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Savinc J, Dougall N, Maxwell M, Karatzias T, O'Connor R, Williams B, John A, Cheyne H, Fyvie C, Bisson J, Hibberd C, Abbott-Smith S, Nolan L. Childhood adversity, mental health and suicide (CHASE): a longitudinal case-control linked data study of lifetime inpatient records associated with suicide. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.1878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
ObjectivesChildhood adversity (CA) carries an increased risk of developing later mental health (MH) problems and suicidal behaviour. This study aimed to summarise lifetime hospital attendances for CA and MH in young people who later died by suicide.
ApproachThis study is a retrospective longitudinal case control study. Lifetime Scottish inpatient acute and psychiatric records were linked to death records and summarised for individuals born since 1981 who died by suicide in the period 1991-2017 (cases), and controls (1:10) matched on sex, age, and postcode. Relevant records were coded MH (including self-harm) and/or CA. Descriptive statistics and odds ratios (OR) were computed.
ResultsData for 2,477 and 24,777 ‘cases’ and ‘controls’ were extracted, of whom 2,106 cases (85%) and 13,589 controls (55%) had lifespan hospital records. Mean age at death for cases was 23.7 (SD=4.9) and 75.9% were male. Psychiatric records represented 11.6% and 1.4% of records for cases and controls, respectively.
For the age range 10-18, Maltreatment & violence-related codes were recorded for 160 (7.6%) cases and 371 (2.7%) controls, corresponding to OR=2.9 (95%CI: 2.4-3.6). This was compared with MH at 458 (21.7%) cases and 560 (4.1%) controls and OR=6.5 (95%CI: 5.7-7.4). The highest adjusted ORs were for self-harm episodes recorded in general hospital with aORmale=6.56 (95%CI: 4.96-8.68) and aORfemale=6.87 (95%CI: 4.99-9.48).
ConclusionAll CA and MH presentations in inpatient hospital records were associated with greater risk of subsequent suicide, with the strongest association for self-harm.
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Grandison G, Karatzias T, Fyvie C, Hyland P, O'Connor RC, Dickson A. Suicidal Histories in Adults Experiencing Psychological Trauma: Exploring Vulnerability and Protective Factors. Arch Suicide Res 2022; 26:155-168. [PMID: 32348712 DOI: 10.1080/13811118.2020.1758262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study aimed to identify vulnerability and protective factors for suicidal histories among adults experiencing psychological trauma. METHOD Adults seeking treatment for psychological trauma (N = 113) completed self-report questionnaires measuring childhood trauma history, self-concept, relational functioning, emotion regulation, living arrangements, employment status, marital status, and suicidal history. Independent samples t-tests were used to determine variables on which those with and without suicidal histories differed significantly. These variables were then entered into a binary logistic regression model to identify factors which independently distinguished between those with and without a suicidal history. RESULTS Univariate differences were found for childhood emotional abuse (CEA), childhood emotional neglect (CEN), emotion deactivation, and employment status, with those in the suicidal history group scoring higher on all of these. CEA (OR = 1.13, 95% CI = 1.01-1.27) and employment status (OR = 4.12, 95% CI = 1.23-13.73) remained significant predictors of suicidal status in the multivariable logistic regression. CONCLUSIONS CEA was an independent vulnerability factor for suicidal risk, highlighting the need for clinicians to assess exposure to such trauma in those presenting with proximal traumatic experiences. Being in employment was an independent protective factor against suicidal risk, highlighting the importance of social buffers or networks when faced with traumatic situations.
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3
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Karatzias T, Shevlin M, Hyland P, Fyvie C, Grandison G, Ben-Ezra M. ICD-11 posttraumatic stress disorder, complex PTSD and adjustment disorder: the importance of stressors and traumatic life events. Anxiety Stress Coping 2021; 34:191-202. [PMID: 32744873 DOI: 10.1080/10615806.2020.1803006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Although ICD-11 adjustment (AjD), posttraumatic stress (PTSD) and complex posttraumatic stress (CPTSD) are commonly diagnosed disorders following exposure to stressful or traumatic life events, their dimensional structure and co-occurrence has never been tested in a single study. The present study explored the latent structure of AjD, PTSD, and CPTSD symptoms and their relationship to stressful and traumatic life events to determine the degree of distinctiveness between these constructs.Methods: Participants were clinical patients (N = 331) who completed self-report measures of stressful and traumatic life events, AjD (The Adjustment Disorder - New Module 8 (ADNM-8)) and PTSD / CPTSD (The International Trauma Questionnaire - ITQ).Results: Using confirmatory factor analysis, a second-order model comprised of correlated latent variables of AjD, PTSD, and CPTSD provided the best fit of the data. It was also found that stressors and traumatic life events were positively associated with all of these conditions although childhood trauma was only associated with CPTSD.Conclusions: The current findings support the ICD-11 model of related-but-distinct stress-related disorders. We discuss the existence of a stress-response continuum and how the current findings impact the development of clinical interventions that may be shared across, or unique to, each stress-related disorder.
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Affiliation(s)
- Thanos Karatzias
- Edinburgh Napier University, School of Health & Social Care, Edinburgh, UK.,NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK
| | - Mark Shevlin
- Ulster University, School of Psychology, Derry, Northern Ireland
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland.,Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - Claire Fyvie
- NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK
| | - Graeme Grandison
- Edinburgh Napier University, School of Health & Social Care, Edinburgh, UK
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4
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Karatzias T, Shevlin M, Fyvie C, Grandison G, Garozi M, Latham E, Sinclair M, Ho GWK, McAnee G, Ford JD, Hyland P. Adverse and benevolent childhood experiences in Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD): implications for trauma-focused therapies. Eur J Psychotraumatol 2020; 11:1793599. [PMID: 33029328 PMCID: PMC7473238 DOI: 10.1080/20008198.2020.1793599] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is very little work on the role of positive or benevolent childhood experiences and how such events might offer protection from the insidious effects of adverse experiences in childhood or later in life. OBJECTIVES We set out to test, using latent variable modelling, whether adverse and benevolent childhood experiences could be best described as a single continuum or two correlated constructs. We also modelled the relationship between adverse and benevolent childhood experiences and ICD-11 PTSD and Complex PTSD (CPTSD) symptoms and explored if these associations were indirect via psychological trauma. METHODS Data were collected from a trauma-exposed sample (N = 275) attending a specialist trauma care centre in the UK. Participants completed measures of childhood adverse and benevolent experiences, traumatic exposure, and PTSD and CPTSD symptoms. RESULTS Findings suggested that adverse childhood experiences operate only indirectly on PTSD and CPTSD symptoms through lifetime trauma exposure, and with a stronger effect for PTSD. Benevolent childhood experiences directly predicted only CPTSD symptoms. CONCLUSIONS Benevolent and traumatic experiences seem to form unique associations with PTSD and CPTSD symptoms. Future research is needed to explore how benevolent experiences can be integrated within existing psychological interventions to maximise recovery from traumatic stress.
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Affiliation(s)
- Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK.,Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
| | - Mark Shevlin
- School of Psychology, Ulster University, Derry, Northern Ireland
| | - Claire Fyvie
- Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
| | | | - Maria Garozi
- Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
| | - Emma Latham
- Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
| | | | - Grace Wing Ka Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Grainne McAnee
- School of Psychology, Ulster University, Derry, Northern Ireland
| | - Julian D Ford
- Schools of Medicine and Law, University of Connecticut, Farmington, CT, USA
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland.,Centre for Global Health, Trinity College Dublin, Dublin, Ireland
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5
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Rudd B, Karatzias T, Bradley A, Fyvie C, Hardie S. Personally meaningful recovery in people with psychological trauma: Initial validity and reliability of the Individual Recovery Outcomes Counter (I.ROC). Int J Ment Health Nurs 2020; 29:387-398. [PMID: 31697034 DOI: 10.1111/inm.12671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2019] [Indexed: 11/27/2022]
Abstract
Individual Recovery Outcomes Counter (I.ROC) is a brief tool measuring personal recovery designed for collaborative use within support. This study aimed to investigate the psychometric properties of a self-report version of the I.ROC within a trauma population. A total of 107 adults attending trauma interventions in an NHS service in Scotland completed I.ROC alongside measures of self-esteem, mental illness symptoms, and functional impairment. Scores on each measure were compared to evaluate the convergent validity of I.ROC. Internal consistency and factor analytical techniques were also used to assess the structural validity and reliability of the measure. Results of internal consistency, convergent validity, and factor analysis provide preliminary support for I.ROC's validity within a trauma population. Previously proposed models were a poor fit for the current sample; principal components analysis suggested a three-factor structure with acceptable internal consistency, comprising ten of the original twelve items (I.ROC-10). Correlations with all measures reached significance for the original and modified I.ROC and its subscales. I.ROC appears to be a valid and reliable tool for use in measuring recovery within a trauma population, but further research is needed to examine the structural validity of I.ROC.
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Affiliation(s)
- Bridey Rudd
- Department of Psychology, Abertay University, Dundee, UK.,Penumbra, Norton Park, Edinburgh, UK
| | - Thanos Karatzias
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK.,NHS Lothian, Rivers Centre, Fountainbridge Library Building, Edinburgh, UK
| | - Aoife Bradley
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Claire Fyvie
- NHS Lothian, Rivers Centre, Fountainbridge Library Building, Edinburgh, UK
| | - Scott Hardie
- Department of Psychology, Abertay University, Dundee, UK
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6
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Abstract
Debate exists in the trauma literature regarding the role of dissociation in traumatic stress disorders. With the release of the new ICD-11 diagnostic guideline for posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD), this issue warrants further attention. In the current study, we provide a preliminary assessment of the associations between ICD-11 CPTSD and dissociative experiences. This study is based on a sample (N = 106) of highly traumatized clinical patients from the United Kingdom who completed measures of traumatic stress and dissociative experiences. The majority of participants met the diagnostic criteria for CPTSD (69.1%, n = 67), with few patients qualifying for a diagnosis of PTSD (9.3%, n = 9). Those with CPTSD had significantly higher levels of dissociative experiences compared to those with PTSD (Cohen's d = 1.04) and those with no diagnosis (Cohen's d = 1.44). Three CPTSD symptom clusters were multivariately associated with dissociation: Affective Dysregulation (β = .33), Re-experiencing in the here and now (β = .24), and Disturbed Relationships (β = .22). These findings indicate that dissociative experiences are particularly relevant for clinical patients with CPTSD. Future longitudinal work will be needed to determine if dissociation is a risk factor for, or outcome of, CPTSD.
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Affiliation(s)
- Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Mark Shevlin
- School of Psychology, Ulster University, Derry, Northern Ireland
| | - Claire Fyvie
- NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK
| | - Marylène Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, CA, USA
| | - Thanos Karatzias
- NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK.,School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
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7
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Fyvie C, Easton P, Moreton G, McKeever J, Karatzias T. The Rivers Centre in Scotland: An Attachment-Based Service Model for People With Complex Posttraumatic Stress Disorder. J Trauma Stress 2019; 32:864-869. [PMID: 31730228 DOI: 10.1002/jts.22458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 09/02/2019] [Accepted: 09/07/2019] [Indexed: 11/09/2022]
Abstract
The Rivers Centre in Edinburgh, Scotland (United Kingdom) operated for nearly 20 years as a traditional specialist trauma service, delivering psychological therapies to an adult population affected by trauma. Embedded in a health and social care system whose characteristics were unhelpful for people with histories of insecure attachment experiences, the Rivers Centre aimed to find a different way of working, and in January 2017, it relaunched with a new model of service. The aim of this paper is to describe the new service model from an organizational perspective in the context of attachment theory. At the heart of the model is the premise that to be effective, a trauma service needs to provide people with an alternative model of attachment. Early signs from service audit data indicate that an attachment-based way of working can improve engagement and can provide a supportive and responsive environment in which people can learn to recover.
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Affiliation(s)
- Claire Fyvie
- NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, United Kingdom
| | - Paula Easton
- NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, United Kingdom
| | - Gill Moreton
- NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, United Kingdom
| | - Jenny McKeever
- NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, United Kingdom
| | - Thanos Karatzias
- NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, United Kingdom.,Edinburgh Napier University, School of Health & Social Care, Edinburgh, United Kingdom
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8
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Dougall N, Savinc J, Maxwell M, Karatzias T, O'Connor RC, Williams B, Grandison G, John A, Cheyne H, Fyvie C, Bisson JI, Hibberd C, Abbott-Smith S, Nolan L. Childhood adversity, mental health and suicide (CHASE): a methods protocol for a longitudinal case-control linked data study. Int J Popul Data Sci 2019; 5:1338. [PMID: 34232970 PMCID: PMC7473285 DOI: 10.23889/ijpds.v5i1.1338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction Suicide is a tragic outcome with devastating consequences. In 2018, Scotland experienced a 15% increase in suicide from 680 to 784 deaths. This was marked among young people, with an increase of 53% in those aged 15-24, the highest since 2007. Early intervention in those most at risk is key, but identification of individuals at risk is complex, and efforts remain largely targeted towards universal suicide prevention strategies with little evidence of effectiveness. Recent evidence suggests childhood adversity is a predictor of subsequent poor social and health outcomes, including suicide. This protocol reports on methodology for harmonising lifespan hospital contacts for childhood adversity, mental health, and suicidal behaviour. This will inform where to 1) focus interventions, 2) prioritise trauma-informed approaches, and 3) adapt support avenues earlier in life for those most at risk. Methods This study will follow a case-control design. Scottish hospital data (physical health SMR01; mental health SMR04; maternity/birth record SMR02; mother’s linked data SMR01, SMR04, death records) from 1981 to as recent as available will be extracted for people who died by suicide aged 10-34, and linked on Community Health Index unique identifier. A randomly selected control population matched on age and geography at death will be extracted in a 1:10 ratio. International Classification of Disease (ICD) codes will be harmonised between ICD9-CM, ICD9, ICD10-CM and ICD10 for childhood adversity, mental health, and suicidal behaviour. Results ICD codes for childhood adversity from four key studies are reported in two categories, 1) Maltreatment or violence-related codes, and 2) Codes suggestive of maltreatment. ‘Clinical Classifications Software’ ICD codes to operationalise mental health codes are also reported. Harmonised lifespan ICD categories were achieved semi-automatically, but required labour-intensive supplementary manual coding. Cross-mapped codes are reported. Conclusion There is a dearth of evidence about touchpoints prior to suicide. This study reports methods and harmonised ICD codes along the lifespan to understand hospital contact patterns for childhood adversity, which come to the attention of hospital practitioners. Key words Childhood Adversity, Adverse Childhood Experiences, Mental Health, Self-harm, Suicide, Suicidality, Violence, Hospital episodes, Routine Data, Data Linkage, Study Protocol
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Affiliation(s)
- N Dougall
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, EH11 4BN, UK
| | - J Savinc
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, EH11 4BN, UK
| | - M Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit, Scion House, University of Stirling, Stirling, FK9 4LA, UK
| | - T Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, EH11 4BN, UK
| | - R C O'Connor
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
| | - B Williams
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, EH11 4BN, UK
| | - G Grandison
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, EH11 4BN, UK
| | - A John
- Swansea University Medical School, Swansea University, Swansea, SA2 8PP, UK
| | - H Cheyne
- Nursing, Midwifery and Allied Health Professions Research Unit, Scion House, University of Stirling, Stirling, FK9 4LA, UK
| | - C Fyvie
- The Rivers Centre, NHS Lothian, Edinburgh, EH11 1BG, UK
| | - J I Bisson
- Cardiff University School of Medicine, Cardiff University, Cardiff, CF24 4HQ, UK
| | - C Hibberd
- Faculty of Health Sciences & Sport, University of Stirling, Stirling, FK9 4LA, UK
| | - S Abbott-Smith
- Child and Adolescent Mental Health Service (CAMHS), NHS Lothian, Edinburgh, EH10 5HF, UK
| | - L Nolan
- Aberlour, Scotland's children's charity (SC007991), Stirling, FK8 2JR, UK
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9
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Vang ML, Shevlin M, Karatzias T, Fyvie C, Hyland P. Dissociation fully mediates the relationship between childhood sexual and emotional abuse and DSM-5 PTSD in a sample of treatment-seeking adults. European Journal of Trauma & Dissociation 2018. [DOI: 10.1016/j.ejtd.2018.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Hyland P, Shevlin M, Fyvie C, Karatzias T. Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder in DSM-5 and ICD-11: Clinical and Behavioral Correlates. J Trauma Stress 2018; 31:174-180. [PMID: 29577450 DOI: 10.1002/jts.22272] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/16/2017] [Accepted: 12/18/2017] [Indexed: 11/09/2022]
Abstract
The American Psychiatric Association and the World Health Organization provide distinct trauma-based diagnoses in the fifth edition of the Diagnostic and Statistical Manual (DSM-5), and the forthcoming 11th version of the International Classification of Diseases (ICD-11), respectively. The DSM-5 conceptualizes posttraumatic stress disorder (PTSD) as a single, broad diagnosis, whereas the ICD-11 proposes two "sibling" disorders: PTSD and complex PTSD (CPTSD). The objectives of the current study were to: (a) compare prevalence rates of PTSD/CPTSD based on each diagnostic system; (b) identify clinical and behavioral variables that distinguish ICD-11 CPTSD and PTSD diagnoses; and (c) examine the diagnostic associations for ICD-11 CPTSD and DSM-5 PTSD. Participants in a predominately female clinical sample (N = 106) completed self-report scales to measure ICD-11 PTSD and CPTSD, DSM-5 PTSD, and depression, anxiety, borderline personality disorder, dissociation, destructive behaviors, and suicidal ideation and self-harm. Significantly more people were diagnosed with PTSD according to the DSM-5 criteria (90.4%) compared to those diagnosed with PTSD and CPTSD according to the ICD-11 guidelines (79.8%). An ICD-11 CPTSD diagnosis was distinguished from an ICD-11 PTSD diagnosis by higher levels of dissociation (d = 1.01), depression (d = 0.63), and borderline personality disorder (d = 0.55). Diagnostic associations with depression, anxiety, and suicidal ideation and self-harm were higher for ICD-11 CPTSD compared to DSM-5 PTSD (by 10.7%, 4.0%, and 7.0%, respectively). These results have implications for differential diagnosis and for the development of targeted treatments for CPTSD.
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Affiliation(s)
- Philip Hyland
- School of Business, National College of Ireland, Dublin, Ireland.,Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - Mark Shevlin
- School of Psychology, Ulster University, Derry, Northern Ireland
| | - Claire Fyvie
- Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, United Kingdom
| | - Thanos Karatzias
- Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, United Kingdom.,School of Health & Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
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11
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Shevlin M, Hyland P, Karatzias T, Fyvie C, Roberts N, Bisson JI, Brewin CR, Cloitre M. Alternative models of disorders of traumatic stress based on the new ICD-11 proposals. Acta Psychiatr Scand 2017; 135:419-428. [PMID: 28134442 DOI: 10.1111/acps.12695] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Although there is emerging evidence for the factorial validity of the distinction between post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) proposed in ICD-11, such evidence has been predominantly based on using selected items from individual scales that describe these factors. We have attempted to address this gap in the literature by testing a range of alternative models of disorders of traumatic stress using a broader range of symptoms and standardized measures. METHOD Participants in this cross-sectional study were a sample of individuals who were referred for psychological therapy to a National Health Service (NHS) trauma centre in Scotland (N = 195). Participants were recruited over a period of 18 months and completed measures of stressful life events, DSM-5 PTSD, emotion dysregulation, self-esteem and interpersonal difficulties. RESULTS Overall, results indicate that a structural model incorporating six first-order factors (re-experiencing, avoidance of traumatic reminders, sense of threat, affective dysregulation, negative self-concept and disturbances in relationships) and two second-order factors (PTSD and disturbances in self-organization [DSO]) was the best fitting. The model presented with good concurrent validity. Childhood trauma was found to be more strongly associated with DSO than with PTSD. CONCLUSION Our results are in support of the ICD-11 proposals for PTSD and CPTSD.
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Affiliation(s)
- M Shevlin
- School of Psychology, Ulster University, Derry, UK
| | - P Hyland
- School of Business, National College of Ireland, Dublin, Ireland
| | - T Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK.,Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
| | - C Fyvie
- Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
| | - N Roberts
- Psychology and Counselling Directorate, Cardiff and Vale University Health Board, Cardiff, UK
| | - J I Bisson
- School of Medicine, Cardiff University, Cardiff, UK
| | - C R Brewin
- Clinical, Education & Health Psychology, University College London, London, UK
| | - M Cloitre
- School of Medicine, New York University, New York, NY, USA.,National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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12
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Karatzias T, Shevlin M, Fyvie C, Hyland P, Efthymiadou E, Wilson D, Roberts N, Bisson JI, Brewin CR, Cloitre M. An initial psychometric assessment of an ICD-11 based measure of PTSD and complex PTSD (ICD-TQ): Evidence of construct validity. J Anxiety Disord 2016; 44:73-79. [PMID: 27776256 DOI: 10.1016/j.janxdis.2016.10.009] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/01/2016] [Accepted: 10/13/2016] [Indexed: 11/18/2022]
Abstract
Among the conditions following exposure to traumatic life events proposed by ICD-11 are Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). The primary aim of this study was to provide an assessment of the reliability and validity of a newly developed self-report measure of ICD-11 PTSD and CPTSD: the ICD-11 Trauma Questionnaire (ICD-TQ). Participants in this study were a sample of individuals who were referred for psychological therapy to a National Health Service (NHS) trauma centre in Scotland (N=193). Participants completed the ICD-TQ and measures of traumatic life events, DSM-5 PTSD, emotion dysregulation, self-esteem, and interpersonal difficulties. Confirmatory factor analysis results supported the factorial validity of the ICD-TQ with results in line with ICD-11 proposals. The ICD-TQ demonstrated satisfactory internal reliability, and correlation results indicated that the scale exhibited convergent and discriminant validity. Current results provide initial support for the psychometric properties of this initial version of the ICD-TQ. Future theoretical and empirical work will be required to generate a final version of the ICD-TQ that will match the diagnostic structure of PTSD and CPTSD when ICD-11 is published.
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Affiliation(s)
- Thanos Karatzias
- Edinburgh Napier University, School of Health & Social Care, Edinburgh, UK; NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK.
| | - Mark Shevlin
- Ulster University, School of Psychology, Derry, UK
| | - Claire Fyvie
- NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK
| | - Philip Hyland
- National College of Ireland, School of Business, Dublin, Ireland
| | | | - Danielle Wilson
- NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK
| | - Neil Roberts
- Psychology and Counselling Directorate, Cardiff and Vale University Health Board, Cardiff, UK
| | | | - Chris R Brewin
- University College London, Clinical, Education & Health Psychology, London, UK
| | - Marylene Cloitre
- New York University, School of Medicine, USA; National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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