Validation of the International Trauma Questionnaire-Child and Adolescent Version (ITQ-CA) in a Chinese mental health service seeking adolescent sample

Using explainable machine learning to investigate the relationship between childhood maltreatment, positive psychological traits, and CPTSD symptoms

Background: The functional impairment resulting from CPTSD symptoms is enduring and far-reaching. Existing research has found that CPTSD symptoms are closely associated with childhood maltreatment; however, researchers debate whether CPTSD symptoms are predominantly influenced by a specific type of childhood maltreatment or the combined influence of multiple maltreatment types.Objective: (1) Examines the impact of childhood maltreatment on CPTSD symptoms, specifically exploring whether specific types of maltreatment or the cumulative exposure to multiple types of maltreatment play a predominant role. (2) Investigates the role of positive psychological traits in this relationship, assessing whether these traits serve as protective factors or are outcomes of the negative psychological consequences of maltreatment.Methods: A sample of 1894 adolescents (Mage = 13.88; SD = 1.00) from a chronically impoverished rural area in China completed the International Trauma Questionnaire - Child and Adolescent Version for CPTSD symptoms, the Childhood Trauma Questionnaire - Short Form for childhood maltreatment types. Positive psychological traits, including mindfulness, self-compassion, and gratitude, were measured using the Mindful Attention Awareness Scale (MAAS), the Self-Compassion Scale - Short Form, and the Gratitude Questionnaire. We addressed the research question using explainable machine learning methods, with SHAP enhancing model interpretability.Results: The findings indicate that emotional abuse is the most effective predictor of CPTSD symptoms, with individuals who experienced emotional abuse showing higher rates of other forms of maltreatment. Among positive psychological traits, mindfulness contributes the most, followed by self-compassion, while gratitude shows no significant association with CPTSD symptoms. Additionally, individuals with poor positive psychological traits are more likely to have experienced maltreatment, whereas those with higher positive traits are less exposed to abuse.Conclusions: Emotional abuse and low levels of positive psychological traits are strongly associated with CPTSD symptoms in adolescents from impoverished areas, with positive traits showing limited buffering effects against maltreatment.

Psychometric Properties of the ITQ for Measuring ICD-11 Complex PTSD in a Spanish Sample of Women Survivors of Intimate Partner Violence

Complex posttraumatic stress disorder (CPTSD) is related to prolonged, multiple, and interpersonal exposure to traumas. Several studies in different populations have focused on implementing the International Trauma Questionnaire (ITQ) to assess PTSD and CPTSD, though not in women survivors of intimate partner violence. The aim was to assess the psychometric properties of this measure in this population. The results obtained for this sample (N = 340) indicated excellent internal ITQ reliability. Moreover, a six-factor CPTSD first-order correlated model was considered, and concurrent validity supported ITQ administration to this population.

Posttraumatic stress disorder in disaster-exposed youth: examining diagnostic concordance and model fit using ICD-11 and DSM-5 criteria

BACKGROUND

Competing definitions of posttraumatic stress disorder (PTSD) have been proposed by ICD-11 and DSM-5; it is unclear which diagnostic model works best for children and adolescents. Although other studies have predicted the impact of these models by approximating the criteria using older measures, this study advances the research by comparing measures designed to assess ICD-11 and DSM-5 criteria in hurricane-exposed youth. This study evaluates ICD-11 and DSM-5 (both the standard and preschool-age) diagnostic models by identifying diagnostic rates, evaluating diagnostic concordance, investigating the predictive value of constructs associated with PTSD (demographics, disaster threat and exposure, functional impairment), and examining model fit.

METHOD

The sample was exposed to Hurricane Ian (2022), a deadly Category 5 hurricane. Parents reported on disaster exposure and their child's PTSD symptoms (n = 152; ages 7-17) using the International Trauma Questionnaire for Children and Adolescents Caregiver Version (ITQ-CG) for ICD-11 criteria and UCLA PTSD Reaction Index for DSM-5, Parent/Caregiver Report Version (RI-5) for DSM-5 criteria.

RESULTS

ICD-11 PTSD symptom criteria rates were 24% and dropped to 20% when the impairment criterion was added. PTSD symptom criteria rates were 11% (10% with impairment) for DSM-5 and 13% (12% with impairment) for DSM-5 Preschool. ICD-11 rates were higher than DSM-5 and DSM-5 Preschool rates. There was no difference between DSM-5 and DSM-5 Preschool rates of PTSD. There was moderate to substantial concordance between ICD-11 and the DSM-5 models. All diagnostic models were associated with exposure and impairment, but only ICD-11 was associated with threat. ICD-11 was the only one to evidence acceptable model fit.

CONCLUSIONS

Using the ITQ-CG and RI-5 to assess PTSD in youth, results showed higher PTSD diagnostic rates for ICD-11 than DSM-5; this contradicts prior findings (based off approximated ICD-11 criteria) and seems largely due to differences in symptom thresholds used by the two measures. The ITQ-CG exhibited excellent model fit and was associated with several constructs important to PTSD.

Self-harm, Suicide, and ICD-11 Complex Posttraumatic Stress Disorder in Treatment-Seeking Adolescents with Major Depression

Posttraumatic stress disorder (PTSD) is linked with self-harm and suicide, but few studies have examined these severe outcomes in relation to complex trauma. This study examined the associations between self-harm and suicide-related phenomena with ICD-11 complex PTSD (CPTSD) among treatment-seeking youths. A convenience sample of 109 adolescents with major depression (69.7% female; mean age = 15.24) were recruited from an outpatient psychiatric clinic. Participants completed measures for ICD-11 CPTSD, adverse childhood experiences (ACEs), self-harm behaviors, and past-year history of four suicide-related phenomena. Relationships between each self-harm and suicide-related variable with CPTSD were assessed at the symptom and diagnostic levels. Participants reported an average of three ACEs; 33.9% met diagnostic requirements for ICD-11 CPTSD. Past-year suicidal thought and attempt, but not self-harm, significantly associated with CPTSD status. At the symptom level, self-harm associated with CPTSD total symptom and all symptom clusters scores, with strongest associations found with symptoms of negative self-concept. CPTSD total symptom scores also associated strongly with past-year history of suicidal thought, plan, and attempt; the three core PTSD symptom clusters scores consistently and strongly linked with these suicide-related phenomena. For symptoms of complex trauma, relationship disturbances associated with having a suicide attempt, and negative self-concept associated with both having a plan and an attempt. Assessing and targeting ICD-11 CPTSD symptoms have potential to reduce self-harm and suicidality in young people experiencing mental distress, particularly for those with a trauma history and regardless of whether they meet criteria for a diagnosable trauma response.

Psychometric properties of International Trauma Questionnaire (ITQ) and symptom structure of complex post-traumatic stress disorder among Chinese patients with MDD

AIMS

To assess the validity and internal reliability of the International Trauma Questionnaire (ITQ) among patients diagnosed with major depressive disorder (MDD) and to explore the network structure of Complex post-traumatic stress disorder (CPTSD) among MDD patients in China.

METHODS

Eligible individuals were recruited from a large tertiary hospital in Guangdong Province. Trained researchers conducted in-person interviews and administered self-report questionnaires, including demographics, medical information, and psychological assessments. Confirmatory factor analyses (CFA) and network analysis were performed, with calculations of Average Variance Extracted (AVE), Cronbach's α, and composite reliability.

RESULTS

A total of 113 patients with MDD participated in this study. The correlated six-factor one-order model was a good representation of the latent structure of ITQ (χ2= 60.114, df = 39, P = 0.017, SRMR = 0.070, RMSEA = 0.050, TLI = 0.952, CFI = 0.972, BIC = 175.508). All ITQ subscales possessed acceptable convergent validity and internal reliability, except for affective dysregulation and re-experiencing. The square root of AVE for affective dysregulation was lower than its correlations with other clusters. Network analysis revealed that node C4 ('I feel worthless'), as a core symptom, was significantly associated with the development of CPTSD.

CONCLUSIONS

The clinical applicability of the ITQ was demonstrated by its overall validity and reliability among patients with MDD. However, the affective dysregulation and re-experiencing clusters still need to be revised and enhanced. Timely screening, recognition, and diagnosis are critical due to the worse clinical outcomes seen in comorbid patients.

Retrospective ACEs predict complex PTSD symptoms in a large sample of Chinese young adults longitudinally: the moderating role of self-compassion

This longitudinal study in Mainland China (2021-2022) explored the impact of adverse childhood experiences (ACEs) on complex posttraumatic stress disorder (CPTSD) symptoms, with a focus on the role of self-compassion. Among 18,933 surveyed university students, 21.2% reported experiencing at least one ACE. Results revealed a clear relationship between ACEs and CPTSD symptoms. Furthermore, self-compassion, particularly the dimensions of self-judgment and isolation, moderated the association between retrospective ACEs and posttraumatic stress disorder (PTSD) and disturbance in self-organization (DSO) symptoms. These findings highlight the enduring impact of ACEs on CPTSD symptoms and emphasize the importance of early identification and targeted interventions, especially addressing self-judgment and isolation, to mitigate CPTSD risk among young Chinese adults.

Sleep disorders mediate the link between childhood trauma and depression severity in children and adolescents with depression

BACKGROUND

Childhood trauma is closely related to the onset of depression and more severe depressive symptoms; however, the specific mechanisms are unclear. We aimed to examine the relationship between childhood trauma and sleep disorders in children and adolescents with depression and to explore further the role of sleep disorders in the relationship between childhood trauma and depression severity.

METHODS

A total of 285 children and adolescents with depression completed all scale assessments, including the Childhood Trauma Questionnaire, Self-Reported Insomnia Severity Index and Epworth Sleepiness Scale, and the Center for Epidemiologic Studies Depression Scale. A simple mediation model was used as a theoretical model to examine whether sleep disorders could mediate the relationship between childhood trauma and depression severity.

RESULTS

Among children and adolescents with depression, childhood trauma is about 78.9%. Compared with patients without childhood trauma, patients with childhood trauma had a higher incidence of sleep disorders (Z = 17.59, P < 0.001), which were characterized by insomnia (Z = 14.45, P < 0.001), not hypersomnia (Z = 2.77, P = 0.096). Different childhood trauma subtypes significantly affected sleep disorders and insomnia (all P < 0.05). Insomnia partially mediated the relationship between childhood trauma and depression severity, and the mediating effect accounted for 35.90%.

CONCLUSION

This study found a high rate of concurrent childhood trauma and insomnia among children and adolescents with depression. Insomnia, as a mediator between childhood trauma and depression severity, partially mediates the relationship.