Boyes M, Leaning J. Daily stressors and mental health following disaster: A school-based assessment of adolescent disaster survivors in China and Nepal. J Trauma Stress 2022; 35:1721-1733. [PMID: 36067255 PMCID: PMC10087694 DOI: 10.1002/jts.22876] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/05/2022] [Accepted: 07/04/2022] [Indexed: 12/30/2022]
Abstract
Postdisaster daily stressors, the economic and social challenges caused or exacerbated by disasters, have significant consequences for mental health but are rarely investigated in child and adolescent populations. We assessed posttraumatic stress symptoms (PTSS), depression, and anxiety among adolescents affected by disasters in China and Nepal and examined the specific contributions of disaster-related trauma exposure and daily stressors across mental health outcomes. A school-based, cross-sectional study was conducted with a stratified random sampling design. Adolescents living in disaster-affected areas of southern China and Nepal (N = 4,215, 52.7% female, age range: 15-19 years) completed translated, validated measures. Mixed effects logistic regression analyses were conducted using a priori risk factors. PTSS were reported by 22.7% of participants and were higher among Nepali adolescents but did not differ between genders. Depressive symptoms were reported by 45.2% of the sample and were higher among Nepali adolescents and girls in both countries. Across all settings, disaster-related trauma exposure was a significant risk factor for PTSS, depressive, and anxiety symptoms, China: odds ratios (ORs) = 1.44-2.06, Nepal, ORs = 1.21-2.53. High levels of household and interpersonal daily stressors further improved the models and contributed significantly to all mental health difficulties, China: ORs = 1.77-1.98, Nepal: ORs = 1.49-1.90. Postdisaster economic insecurity and interpersonal stressors are thus, likely to worsen adolescent mental health outcomes. Programs that identify and address structural inequalities for adolescents in disaster-affected settings will have cascading effects for mental health.
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Affiliation(s)
- Elizabeth A Newnham
- School of Population Health, Curtin University, Perth, Australia.,FXB Center for Health and Human Rights, Harvard University, Boston, Massachusetts, USA.,Curtin enAble Institute, Curtin University, Perth, Australia
| | - Xue Gao
- School of Population Health, Curtin University, Perth, Australia
| | | | - Feng Jiao
- Public Health School, Kunming Medical University, Kunming City, China
| | - Elizabeth Nathan
- Women and Infants' Research Foundation, Perth, Australia.,Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Australia
| | - Mark Boyes
- School of Population Health, Curtin University, Perth, Australia.,Curtin enAble Institute, Curtin University, Perth, Australia
| | - Jennifer Leaning
- FXB Center for Health and Human Rights, Harvard University, Boston, Massachusetts, USA
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7
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Ho GWK, Liu H, Karatzias T, Hyland P, Cloitre M, Lueger-Schuster B, Brewin CR, Guo C, Wang X, Shevlin M. Validation of the International Trauma Questionnaire-Child and Adolescent Version (ITQ-CA) in a Chinese mental health service seeking adolescent sample. Child Adolesc Psychiatry Ment Health 2022; 16:66. [PMID: 35962396 PMCID: PMC9375312 DOI: 10.1186/s13034-022-00497-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/13/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The International Trauma Questionnaire-Child and Adolescent version (ITQ-CA) is a self-report measure that assesses posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) based on the diagnostic formulation of the 11th version of the International Classification of Diseases (ICD-11). This study aimed to provide a Chinese translation and psychometric evaluation of the ITQ-CA using a sample of mental-health service seeking adolescents in Mainland China. METHODS The ITQ-CA was translated and back-translated from English to simplified Chinese and finalized with consensus from an expert panel. Adolescents ages 12-17 were recruited via convenience sampling from an outpatient psychiatric clinic in Mainland China. Participants completed the ITQ-CA; measures of four criterion variables (depression, anxiety, stress, adverse childhood experiences); and the PTSD Checklist for DSM-5 (PCL-5). Construct validity, concurrent validity, and comparison of PTSD caseness between ICD-11 and DSM-5 measures were assessed. RESULTS The final sample consisted of 111 Chinese adolescents (78% female; mean age of 15.23), all diagnosed with a major depressive disorder. Confirmatory factor analysis indicated the two-factor second-order model provided optimal fit. All criterion variables were positively and significant correlated with the six ITQ-CA symptom cluster summed scores. In the present sample, 69 participants (62.16%) met symptom criteria for ICD-PTSD or CPTSD using the ITQ-CA, and 73 participants (65.77%) met caseness for DSM-5 PTSD using the PCL-5. Rates of PTSD symptom cluster endorsement and caseness deriving from both diagnostic systems were comparable. CONCLUSIONS The Chinese ITQ-CA has acceptable psychometric properties and confers additional benefits in identifying complex presentations of trauma-related responses in younger people seeking mental health services.
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Affiliation(s)
- G. W. K. Ho
- grid.16890.360000 0004 1764 6123School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - H. Liu
- grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China ,grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - T. Karatzias
- grid.20409.3f000000012348339XSchool of Health & Social Care, Edinburgh Napier University, Edinburgh, UK ,grid.39489.3f0000 0001 0388 0742Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
| | - P. Hyland
- grid.95004.380000 0000 9331 9029Maynooth University, Maynooth, Ireland
| | - M. Cloitre
- grid.168010.e0000000419368956Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, USA ,grid.280747.e0000 0004 0419 2556National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA USA
| | - B. Lueger-Schuster
- grid.10420.370000 0001 2286 1424Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
| | - C. R. Brewin
- grid.83440.3b0000000121901201Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - C. Guo
- grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China ,grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - X. Wang
- grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China ,grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - M. Shevlin
- grid.12641.300000000105519715School of Psychology, Ulster University, Derry, Northern Ireland
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Olin CC, McDevitt-Murphy ME, Leonard SJ, Acuff SF. Wanting, Liking, and Missing Out: Exploring the Role of Reward Functioning in the Overlap Between PTSD and Depression. J Nerv Ment Dis 2022; 210:497-503. [PMID: 35766543 DOI: 10.1097/nmd.0000000000001456] [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] [Indexed: 11/26/2022]
Abstract
ABSTRACT Diminished reward functioning (anhedonia) is an aspect of multiple psychiatric diagnoses and is a critical component of depression, yet it has rarely been examined in the context of posttraumatic stress disorder (PTSD). Deficits in reward function may be a transdiagnostic factor contributing to the high rate of comorbidity between PTSD and depression. The present study examined the commonality and distinction between PTSD and depression and their relationship to reward functioning using a bifactor model in a sample of 106 trauma-exposed undergraduates. Results indicated a strong commonality factor between PTSD and depression. Of three indices of reward functioning (i.e., hedonic pleasure, reward motivation, and environmental reward availability), environmental reward availability alone was related to unique latent factors for PTSD and depression, and their commonality. Findings suggest that environmental context may be the key to understanding the role of reward in PTSD, depression, and psychopathology broadly.
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Affiliation(s)
- Cecilia C Olin
- Department of Psychology, University of Memphis, Memphis, Tennessee
| | | | | | - Samuel F Acuff
- Department of Psychology, University of Memphis, Memphis, Tennessee
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9
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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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10
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Wang Y, Chen J, Liu X, Lin X, Sun Y, Wang N, Wang J, Luo F. The more mindfulness practice, the more post-trauma stress symptoms? Trait mindfulness and PTSS during the COVID-19 pandemic. CURRENT PSYCHOLOGY 2022:1-12. [PMID: 35309291 PMCID: PMC8923566 DOI: 10.1007/s12144-022-02964-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 11/23/2022]
Abstract
Investigating the contributing factors of post-traumatic stress symptoms (PTSS) has always been an important topic in the field of traumatic psychology research. The current study explored the influences of pandemic/epidemic experiences, meditation experiences, and trait mindfulness on PTSS and the mediating role of emotional resilience during the COVID-19 pandemic. A total of 522 participants in Hubei province completed the Five Facet Mindfulness Questionnaire, the Adolescents' Emotional Resilience Questionnaire, and the PTSD Checklist for DSM-5. The results showed that (1) participants who had family or friends diagnosed with COVID-19 scored higher on avoidance. (2) Participants who had family or friends had been diagnosed with SARS or H1N1 scored higher on PTSS. (3) Participants with meditation experience scored significantly higher on all dimensions of PTSS, other than avoidance. (4) The mediating role of recovering from negative emotions in the relationship between trait mindfulness and PTSS was significant (95%CI= [-0.212, -0.094]), while the generating positive emotion was not significant (95%CI= [-0.050, 0.071]). Individuals with pandemic/epidemic experience are more likely to have a high level of PTSS. Individuals who have meditation experience also express a higher level of PTSS, which may be a result of the quality of meditation. Trait mindfulness and the ability to recover from negative emotions were protective factors against PTSS.
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Affiliation(s)
- Yuzheng Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinses Academy of Science, Beijing, People’s Republic of China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, People’s Republic of China
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Jing Chen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinses Academy of Science, Beijing, People’s Republic of China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Xinya Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinses Academy of Science, Beijing, People’s Republic of China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Xiaoxiao Lin
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinses Academy of Science, Beijing, People’s Republic of China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Yabin Sun
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinses Academy of Science, Beijing, People’s Republic of China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Ning Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinses Academy of Science, Beijing, People’s Republic of China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Jinyan Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinses Academy of Science, Beijing, People’s Republic of China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Fei Luo
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinses Academy of Science, Beijing, People’s Republic of China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, People’s Republic of China
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11
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Krüger-Gottschalk A, Ehring T, Knaevelsrud C, Dyer A, Schäfer I, Schellong J, Rau H, Köhler K. Confirmatory factor analysis of the Clinician-Administered PTSD Scale (CAPS-5) based on DSM-5 vs. ICD-11 criteria. Eur J Psychotraumatol 2022; 13:2010995. [PMID: 35070160 PMCID: PMC8774060 DOI: 10.1080/20008198.2021.2010995] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Many studies have investigated the latent structure of the DSM-5 criteria for posttraumatic stress disorder (PTSD). However, most research on this topic was based on self-report data. We aimed to investigate the latent structure of PTSD based on a clinical interview, the Clinician-Administered PTSD Scale (CAPS-5). METHOD A clinical sample of 345 participants took part in this multi-centre study. Participants were assessed with the CAPS-5 and the Posttraumatic Stress Disorder Checklist (PCL-5). We evaluated eight competing models of DSM-5 PTSD symptoms and three competing models of ICD-11 PTSD symptoms. RESULTS The internal consistency of the CAPS-5 was replicated. In CFAs, the Anhedonia model emerged as the best fitting model within all tested DSM-5 models. However, when compared with the Anhedonia model, the non-nested ICD-11 model as a less complex three-factor solution showed better model fit indices. DISCUSSION We discuss the findings in the context of earlier empirical findings as well as theoretical models of PTSD.
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Affiliation(s)
| | - Thomas Ehring
- Department of Psychology, LMU Munich, Munich, Germany
| | - Christine Knaevelsrud
- Department of Clinical Psychology and Psychotherapy, Free University Berlin, Berlin, Germany
| | - Anne Dyer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Ingo Schäfer
- Centre for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Schellong
- Department of Psychotherapy and Psychosomatic Medicine, Technical University Dresden, Dresden, Germany
| | - Heinrich Rau
- German Armed Forces Center for Military Mental Health, German Armed Forces Hospital Berlin, Berlin, Germany
| | - Kai Köhler
- German Armed Forces Center for Military Mental Health, German Armed Forces Hospital Berlin, Berlin, Germany
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12
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Lu W, Yanos PT, Waynor W, Jia Y, Siriram A, Leong A, Gill K, Mueser KT. Psychometric properties of post-traumatic stress disorder (PTSD) checklist for DSM-5 in persons with serious mental illness. Eur J Psychotraumatol 2022; 13:2038924. [PMID: 35251532 PMCID: PMC8890571 DOI: 10.1080/20008198.2022.2038924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND PCL-5 is a self-report measure consisting of 20 items that are used to assess the symptoms of Post-Traumatic Stress Disorder (PTSD) according to the DSM-5. OBJECTIVE This study evaluated the factor structure of the Post-Traumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5) in people with serious mental illness. METHOD The sample in Study 1 included 536 participants with serious mental illness who were receiving supported employment services through community mental health agencies or supported housing programmes. Confirmatory factor analysis assessed the fit of six different models of PTSD. RESULTS Results indicated that Armour's Hybrid 7-factor model composed of re-experiencing, avoidance, dysphoria, dysphoric arousal, anxious arousal, negative affect, anhedonia, and externalizing behaviours demonstrated the best fit. Study 2 found support for convergent validity for PCL-5 among 132 participants who met criteria for PTSD. CONCLUSION Findings provide support for the psychometric properties of the PCL-5 and the conceptualization of the 7-factor hybrid model and the 4-factor DSM-5 model of PTSD among persons living with serious mental illness.
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Affiliation(s)
- Weili Lu
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Piscataway, NJ, USA
| | | | - William Waynor
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Piscataway, NJ, USA
| | - Yuane Jia
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Piscataway, NJ, USA
| | - Amanda Siriram
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Piscataway, NJ, USA
| | - Alyssa Leong
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Piscataway, NJ, USA
| | - Kenneth Gill
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Piscataway, NJ, USA
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13
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Oxytocin receptor variant rs53576 genotype is associated with dysphoric arousal symptoms of DSM-5 posttraumatic stress disorder in Chinese earthquake survivors. Chin J Traumatol 2021; 24:209-213. [PMID: 33863620 PMCID: PMC8343244 DOI: 10.1016/j.cjtee.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/27/2021] [Accepted: 03/20/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Evidence suggests that the oxytocin receptor (OXTR) gene may be involved in the psychopathology of posttraumatic stress disorder (PTSD). This study aimed to investigate the effects of OXTR rs53576 genotype on PTSD symptoms introduced in the Diagnostic and Statistical Manual, Fifth Edition (DSM-5). METHODS This study was a cross-sectional study conducted among 1140 adults who had personally experienced the Wenchuan earthquake. PTSD symptoms were measured with the PTSD checklist for DSM-5. A custom-by-design 2 × 48-Plex SNPscanTM Kit were used to determine the OXTR rs53576. Multiple regression models were used to analyze the independent and interactive effects of OXTR rs53576 genotype and earthquake exposure on the severity of total PTSD symptoms and different dimensions of PTSD symptoms. RESULTS The results revealed that the rs53576 genotype could significantly predict PTSD symptoms (β = 0.055, p = 0.045). Further analysis showed that the rs53576 genotype was only significantly associated with dysphoric arousal symptoms of PTSD (β = 0.080, p = 0.005). The rs53576 genotype × earthquake exposure interaction had no significant effect on different symptom clusters (p > 0.05). CONCLUSION This study showed that the rs53576 genotype was only associated with the dysphoric arousal symptoms but not with other symptom clusters of PTSD. These findings support the role of the OXTR on the psychopathology of PTSD and help us to understand the genetic basis of PTSD.
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14
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McKinnon A, Scheeringa MS, Meiser-Stedman R, Watson P, De Young A, Dalgleish T. The Dimensionality of Proposed DSM-5 PTSD Symptoms in Trauma-Exposed Young Children. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:1799-1809. [PMID: 31172404 PMCID: PMC6805819 DOI: 10.1007/s10802-019-00561-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
A subtype of the posttraumatic stress disorder diagnosis for children 6 years and younger (PTSD-6Y) was introduced in the Diagnostic and Statistical Manual, Fifth Edition (DSM-5). This study utilized confirmatory factor analytic techniques to evaluate the proposed DSM-5 PTSD-6Y factor structure and criterion and convergent validity against competing models. Data for N = 284 (3–6 years) trauma-exposed young children living in New Orleans were recruited following a range of traumas, including medical emergencies, exposure to Hurricane Katrina and repeated exposure to domestic violence. The model was compared to DSM-IV, a 4-factor ‘dysphoria’ model that groups symptoms also associated with anxiety and depression, and alternate 1- and 2- factor models. Convergent validity was established against the Child Behavior Checklist (CBCL). Criterion related validity was established by comparing each model to a categorical rating of impairment. The Dysphoria and PTSD-6Y models offered the better accounts of symptom structure, although neither satisfied minimum requirements for a good fitting model. These two models also only showed small levels of convergence with CBCL dimensions. The 1-factor model offered the most compelling balance of sensitivity and specificity, with the 2-factor model and the Dysphoria model following closely behind. These CFA results do not support the symptom clusters proposed within the DSM-5 for PTSD-6Y. Although a 4-factor Dysphoria model offers a better overall account of clustering patterns (relative to alternate models), alongside acceptable sensitivity and specificity for detecting clinical impairment, it also falls short of being an adequate model in this younger age group.
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Affiliation(s)
- Anna McKinnon
- Centre for Emotional Health, Department of Psychology, Macquarie University, North Ryde, New South Wales, 2109, Australia.
| | - Michael S Scheeringa
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 1440 Canal St., MS 8448, New Orleans, 70112, USA
| | - Richard Meiser-Stedman
- Department of Clinical Psychology, Elizabeth Fry Building, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - Peter Watson
- Medical Research Council Cognition and Brain Sciences Unit, 15 Chaucer Rd, Cambridge, CB2 7EF, UK
| | - Alexandra De Young
- Centre for Children's Burns & Trauma Research, Centre for Children's Health Research, University of Queensland, Level 7, 62 Graham Street, South Brisbane, Queensland, 4101, Australia
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, 15 Chaucer Rd, Cambridge, CB2 7EF, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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15
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Associations between PTSD symptoms and suicide risk: A comparison of 4-factor and 7-factor models. J Psychiatr Res 2020; 129:47-52. [PMID: 32563777 DOI: 10.1016/j.jpsychires.2020.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/11/2020] [Accepted: 06/01/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND While posttraumatic stress disorder (PTSD) symptoms in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are categorized into four clusters, emerging studies suggest the disorder is best characterized by seven symptom clusters: re-experiencing, avoidance, negative affect, anhedonia, externalizing behaviors, and anxious and dysphoric arousal symptoms. However, data are sparse regarding the relation between this novel model of DSM-5 PTSD symptoms and suicide risk. METHODS Using data from the National Survey for Stress and Health, a sample of 6180 Japanese individuals, we evaluated the relationship between suicide ideation and PTSD symptoms using 4- and 7-factor models. RESULTS Different association patterns were observed between each model and suicidal ideation. In the 4-factor model, we found re-experiencing feelings (odds ratio [OR] = 1.03, 95% confidence interval [CI] = 1.01-1.06, p = 0.002), negative alterations in cognition and mood symptoms (OR = 1.08, 95%CI = 1.06-1.09, p < 0.001), and hyperarousal (OR = 1.03, 95% CI = 1.01-1.05, p = 0.014) were associated with increased suicide ideation. In the 7-factor model, we found re-experiencing feelings (OR = 1.04, 95%CI = 1.02-1.06, p = 0.001), negative affect (OR = 1.04, 95%CI = 1.01-1.07, p = 0.012), anhedonia (OR = 1.08-1.16, 95%CI, p < 0.001), and externalizing behavior (OR = 1.12, 95%CI = 1.07-1.17, p < 0.001) were associated with increased suicide risk. CONCLUSIONS A more refined 7-factor model of DSM-5 PTSD symptoms may help us understand their associations with comorbid psychopathology and suicide. Prevention and treatment efforts that target distinct aspects of the PTSD phenotype may be more effective in mitigating key clinical and functional outcomes in this population.
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16
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Li G, Wang L, Cao C, Fang R, Bi Y, Liu P, Luo S, Hall BJ, Elhai JD. An exploration of the DSM-5 posttraumatic stress disorder symptom latent variable network. Eur J Psychotraumatol 2020; 11:1759279. [PMID: 32922682 PMCID: PMC7448915 DOI: 10.1080/20008198.2020.1759279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/05/2020] [Accepted: 04/09/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Both the latent variable model and the network model have been widely used to conceptualize mental disorders. However, it has been pointed out that there is no clear dichotomy between the two models, and a combination of these two model could enable a better understanding of psychopathology. The recently proposed latent network model (LNM) has provided a statistical framework to enable this combination. Evidence has shown that posttraumatic stress disorder (PTSD) could be a suitable candidate disorder to study the combined model. In the current study, we initiated the first investigation of the latent network of PTSD symptoms. METHODS The latent network of DSM-5 PTSD symptoms was estimated in 1196 adult survivors of China's 2008 Wenchuan earthquake. Validation testing of the latent network was conducted in a replication sample of children and adolescent who experienced various trauma types. PTSD symptoms were measured by the PTSD Checklist for DSM-5 (PCL-5). The latent network was estimated using the seven-factor hybrid model of DSM-5 PTSD symptoms, analysed using the R package lvnet. RESULTS The latent network model demonstrated good fit in both samples. A strong weighted edge between the intrusion and avoidance dimensions was identified (regularized partial correlation = 0.75). The externalizing behaviour dimension demonstrated the highest centrality in the latent network. CONCLUSIONS This study is the first to investigate the latent network of DSM-5 PTSD symptoms. Results suggest that both latent symptom dimension and associations between the dimensions should be considered in future PTSD studies and clinical practices.
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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
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Shenzhen Key Laboratory of Affective and Social Cognitive Science, 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
| | - Yajie Bi
- 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 psychosomatics, People’s Hospital of Deyang City, Deyang, Shichuan, China
| | - Shu Luo
- Department of psychosomatics, People’s Hospital of Deyang City, Deyang, Shichuan, China
| | - Brian J. Hall
- Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, University of Macau, Avenida da Universidade, 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
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17
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Cao C, Wang L, Wu J, Bi Y, Yang H, Fang R, Li G, Liu P, Luo S, Hall BJ, Elhai JD. A comparison of ICD- 11 and DSM-5 criteria for PTSD among a representative sample of Chinese earthquake survivors. Eur J Psychotraumatol 2020; 11:1760481. [PMID: 32922684 PMCID: PMC7448929 DOI: 10.1080/20008198.2020.1760481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Striking differences regarding the diagnosis of PTSD exist between the ICD-11 and DSM-5. This study compared the prevalence and comorbidity of PTSD between the ICD-11 and DSM-5. METHODS An epidemiological sample of 1160 Chinese adult earthquake survivors collected nine and a half years following the Wenchuan earthquake, in Sichuan province. The PTSD Checklist for DSM-5 (PCL-5), the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7) were used to measure PTSD, depression, and anxiety symptoms. RESULTS The ICD-11 PTSD criteria yielded higher prevalence estimates than the DSM-5 criteria. There were no significant differences in PTSD's comorbidity with major depressive disorder (MDD) or generalized anxiety disorder (GAD) between the ICD-11 and DSM-5 criteria. CONCLUSIONS Results found that the ICD-11 and DSM-5 performed differently in assessing PTSD prevalence, but showed similar co-occurrence with MDD and GAD. This study adds to knowledge about the similarities and differences of using different PTSD criteria and carries implications for clinical and research utilization of the two widely used PTSD diagnostic criteria.
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Affiliation(s)
- Chengqi Cao
- Center for Brain Disorder and Cognitive Science, Shenzhen University, Shenzhen, China
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, 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
| | - Jianhui Wu
- Center for Brain Disorder and Cognitive Science, Shenzhen University, Shenzhen, China
| | - Yajie Bi
- 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
| | - Haibo Yang
- Academy of Psychology and Behavior, Tianjin Normal University, Tianjin, 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
| | - 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
| | - Ping Liu
- Department of Psychosomatics, People’s Hospital of Deyang City, Deyang, Sichuan, China
| | - Shu Luo
- Department of Psychosomatics, People’s Hospital of Deyang City, Deyang, Sichuan, China
| | - Brian 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, and Department of Psychiatry, University of Toledo, Toledo, OH, USA
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18
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Cao X, Wang L, Cao C, Fang R, Chen C, Hall BJ, Elhai JD. Depicting the associations between different forms of psychopathology in trauma-exposed adolescents. Eur Child Adolesc Psychiatry 2020; 29:827-837. [PMID: 31489500 DOI: 10.1007/s00787-019-01400-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/30/2019] [Indexed: 01/21/2023]
Abstract
Psychiatric comorbidity in traumatized youth is prevalent, but such associations between two disorders may be confounded with other comorbid conditions. Few studies have examined the unique relationships among multiple disorders. Which disorders maximally explain the relationships between others and whether such disorders differ by sex remain largely unknown. Using a construct-level network approach, this study characterized the independent associations among nine prevalent emotional and behavioral disorders/problems evaluated by the PTSD Checklist for DSM-5, the Revised Children's Anxiety and Depression Scale, and the Youth Self-Report in a sample of 1181 disaster-exposed adolescents (53.9% girls; a mean age of 14.3 ± 0.8 years). The associations were strong among the seven internalizing problems and between the two externalizing ones, but weaker between these two spectra of psychopathology. Major depressive disorder (MDD) was most strongly connected with others, maximally accounting for the associations, especially those between the two spectra. Overall and individual association strength and the connecting role of MDD were generally equivalent across sex. These findings highlight the necessity of MDD in linking comorbid forms of psychopathology in traumatized youth, and suggest MDD as a potential intervention priority in this population.
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Affiliation(s)
- Xing Cao
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Beijing, 100101, 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, 16 Lincui Road, Beijing, 100101, China.
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
| | - Chengqi Cao
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Ruojiao Fang
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Chen Chen
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Brian J Hall
- Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, University of Macau, Macau, 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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19
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Öğülmüş S, Boysan M, Fidan-Acar Ö, Koca H. The underlying dimensions of DSM-5 posttraumatic stress disorder (PTSD) and their relationships with mental and somatoform dissociation, depression and anxiety among jail inmates. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2020. [DOI: 10.1080/03069885.2020.1738338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Selahiddin Öğülmüş
- Department of Guidance and Psychological Counseling, Faculty of Educational Sciences, Ankara University, Ankara, Turkey
| | - Murat Boysan
- Department of Psychology, Faculty of Social Sciences and Humanities, Ankara Social Sciences University, Ankara, Turkey
| | - Özlem Fidan-Acar
- Van M Type Correctional Institution, Department of Penalty and Arresting Houses, Turkish Republic Ministry of Justice, Van, Turkey
| | - Hanife Koca
- Van M Type Correctional Institution, Department of Penalty and Arresting Houses, Turkish Republic Ministry of Justice, Van, Turkey
- Çanakkale Correctional Institution, Department of Penalty and Arresting Houses, Turkish Republic Ministry of Justice, Çanakkale, Turkey
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20
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Wang N, Chung MC, Wang Y. The relationship between posttraumatic stress disorder, trauma centrality, posttraumatic growth and psychiatric co-morbidity among Chinese adolescents. Asian J Psychiatr 2020; 49:101940. [PMID: 32065961 DOI: 10.1016/j.ajp.2020.101940] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/09/2020] [Accepted: 02/08/2020] [Indexed: 10/25/2022]
Abstract
This study examined the inter-relationship between posttraumatic stress disorder (PTSD) from past trauma, psychiatric co-morbidity, trauma centrality and posttraumatic growth (PTG) among Chinese adolescents. Nine hundred and forty-eight Chinese adolescents (M = 462, F = 486) were recruited from two secondary schools. They completed the Posttraumatic Stress Disorder Checklist for DSM-5, the Centrality of Events Scale, the Posttraumatic Growth Inventory, the General Health Questionnaire-28, and the Educational Stress Scale for Adolescents. After controlling for demographic variables and levels of academic stress, structural equation modeling showed that PTSD was positively associated with trauma centrality and psychiatric co-morbidity but negatively associated with posttraumatic growth. Trauma centrality mediated the impacts of PTSD on posttraumatic growth and psychiatric co-morbidity. To conclude, PTSD from past trauma could impact adolescents' ways of perceiving positive aspects of their trauma and psychological well-being. Such impact, however, was influenced by the changes in their self-concept.
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Affiliation(s)
- Na Wang
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong.
| | - Man Cheung Chung
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong.
| | - Yabing Wang
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong.
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21
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Armour C, Greene T, Contractor AA, Weiss N, Dixon-Gordon K, Ross J. Posttraumatic Stress Disorder Symptoms and Reckless Behaviors: A Network Analysis Approach. J Trauma Stress 2020; 33:29-40. [PMID: 32086982 DOI: 10.1002/jts.22487] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 10/21/2019] [Accepted: 12/10/2019] [Indexed: 12/17/2022]
Abstract
Existing literature indicates a theoretical and empirical relation between engagement in reckless behaviors and posttraumatic stress disorder (PTSD). Thus, the DSM-5 revision of the PTSD nosology added a new "reckless or self-destructive behavior" (RSDB) symptom (Criterion E2). The current study applied a network analytic approach to examine the item-level relations among a range of reckless behaviors and PTSD symptom clusters. Participants were recruited from Amazon's Mechanical Turk (N = 417), and network analysis was conducted with 20 variables: six PTSD symptom clusters, corresponding to the hybrid model of PTSD (Armour et al., 2015) and excluding the externalizing behavior cluster (Community 1), and 14 items related to reckless behavior (Community 2). The results showed that the network associations were strongest within each construct (i.e., within PTSD and within reckless behaviors), although several bridge connections (i.e., between PTSD clusters and reckless behaviors) were identified. Most reckless behavior items had direct associations with one or more PTSD symptom clusters. The present findings support the existence of close relations between a variety of reckless behaviors and PTSD symptom clusters beyond their relations with DSM Criterion E2. The results provide testable hypotheses about the associations between specific reckless behaviors and PTSD symptom clusters, which may inform future research.
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Affiliation(s)
- Cherie Armour
- School of Psychology, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Talya Greene
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | | | - Nicole Weiss
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Katherine Dixon-Gordon
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Jana Ross
- School of Psychology, Queen's University Belfast, Northern Ireland, United Kingdom
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22
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Carvalho T, da Motta C, Pinto-Gouveia J. Portuguese version of the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Comparison of latent models and other psychometric analyses. J Clin Psychol 2020; 76:1267-1282. [PMID: 31975500 DOI: 10.1002/jclp.22930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This psychometric study explores the Portuguese version of the Posttraumatic Stress Disorder (PTSD) Checklist (PCL-5). It aims to clarify the best-fitting latent structure among competing PTSD models (Diagnostic and Statistical Manual of Mental Disorders-fifth edition [DSM-5], Dysphoria, Dysphoric Arousal, Anhedonia, Externalizing Behavior, And Hybrid models) and its implications for PTSD measurement. METHOD Psychometric analyses were conducted in a sample from the general population of firefighters (N = 446), except the temporal stability, which was tested in a subsample of 100 participants. RESULTS The models presented significant differences in a global fit. The Hybrid model presented the best-fitting structure, but the DSM-5 model showed more favorable reliability and convergent validity in Confirmatory Factor Analyses. The DSM-5 model also proved to be internally consistency, temporally stable, and presented convergent validity. CONCLUSION The Portuguese version of PCL-5 is reliable and valid. The findings suggest the appropriateness of the DSM-5 model to assess PTSD symptomatology, encouraging its use in clinical, and research settings.
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Affiliation(s)
- Teresa Carvalho
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,Instituto Superior Miguel Torga, Coimbra, Portugal
| | - Carolina da Motta
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - José Pinto-Gouveia
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
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23
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Correia-Santos P, Morgado D, Maia ÂC, Levendosky A, Jongenelen I, Pinto RJ. Alternative Models of DSM-5 Posttraumatic Stress Disorder in Portuguese Adolescents Exposed to Trauma and Childhood Adversity. J Trauma Stress 2019; 32:908-917. [PMID: 31814166 DOI: 10.1002/jts.22469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 11/11/2022]
Abstract
The factor structure of DSM-5 posttraumatic stress disorder (PTSD) has been extensively debated, with evidence supporting the recently proposed seven-factor hybrid model. However, few studies examining PTSD symptom structure have assessed the implications of these proposed models on diagnostic criteria and PTSD prevalence. In the present study, we examined seven alternative DSM-5 PTSD models within a confirmatory factor analysis (CFA), using the Child PTSD Symptom Scale-Self-Report for DSM-5 (CPSS-5). Additionally, we generated prevalence rates for each of the seven models by using a symptom-based diagnostic algorithm and assessed whether substance abuse, depression, anxiety symptoms, and daily functioning were differentially associated with PTSD depending on the model used to derive the diagnosis. Participants were 317 adolescents aged 13-17 years (M = 15.93, SD = 1.23) who had experienced a DSM-5 Criterion A trauma and/or childhood adversity. The CFA results showed good fit indices for all models, with the seven-factor hybrid model presenting the best fit. The rates of PTSD diagnosis varied according to each model. The four-factor DSM-5 model presented the highest rate (30.6%), and the seven-factor hybrid model presented the lowest rate (17.4%). Similar to the CFA analysis, the inclusion criteria for the diagnosis based on the hybrid model also presented the strongest associations with daily functional impairment, odds ratio (OR) = 1.48, 95% CI [1.25, 1.75]; and adverse childhood experiences, OR = 1.46, 95% CI [1.16, 1.82]. Research and clinical implications of these results are discussed, and suggestions for future investigation are presented.
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Affiliation(s)
| | - Diogo Morgado
- School of Psychology, University of Minho, Braga, Portugal
| | - Ângela C Maia
- School of Psychology, University of Minho, Braga, Portugal
| | - Alytia Levendosky
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Inês Jongenelen
- Faculty of Psychology, HEI-Lab, University Lusófona of Porto, Porto, Portugal
| | - Ricardo J Pinto
- Faculty of Psychology, HEI-Lab, University Lusófona of Porto, Porto, Portugal
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Smith P, Dalgleish T, Meiser‐Stedman R. Practitioner Review: Posttraumatic stress disorder and its treatment in children and adolescents. J Child Psychol Psychiatry 2019; 60:500-515. [PMID: 30350312 PMCID: PMC6711754 DOI: 10.1111/jcpp.12983] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2018] [Indexed: 01/19/2023]
Abstract
Important advances in understanding traumatic stress reactions in children and young people have been made in recent years. The aim of this review was to synthesise selected recent research findings, with a focus on their relevance to clinical practice. We therefore address: findings on the epidemiology of trauma exposure and Posttraumatic Stress Disorder (PTSD); recent changes to diagnostic classification; implications for screening and assessment of traumatic stress reactions; and treatment outcome studies including interventions for acute and chronic PTSD, dissemination of effective treatments into community settings, and early interventions. We conclude with recommendations for clinical practice and suggestions for future areas of research.
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Affiliation(s)
- Patrick Smith
- Department of PsychologyInstitute of Psychiatry Psychology & NeuroscienceKing's College LondonLondonUK
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences UnitUniversity of CambridgeCambridgeUK,Cambridgeshire and Peterborough NHS Foundation TrustCambridgeUK
| | - Richard Meiser‐Stedman
- Department of Clinical Psychology, Norwich Medical SchoolUniversity of East AngliaNorwichUK
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25
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Abstract
PURPOSE OF REVIEW This review summarizes the latest evidence and developments in the validation of PTSD diagnostic criteria for children 6 years and under (PTSD<6Y), discusses the limitations of the current diagnostic criteria, and highlights areas for future research. RECENT FINDINGS Research has found that the DSM-5 PTSD<6Y, and a similar version in the DC:0-5, currently provides the most developmentally sensitive classification of PTSD for young children. In contrast, preliminary evidence suggests that the ICD-11 criteria might not appropriately capture PTSD in young children. The inclusion of PTSD<6Y, the first developmental subtype in the DSM-5, represents an important step towards having a diagnostic system that is developmentally sensitive and relevant across the life span. However, further validation work and research with regard to the definition of trauma and functional impairment as well as with the age-appropriate description of symptoms is needed, especially in the youngest age group (0-3 years).
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Affiliation(s)
- Alexandra C De Young
- Child Health Research Centre, The University of Queensland, Level 7, 62 Graham Street, South Brisbane, QLD, 4101, Australia.
| | - Markus A Landolt
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland.,Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland
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Ross J, Kaliská L, Halama P, Lajčiaková P, Armour C. Examination of the latent structure of DSM-5 posttraumatic stress disorder symptoms in Slovakia. Psychiatry Res 2018; 267:232-239. [PMID: 29940453 DOI: 10.1016/j.psychres.2018.06.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/29/2018] [Accepted: 06/11/2018] [Indexed: 12/16/2022]
Abstract
The latent structure of posttraumatic stress disorder (PTSD) has been widely discussed, with the majority of studies in this area being conducted in the US. The current study aimed to extend this area of research by comparing seven existing PTSD factor models in a sample of 754 trauma-exposed university students from Slovakia, where similar research has not been conducted yet. The sample was predominantly female (83.69%), with a mean age of 22.68 years. The comparison of competing models revealed that the Anhedonia model, consisting of six inter-correlated factors of reexperiencing, avoidance, negative affect, anhedonia, dysphoric arousal and anxious arousal, provided the best fit. Several factors of the Anhedonia model also showed differential relationships with the external variables of anxiety and depression. The study contributes to the limited literature on the latent structure of PTSD in Eastern Europe.
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Affiliation(s)
- Jana Ross
- Psychology Research Institute, Ulster University, Coleraine, Northern Ireland, UK.
| | - Lada Kaliská
- Department of Psychology, Faculty of Education, Matej Bel University, Banská Bystrica, Slovakia
| | - Peter Halama
- Department of Psychology, Faculty of Arts, Trnava University in Trnava, Trnava, Slovakia
| | - Petra Lajčiaková
- Department of Psychology, Faculty of Arts and Letters, Catholic University in Ružomberok, Slovakia
| | - Cherie Armour
- Psychology Research Institute, Ulster University, Coleraine, Northern Ireland, UK.
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27
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Makhubela M. Latent structure of the Post-Traumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5) in South African mortuary workers. JOURNAL OF PSYCHOLOGY IN AFRICA 2018. [DOI: 10.1080/14330237.2018.1475909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Malose Makhubela
- Department of Psychology, University of Pretoria, Pretoria, South Africa
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28
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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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29
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Silverstein MW, Dieujuste N, Kramer LB, Lee DJ, Weathers FW. Construct validation of the hybrid model of posttraumatic stress disorder: Distinctiveness of the new symptom clusters. J Anxiety Disord 2018; 54:17-23. [PMID: 29421368 DOI: 10.1016/j.janxdis.2017.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/31/2017] [Accepted: 12/13/2017] [Indexed: 11/29/2022]
Abstract
Despite the factor analytic support for the seven-factor hybrid model (Armour et al., 2015) of posttraumatic stress disorder (PTSD), little research has examined the degree to which newly established symptom clusters (i.e., negative affect, anhedonia, dysphoric arousal, anxious arousal, externalizing behavior) functionally and meaningfully differ in their associations with other clinical phenomena. The aim of the current study was to examine the degree to which newly established PTSD symptom clusters differentially relate to co-occurring psychopathology and related clinical phenomena through Wald testing using latent variable modeling. Participants were 535 trauma-exposed undergraduates who completed the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5; Weathers et al., 2013) and Personality Assessment Inventory (PAI; Morey, 1991). As expected and in line with results from previous studies, significant heterogeneity emerged for dysphoric arousal, anxious arousal, and externalizing behavior. However, there was less evidence for the distinctiveness of negative affect and anhedonia. Results indicate that only some of the newly established symptom clusters significantly differ in their associations with related clinical phenomena and that the hybrid model might not provide a meaningful framework for understanding which PTSD symptoms relate to associated features. Limitations include a non-clinical sample and reliance on retrospective self-report assessment measures.
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Affiliation(s)
| | - Nathalie Dieujuste
- VISN 19 Rocky Mountain MIRECC, Denver Veterans Affairs Medical Center, United States
| | | | - Daniel J Lee
- Veterans Affairs Boston Healthcare System, Boston University School of Medicine, United States
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Sachser C, Berliner L, Holt T, Jensen T, Jungbluth N, Risch E, Rosner R, Goldbeck L. Comparing the dimensional structure and diagnostic algorithms between DSM-5 and ICD-11 PTSD in children and adolescents. Eur Child Adolesc Psychiatry 2018; 27:181-190. [PMID: 28761989 DOI: 10.1007/s00787-017-1032-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/19/2017] [Indexed: 11/24/2022]
Abstract
In contrast to the DSM-5, which expanded the posttraumatic stress disorder (PTSD) symptom profile to 20 symptoms, a workgroup of the upcoming ICD-11 suggested a reduced symptom profile with six symptoms for PTSD. Therefore, the objective of the study was to investigate the dimensional structure of DSM-5 and ICD-11 PTSD in a clinical sample of trauma-exposed children and adolescents and to compare the diagnostic rates of PTSD between diagnostic systems. The study sample consisted of 475 self-reports and 424 caregiver-reports on the child and adolescent trauma screen (CATS), which were collected at pediatric mental health clinics in the US, Norway and Germany. The factor structure of the PTSD construct as defined in the DSM-5 and in alternative models of both DSM-5 and ICD-11 was investigated using confirmatory factor analyses (CFA). To evaluate differences in PTSD prevalence, McNemar's tests for correlated proportions were used. CFA results demonstrated excellent model fit for the proposed ICD-11 model of PTSD. For the DSM-5 models we found the best fit for the hybrid model. Diagnostic rates were significantly lower according to ICD-11 (self-report: 23.4%; caregiver-report: 16.5%) compared with the DSM-5 (self-report: 37.8%; caregiver-report: 31.8%). Agreement was low between diagnostic systems. Study findings provide support for an alternative latent dimensionality of DSM-5 PTSD in children and adolescents. The conceptualization of ICD-11 PTSD shows an excellent fit. Inconsistent PTSD constructs and significantly diverging diagnostic rates between DSM-5 and the ICD-11 will result in major challenges for researchers and clinicians in the field of psychotraumatology.
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Affiliation(s)
- Cedric Sachser
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Ulm Universtity, Steinhövelstraße 1, 89075, Ulm, Germany.
| | - Lucy Berliner
- Harborview Center for Sexual Assault and Traumatic Stress, Seattle, USA
| | - Tonje Holt
- Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway.,Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Tine Jensen
- Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | | | - Elizabeth Risch
- Center on Child Abuse and Neglect, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Rita Rosner
- Department of Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Lutz Goldbeck
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Ulm Universtity, Steinhövelstraße 1, 89075, Ulm, Germany
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31
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Liu L, Wang L, Cao C, Cao X, Zhu Y, Liu P, Luo S, Zhang J. Serotonin transporter 5-HTTLPR genotype is associated with intrusion and avoidance symptoms of DSM-5 posttraumatic stress disorder (PTSD) in Chinese earthquake survivors. ANXIETY STRESS AND COPING 2017; 31:318-327. [PMID: 29280387 DOI: 10.1080/10615806.2017.1420174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Prior studies have found that the serotonin transporter gene-linked polymorphic region (5-HTTLPR) interacts with trauma exposure to increase general risk for Posttraumatic Stress Disorder (PTSD). However, there is little knowledge about the effects of the interaction on distinct symptom clusters of PTSD. This study aimed to investigate the relation between the interaction of 5-HTTLPR and earthquake-related exposures and a contemporary phenotypic model of DSM-5 PTSD symptoms in a traumatised adult sample from China. DESIGN A cross-sectional design with gene-environment interaction (G × E) approach was adopted. METHODS Participants were 1131 survivors who experienced 2008 Wenchuan earthquake. PTSD symptoms were assessed with the PTSD Checklist for DSM-5 (PCL-5). The 5-HTTLPR polymorphism was genotyped with capillary electrophoresis (CE) in ABI 3730xl genetic Analyzer. RESULTS Although there was no significant interaction between 5-HTTLPR and traumatic exposure on total PTSD symptoms, respondents with the LL genotype of 5-HTTLPR who were highly exposed to the earthquake experienced lower intrusion and avoidance symptoms than those with the S-allele carriers. CONCLUSIONS The findings suggest that the 5-HTTLPR may have an important impact on the development of PTSD and add to the extant knowledge on understanding and treating of posttraumatic psychopathology.
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Affiliation(s)
- Luobing Liu
- a Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology , Chinese Academy of Sciences , Beijing , People's Republic of China.,b University of Chinese Academy of Sciences , Beijing , People's Republic of China
| | - Li Wang
- a Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology , Chinese Academy of Sciences , Beijing , People's Republic of China.,b University of Chinese Academy of Sciences , Beijing , People's Republic of China
| | - Chengqi Cao
- a Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology , Chinese Academy of Sciences , Beijing , People's Republic of China.,b University of Chinese Academy of Sciences , Beijing , People's Republic of China
| | - Xing Cao
- a Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology , Chinese Academy of Sciences , Beijing , People's Republic of China.,b University of Chinese Academy of Sciences , Beijing , People's Republic of China
| | - Ye Zhu
- a Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology , Chinese Academy of Sciences , Beijing , People's Republic of China.,b University of Chinese Academy of Sciences , Beijing , People's Republic of China
| | - Ping Liu
- c People's Hospital of Deyang City , Deyang , People's Republic of China
| | - Shu Luo
- c People's Hospital of Deyang City , Deyang , People's Republic of China
| | - Jianxin Zhang
- a Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology , Chinese Academy of Sciences , Beijing , People's Republic of China
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32
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Mordeno IG, Hall BJ. DSM-5-based latent PTSD models: Assessing structural relations with GAD in Filipino post-relocatees. Psychiatry Res 2017; 258:1-8. [PMID: 28964957 DOI: 10.1016/j.psychres.2017.09.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/12/2017] [Accepted: 09/22/2017] [Indexed: 12/28/2022]
Abstract
An increasing number of studies investigated the latent factor structure of posttraumatic stress disorder (PTSD) symptomatology following the new fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). To date, there is no consensus on the best representation of PTSD. This study examined six latent PTSD models in a sample of Filipino post-disaster relocatees (N = 523). Further investigation on the relationship of the best-fitting model to generalized anxiety disorder (GAD) in the latent level was conducted. The seven-factor hybrid model consisting of intrusion, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal, was the best fitting model. Latent associations between the factors in the hybrid model and GAD suggest there are core and transdiagnostic features of PTSD. These findings have implications for understanding the underlying mechanism of PTSD and can inform the development of trauma-related interventions, particularly among post-disaster relocatees.
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Affiliation(s)
- Imelu G Mordeno
- College of Education, Mindanao State University, Iligan Institute of Technology, Philippines
| | - Brian J Hall
- Global and Community Mental Health Research Group, Faculty of Social Sciences (E21), University of Macau, Avenida da Universidade, Taipa, Macau, Hong Kong Special Administrative Region; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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33
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Wang L, Cao X, Cao C, Fang R, Yang H, Elhai JD. Factor structure of DSM-5 PTSD symptoms in trauma-exposed adolescents: Examining stability across time. J Anxiety Disord 2017; 52:88-94. [PMID: 28774745 DOI: 10.1016/j.janxdis.2017.07.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/04/2017] [Accepted: 07/18/2017] [Indexed: 11/24/2022]
Abstract
This study investigated the latent structure of DSM-5 PTSD symptoms using two-wave longitudinal data collected from a sample of adolescents exposed to an explosion accident. Two waves of surveys were conducted approximately 3 and 8 months after the accident, respectively. A total of 836 students completed the baseline survey, and 762 students completed the follow-up survey. The results of confirmatory factor analyses(CFA) indicated that a seven-factor hybrid model composed of intrusion, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal and dysphoric arousal factors yielded significantly better data fit at both waves than the other models including the DSM-5 four-factor model, the six-factor anhedonia and externalizing behaviors models. Furthermore, the results of CFA invariance tests supported the longitudinal invariance of the model. Implications and limitations in terms of these results are discussed.
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Affiliation(s)
- 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
| | - Xing Cao
- 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
- 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
| | - 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
| | - Haibo Yang
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Academy of Psychology and Behavior, Tianjin Normal University, Tianjin, China.
| | - Jon D Elhai
- Department of Psychology, and Department of Psychiatry, University of Toledo, Toledo, USA
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34
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Claycomb Erwin M, Charak R, Durham TA, Armour C, Lv X, Southwick SM, Elhai JD, Pietrzak RH. The 7-factor hybrid model of DSM-5 PTSD symptoms and alcohol consumption and consequences in a national sample of trauma-exposed veterans. J Anxiety Disord 2017; 51:14-21. [PMID: 28843574 DOI: 10.1016/j.janxdis.2017.08.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/25/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
The purpose of the present study was to investigate associations between the 7-factor hybrid model of DSM-5 posttraumatic stress disorder (PTSD) symptoms, which includes intrusions, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal symptoms, and alcohol consumption and consequences. A nationally representative sample of 916 trauma-exposed U.S. military veterans were administered the Trauma History Screen, PTSD Checklist-5, and Alcohol Use Disorders Identification Test. Confirmatory factor analyses were conducted to determine associations between the 7-factor hybrid model of PTSD symptoms, and alcohol consumption and consequences. Results revealed that lifetime dysphoric arousal (r=0.31), negative affect (r=0.30), and anhedonia (r=0.29) symptom clusters were most strongly associated with past-year alcohol consequences. No significant associations were observed for alcohol consumption. While the cross-sectional study design does not allow one to ascertain causative associations between PTSD factors and alcohol consumption and consequences, results generally align with the self-medication hypothesis, as PTSD factors reflecting internalizing were most strongly related to alcohol-related consequences. These results underscore the importance of assessing for alcohol use problems in veterans who score highly on PTSD symptoms reflecting internalizing symptomatology.
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Affiliation(s)
| | - Ruby Charak
- Department of Psychological Science, University of Texas-Rio Grande Valley, Edinburg, TX, United States
| | - Tory A Durham
- Department of Psychology, University of Toledo, Toledo, OH, United States
| | - Cherie Armour
- Psychology Research Institute, Ulster University, Northern Ireland, UK
| | - Xin Lv
- Department of Psychology, University of Toledo, Toledo, OH, United States
| | - Steven M Southwick
- U.S. Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Jon D Elhai
- Department of Psychology, University of Toledo, Toledo, OH, United States; Department of Psychiatry, University of Toledo, Toledo, OH, United States.
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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35
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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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36
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Ramos LD, Guimarães FS, Ventriglio A, de Andrade AG, Bhugra D, Lotufo-Neto F, Castaldelli-Maia JM. DSM-5 Post-Traumatic Stress Disorder Criteria in "Precious" (2009): Media Content Analysis for Educational Purposes. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2017; 41:396-404. [PMID: 28364404 DOI: 10.1007/s40596-017-0682-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 02/09/2017] [Indexed: 06/07/2023]
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37
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Dimensionality of DSM-5 posttraumatic stress disorder and its association with suicide attempts: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Soc Psychiatry Psychiatr Epidemiol 2017; 52:715-725. [PMID: 28401275 DOI: 10.1007/s00127-017-1374-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/20/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Emerging confirmatory factor analytic (CFA) studies suggest that posttraumatic stress disorder (PTSD) as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is best characterized by seven factors, including re-experiencing, avoidance, negative affect, anhedonia, externalizing behaviors, and anxious and dysphoric arousal. The seven factors, however, have been found to be highly correlated, suggesting that one general factor may exist to explain the overall correlations among symptoms. METHODS Using data from the National Epidemiologic Survey on Alcohol and Related Conditions-III, a large, national survey of 36,309 U.S. adults ages 18 and older, this study proposed and tested an exploratory bifactor hybrid model for DSM-5 PTSD symptoms. The model posited one general and seven specific latent factors, whose associations with suicide attempts and mediating psychiatric disorders were used to validate the PTSD dimensionality. RESULTS The exploratory bifactor hybrid model fitted the data extremely well, outperforming the 7-factor CFA hybrid model and other competing CFA models. The general factor was found to be the single dominant latent trait that explained most of the common variance (~76%) and showed significant, positive associations with suicide attempts and mediating psychiatric disorders, offering support to the concurrent validity of the PTSD construct. CONCLUSIONS The identification of the primary latent trait of PTSD confirms PTSD as an independent psychiatric disorder and helps define PTSD severity in clinical practice and for etiologic research. The accurate specification of PTSD factor structure has implications for treatment efforts and the prevention of suicidal behaviors.
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38
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Quan L, Zhen R, Yao B, Zhou X. Traumatic exposure and posttraumatic stress disorder among flood victims: Testing a multiple mediating model. J Health Psychol 2017; 25:283-297. [DOI: 10.1177/1359105317707568] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A total of 187 flood victims from Wuhu, a Chinese city affected most severely by a flood during July 2016, were selected to complete self-report measures of traumatic exposure, feelings of safety, fear, posttraumatic negative cognition, and posttraumatic stress disorder. The results found that traumatic exposure could directly predict posttraumatic stress disorder. Besides, traumatic exposure had indirect prediction on posttraumatic stress disorder through three ways, including a one-step path of negative self-cognition, a two-step path from feelings of safety to fear, and a three-step path from feelings of safety to negative self-cognition via fear. Implications and future directions are correspondingly discussed.
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Affiliation(s)
| | - Rui Zhen
- Beijing Normal University, China
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Support for the association between RORA gene polymorphisms and the DSM-5 posttraumatic stress disorder symptoms in male earthquake survivors in China. Asian J Psychiatr 2017; 25:138-141. [PMID: 28262136 DOI: 10.1016/j.ajp.2016.10.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/24/2016] [Accepted: 10/29/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND This study examined the association between interaction of retinoid-related orphan receptor alpha (RORA) (rs8042149) genotype x trauma exposure and post-traumatic stress disorder (PTSD) symptoms. METHODS A total of 1196 Chinese adults who suffered from a deadly 2008 Wenchuan earthquake participated in this study. PTSD symptoms were measured with the PTSD Checklist for DSM-5 (PCL-5). A custom-by-design 2×48-Plex SNPscan™Kit were used to genotype the RORA rs8042149 SNP. RESULTS Our results showed that the interaction of rs8042149 genotype x trauma exposure was associated with total PTSD symptoms in males. Moreover, the rs8042149 genotype x trauma exposure interaction was only associated with severity of the negative affect, anhedonia and dysphoric arousal symptoms in males. LIMITATIONS A moderate sample exposed to a specific event was assessed with a self-reported PTSD measure. CONCLUSIONS This study provides preliminary evidence supporting the functional role of RORA in PTSD, and adds to the knowledge for understanding the genetic underpinnings of PTSD. Moreover, this study carries implications for understanding the comorbidity of PTSD and the sex-specific expression of PTSD's symptoms.
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La Greca AM, Danzi BA, Chan SF. DSM-5 and ICD-11 as competing models of PTSD in preadolescent children exposed to a natural disaster: assessing validity and co-occurring symptomatology. Eur J Psychotraumatol 2017; 8:1310591. [PMID: 28451076 PMCID: PMC5399998 DOI: 10.1080/20008198.2017.1310591] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/20/2017] [Indexed: 01/14/2023] Open
Abstract
Background: Major revisions have been made to the DSM and ICD models of post-traumatic stress disorder (PTSD). However, it is not known whether these models fit children's post-trauma responses, even though children are a vulnerable population following disasters. Objective: Using data from Hurricane Ike, we examined how well trauma-exposed children's symptoms fit the DSM-IV, DSM-5 and ICD-11 models, and whether the models varied by gender. We also evaluated whether elevated symptoms of depression and anxiety characterized children meeting PTSD criteria based on DSM-5 and ICD-11. Method: Eight-months post-disaster, children (N = 327, 7-11 years) affected by Hurricane Ike completed measures of PTSD, anxiety and depression. Algorithms approximated a PTSD diagnosis based on DSM-5 and ICD-11 models. Results: Using confirmatory factor analysis, ICD-11 had the best-fitting model, followed by DSM-IV and DSM-5. The ICD-11 model also demonstrated strong measurement invariance across gender. Analyses revealed poor overlap between DSM-5 and ICD-11, although children meeting either set of criteria reported severe PTSD symptoms. Further, children who met PTSD criteria for DSM-5, but not for ICD-11, reported significantly higher levels of depression and general anxiety than children not meeting DSM-5 criteria. Conclusions: Findings support the parsimonious ICD-11 model of PTSD for trauma-exposed children, although adequate fit also was obtained for DSM-5. Use of only one model of PTSD, be it DSM-5 or ICD-11, will likely miss children with significant post-traumatic stress. DSM-5 may identify children with high levels of comorbid symptomatology, which may require additional clinical intervention.
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Affiliation(s)
| | - BreAnne A Danzi
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Sherilynn F Chan
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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Yang H, Wang L, Cao C, Cao X, Fang R, Zhang J, Elhai JD. The underlying dimensions of DSM-5 PTSD symptoms and their relations with anxiety and depression in a sample of adolescents exposed to an explosion accident. Eur J Psychotraumatol 2017; 8:1272789. [PMID: 28326161 PMCID: PMC5328312 DOI: 10.1080/20008198.2016.1272789] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 11/16/2016] [Accepted: 12/09/2016] [Indexed: 11/21/2022] Open
Abstract
Background: A large number of empirical studies pertaining to the latent dimensions of DSM-5 PTSD symptoms have accumulated. However, there is still a lack of studies specific to youths. Objective: This study sought to investigate the latent dimensions of DSM-5 PTSD symptoms in a sample of adolescents exposed to an explosion accident. Method: Participants were 836 students (407 females and 428 males). Self-reported measures including the PTSD Checklist for DSM-5 and the anxiety and depression subscales of the 21-item Depression Anxiety Stress Scale were administered to participants. Confirmatory factor analysis (CFA) was implemented to test competing factor models. Results: A seven-factor model composed of intrusion, avoidance, negative affect, anhedonia, externalizing behaviours, anxious arousal and dysphoric arousal factors emerged as the best fitting model, and PTSD's factors displayed distinguishable correlations with external measures of anxiety and depression. Conclusions: The findings provide and extend empirical evidence supporting the newly refined seven-factor hybrid model of DSM-5 PTSD symptoms, and have implications for further trauma-related clinical practice and research.
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Affiliation(s)
- Haibo Yang
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Academy of Psychology and Behavior, Tianjin Normal University, Tianjin, China
| | - Li Wang
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Chengqi Cao
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Xing Cao
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Ruojiao Fang
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Jianxin Zhang
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences , Beijing , China
| | - Jon D Elhai
- Department of Psychology, and Department of Psychiatry, University of Toledo , Toledo , OH , USA
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DSM-5 Posttraumatic Stress Disorder Symptom Structure in Disaster-Exposed Adolescents: Stability across Gender and Relation to Behavioral Problems. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 45:803-814. [DOI: 10.1007/s10802-016-0193-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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