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Bressington D, Hyland P, Steele H, Byrne M, Mitchell D, Keane C, Shevlin M, Ho G, Murta JCD, Easpaig BNG, Liu X, Zhai J, Murphy D, Karatzias T. ICD-11 post-traumatic stress disorder and complex post-traumatic stress disorder in mental health support-seeking former-serving Australian defence force veterans. Aust N Z J Psychiatry 2024; 58:416-424. [PMID: 38332613 DOI: 10.1177/00048674241230197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 02/10/2024]
Abstract
BACKGROUND ICD-11 complex post-traumatic stress disorder is a more severe condition than post-traumatic stress disorder, and recent studies indicate it is more prevalent among military samples. In this study, we tested the psychometric properties of the International Trauma Questionnaire, assessed the relative prevalence rates of post-traumatic stress disorder and complex post-traumatic stress disorder in the sample population and explored relationships between complex post-traumatic stress disorder and post-traumatic stress disorder and a range of risk factors. METHODS Survey participants (N = 189) were mental health support-seeking former-serving veterans of the Australian Defence Force (ADF) recruited from primary care. Confirmatory factor analysis was used to test the factorial validity of the International Trauma Questionnaire. RESULTS The latent structure of the International Trauma Questionnaire was best represented by a two-factor second-order model consistent with the ICD-11 model of complex post-traumatic stress disorder. The International Trauma Questionnaire scale scores demonstrated excellent internal reliability. Overall, 9.1% (95% confidence interval = [4.8%, 13.5%]) met diagnostic requirements for post-traumatic stress disorder and an additional 51.4% (95% confidence interval = [44.0%, 58.9%]) met requirements for complex post-traumatic stress disorder. Those meeting diagnostic requirements for complex post-traumatic stress disorder were more likely to have served in the military for 15 years or longer, had a history of more traumatic life events and had the highest levels of depression, anxiety and stress symptoms. CONCLUSION The International Trauma Questionnaire can effectively distinguish between post-traumatic stress disorder and complex post-traumatic stress disorder within primary care samples of Australian Defence Force veterans. A significantly greater proportion of Australian Defence Force veterans met criteria for complex post-traumatic stress disorder than post-traumatic stress disorder. Australian military mental health services should adopt the International Trauma Questionnaire to routinely screen for complex post-traumatic stress disorder and develop complex post-traumatic stress disorder specific interventions to promote recovery in Australian Defence Force veterans with complex post-traumatic stress disorder.
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Affiliation(s)
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | | | - Mitchell Byrne
- Faculty of Health, Charles Darwin University, Darwin, NT, Australia
| | - David Mitchell
- Faculty of Health, Charles Darwin University, Darwin, NT, Australia
- Department of Health, Office of the Chief Psychiatrist, Darwin, NT, Australia
| | - Carol Keane
- Faculty of Health, Charles Darwin University, Darwin, NT, Australia
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Grace Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China SAR
| | | | | | - Xianliang Liu
- Faculty of Health, Charles Darwin University, Darwin, NT, Australia
| | - Jianxia Zhai
- STEM College, RMIT University, Melbourne, VIC, Australia
| | - Dominic Murphy
- Department of Research, Combat Stress, Leatherhead, UK
- King's Centre for Military Health Research, King's College London, London, UK
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
- Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
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Ho GWK, Chan KL, Karatzias T, Hyland P, Fung HW, Shevlin M. Prevalence and validity of ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD: A population-based survey of Hong Kong adults. Asian J Psychiatr 2024; 96:104045. [PMID: 38643682 DOI: 10.1016/j.ajp.2024.104045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 07/05/2023] [Revised: 03/29/2024] [Accepted: 04/06/2024] [Indexed: 04/23/2024]
Abstract
The present study aimed to report the prevalence of ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) in the general adult Hong Kong population, and examine the validity of the Chinese International Trauma Questionnaire (ITQ). This descriptive cross-sectional population-based telephone survey included a representative sample of 1070 non-institutionalized permanent Hong Kong residents ages 18-64 years. Participants provided responses to the Chinese version of the ITQ, and measures of adverse childhood experiences (ACEs), depression, anxiety, and stress. Based on the diagnostic algorithm of the ITQ, 5.9% of the sample screened positive for either CPTSD or PTSD, with CPTSD (4.2%) being more common that PTSD (1.7%). Results of the confirmatory factor analysis indicated the first-order correlated 6-factor model to be the best fitting solution. Symptom cluster summed scores were all positively and significantly correlated with all criterion variables. This investigation established the prevalence rates of ICD-11 PTSD and CPTSD using a general adult population sample in Hong Kong. The Chinese ITQ demonstrated sound factorial validity and concurrent validity. Future research can further characterize ICD-11 PTSD and CPTSD in subgroups using the Chinese ITQ.
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Affiliation(s)
- Grace W K Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, SAR China.
| | - Ko Ling Chan
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, SAR China
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, United Kingdom
| | - Philip Hyland
- Department of Psychology, Maynooth University, Ireland
| | - Hong Wang Fung
- Department of Social Work, Hong Kong Baptist University, Hong Kong, SAR China
| | - Mark Shevlin
- School of Psychology, Ulster University, United Kingdom
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Hyland P, Brewin CR, Cloitre M, Karatzias T, Shevlin M. Responding to concerns related to the measurement of ICD-11 complex posttraumatic stress disorder using the International Trauma Questionnaire. Child Abuse Negl 2024; 147:106563. [PMID: 38007852 DOI: 10.1016/j.chiabu.2023.106563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND A recent study in this journal by Frewen et al. (2023) provided a critical analysis of the most widely used measure of ICD-11 Complex Posttraumatic Stress Disorder (CPTSD), the International Trauma Questionnaire (ITQ). The article was a thoughtful review and gave voice to several widely held concerns about the nature of CPTSD as it is represented in ICD-11 and measured by the ITQ. The primary concern expressed by Frewen et al. was that the symptom profile of ICD-11 CPTSD, as represented in the ITQ, is too simple and fails to provide adequate coverage of the construct. OBJECTIVE Despite its quality, the article included several misunderstandings about the nature of ICD-11 CPTSD, and the function of the ITQ, that we wish to clarify. PARTICIPANTS Not applicable. SETTING Not applicable. RESULTS In this article, we provide a description of what ICD-11 PTSD and CPTSD are, a review of the process that led to their inclusion in ICD-11, how the ITQ was developed and refined to measure these constructs. We then provide responses to several of the most important concerns raised by Frewen et al. CONCLUSIONS: We highlight the clinical utility of the ICD-11 descriptions of PTSD and CPTSD and discuss how the ITQ can be used as part of a suite of clinical assessments to accurately describe and understand common experiences of psychological distress that often result from exposure to traumatic life events.
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Affiliation(s)
- Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland.
| | - Chris R Brewin
- Division of Psychology and Language Sciences, University College London, London, England, United Kingdom
| | - Marylène Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, United States; Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, CA, United States
| | - Thanos Karatzias
- Edinburgh Napier University, School of Health & Social Care, Edinburgh, Scotland, United Kingdom
| | - Mark Shevlin
- School of Psychology, Ulster University, Derry, Northern Ireland, United Kingdom
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Langdon PE, Bisson JI, Rogers G, Swain S, Hiles S, Watkins A, Willner P. Evaluation of an adapted version of the International Trauma Questionnaire for use by people with intellectual disabilities. Br J Clin Psychol 2023; 62:471-482. [PMID: 36932469 DOI: 10.1111/bjc.12421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/05/2023] [Indexed: 03/19/2023]
Abstract
AIMS The International Trauma Questionnaire (ITQ) is a novel assessment instrument that is aligned to the ICD-11 diagnoses of post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD). The purpose of this study was to develop and evaluate an adapted version of the ITQ suitable for use by people with intellectual disabilities. METHODS The ITQ-ID follows the original ITQ, using wording developed in collaboration with a focus group of people with intellectual disabilities The ITQ-ID was administered to 40 people with intellectual disabilities recruited from learning disability forensic and community settings, alongside a Trauma Information Form and the Impact of Event Scale-Intellectual Disabilities (IES-IDs). RESULTS Most participants reported multiple traumatizing events. Around half of the participants met strict criteria for a diagnosis of PTSD, and around three quarters met looser criteria. Depending on definitions, between 66% and 93% of those who met criteria for PTSD also met criteria for a diagnosis of CPTSD. The ITQ-ID showed a single-component structure, with very good-to-excellent internal consistency, excellent test-retest reliability, and evidence of concurrent, discriminant, and content validity. SIGNIFICANCE The results support the potential of the ITQ-ID for assessment of PTSD and CPTSD in people with intellectual disabilities in both clinical and research contexts and highlight the need for further validation work.
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Affiliation(s)
- Peter E Langdon
- Centre for Educational Development, Appraisal and Research and Centre for Mental Health and Wellbeing Research, University of Warwick, Coventry, UK.,Coventry and Warwickshire Partnership NHS Trust, Coventry, UK.,Herefordshire and Worcestershire Health and Care NHS Trust, Worcester, UK
| | - Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Gemma Rogers
- Kent and Medway NHS and Social Care Partnership Trust, Maidstone, UK
| | - Sophie Swain
- Midlands Partnership NHS Foundation Trust, The Redwoods Centre, Shrewsbury, UK
| | - Steve Hiles
- Swansea Trials Unit, Clinical Research Facility, Institute of Life Science, Swansea University, Swansea, UK
| | - Alan Watkins
- Swansea Trials Unit, Clinical Research Facility, Institute of Life Science, Swansea University, Swansea, UK
| | - Paul Willner
- School of Psychology, Swansea University, Swansea, UK
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Niwa M, Kato T, Narita-Ohtaki R, Otomo R, Suga Y, Sugawara M, Narita Z, Hori H, Kamo T, Kim Y. Skills Training in Affective and Interpersonal Regulation Narrative Therapy for women with ICD-11 complex PTSD related to childhood abuse in Japan: a pilot study. Eur J Psychotraumatol 2022; 13:2080933. [PMID: 35695843 PMCID: PMC9186357 DOI: 10.1080/20008198.2022.2080933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Skills Training in Affective and Interpersonal Regulation (STAIR) Narrative Therapy (SNT) has shown efficacy in alleviating symptoms of posttraumatic stress disorder (PTSD) and improving emotion regulation and interpersonal skills among individuals with complex trauma, such as childhood abuse. Although this therapy is expected to be effective for patients with complex PTSD (CPTSD), no study has directly assessed diagnostic and symptom outcomes. Moreover, the potential of therapy to achieve good outcomes in non-Western countries remains unclear. OBJECTIVE This pilot study examined the feasibility, safety, and outcomes of SNT for CPTSD among women with a history of childhood abuse in a Japanese clinical setting. METHODS Ten women aged 21-54 years (M = 29.1 years) with childhood-abuse-related ICD-11 CPTSD were enrolled in this study. The International Trauma Interview and International Trauma Questionnaire were administered to diagnose CPTSD and assess its severity. Symptoms of dissociation and depression, difficulties in emotion regulation and interpersonal relationships, quality of life, and negative cognitions were assessed pretreatment, midtreatment (after the STAIR phase), and immediately posttreatment (after the Narrative Therapy phase), in addition to 3 months after treatment. RESULTS Seven of the 10 participants completed the treatment. The therapists' adherence to the therapy protocol was 96.4%, ranging from 93.6% to 100% across therapists. Serious adverse events were not observed. Among the seven completers, six at posttreatment and all at follow-up no longer met CPTSD diagnosis. Exploratory analyses using the linear mixed-effects model showed significant improvements at posttreatment and follow-up for almost all the variables. CONCLUSIONS The results provide preliminary evidence for the feasibility and safety of SNT for CPTSD in a Japanese clinical setting. This study is the first to report the use of SNT for individuals diagnosed with ICD-11 CPTSD using reliable clinician and self-report measures. HIGHLIGHTS This study examined the feasibility and safety of STAIR Narrative Therapy for women with ICD-11 CPTSD related to childhood abuse in a Japanese clinical setting.High therapy adherence was observed.No serious adverse events occurred.
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Affiliation(s)
- Madoka Niwa
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | | | - Ryoko Narita-Ohtaki
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | | | - Yosuke Suga
- Research Department, Hyogo Institute for Traumatic Stress, Hyogo, Japan
| | - Mayumi Sugawara
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Zui Narita
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hiroaki Hori
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Toshiko Kamo
- Wakamatsu-cho Mental and Skin Clinic, Tokyo, Japan
| | - Yoshiharu Kim
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
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Rossi R, Socci V, Pacitti F, Carmassi C, Rossi A, Di Lorenzo G, Hyland P. The Italian Version of the International Trauma Questionnaire: Symptom and Network Structure of Post-Traumatic Stress Disorder and Complex Post-Traumatic Stress Disorder in a Sample of Late Adolescents Exposed to a Natural Disaster. Front Psychiatry 2022; 13:859877. [PMID: 35693953 PMCID: PMC9174511 DOI: 10.3389/fpsyt.2022.859877] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 01/21/2022] [Accepted: 05/06/2022] [Indexed: 11/27/2022] Open
Abstract
The 11th revision of the International Classification of Diseases has endorsed substantial changes in Post-Traumatic Stress Disorder (PTSD) and has introduced Complex PTSD (cPTSD). The objective of this study was to assess the symptom and network structure of PTSD and cPTSD using the International Trauma Questionnaire- Italian version (ITQ) and the prevalence of PTSD and cPTSD in a community sample of late adolescents enriched with exposure to a destructive earthquake. A 1,010 high school students participated to the study. Confirmatory Factor Analysis supports that a six first-order correlated factors was the best fitting model of ICD-11 PTSD/cPTSD. The network analysis supports a clear separation between core PTSD symptoms and disturbances in self-organization (DSO) symptoms, avoidance, and negative self-concept were the most central items. The prevalence of PTSD and cPTSD was 9.11 and 4.06%, respectively. Female participants reported higher rates of both PTSD and cPTSD. This is the first study to report on ICD-11 PTSD and cPTSD rates on an Italian adolescence community sample. Consistent with other community samples, we found higher rates of PTSD compared to cPTSD. The results confirmed the factorial validity of the ITQ. The network structure highlights the importance of negative self-concept in cPTSD and avoidance in PTSD.
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Affiliation(s)
- Rodolfo Rossi
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Valentina Socci
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesca Pacitti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Rossi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy.,IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Philip Hyland
- Department of Psychology, Maynooth University, Maynooth, Ireland
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Redican E, Nolan E, Hyland P, Cloitre M, McBride O, Karatzias T, Murphy J, Shevlin M. A systematic literature review of factor analytic and mixture models of ICD-11 PTSD and CPTSD using the International Trauma Questionnaire. J Anxiety Disord 2021; 79:102381. [PMID: 33714868 DOI: 10.1016/j.janxdis.2021.102381] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [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] [Received: 02/11/2021] [Revised: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 12/16/2022]
Abstract
The 11th version of the International Classification of Diseases (ICD-11; WHO, 2018) describes two distinct trauma related disorders, Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). This review aims to summarise and synthesize evidence from factor analytic and mixture modelling studies that have investigated the latent structure of the International Trauma Questionnaire. A systematic search of PsycInfo, Web of Science, Scopus and Pubmed databases was conducted to identify relevant articles. Thirty-three studies met the inclusion criteria for this systematic review. The latent structure of the ITQ was best represented by two models; a correlated six-factor model (Re-experiencing, Avoidance, Threat, Affect Dysregulation, Negative Self Concept, and Disturbed Relationships) and a two-factor second-order model (PTSD and Disturbances in Self-Organization). Mixture model studies consistently identified distinct classes representing those displaying PTSD and CPTSD symptoms. Numerous studies demonstrated support for the factorial and discriminant validity of PTSD and CPTSD when analysed in conjunction with other variables. Overall, support was found for the conceptual coherence of PTSD and CPTSD as empirically distinguishable disorders, as measured by the ITQ. The available evidence demonstrates that the ITQ is a valid measure of ICD-11 PTSD and CPTSD. Recommendations for future research are included.
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Affiliation(s)
- Enya Redican
- Ulster University, School of Psychology, Coleraine, UK
| | - Emma Nolan
- Ulster University, School of Psychology, Coleraine, UK
| | - Philip Hyland
- Department of Psychology, Maynooth University, Ireland
| | - Marylene Cloitre
- National Center for PTSD, Verterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Orla McBride
- Ulster University, School of Psychology, Coleraine, UK
| | - Thanos Karatzias
- Edinburgh Napier University, School of Health and Social Care, Edinburgh, UK
| | - Jamie Murphy
- Ulster University, School of Psychology, Coleraine, UK
| | - Mark Shevlin
- Ulster University, School of Psychology, Coleraine, UK.
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Choi H, Lee W, Hyland P. Factor structure and symptom classes of ICD-11 complex posttraumatic stress disorder in a South Korean general population sample with adverse childhood experiences. Child Abuse Negl 2021; 114:104982. [PMID: 33561718 DOI: 10.1016/j.chiabu.2021.104982] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 01/16/2021] [Accepted: 01/24/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACE) are known as risk factors for poor adulthood mental health, including ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). While many studies focused on the association of ACE and CPTSD, examining variant symptom patterns related to ACE is lacking. OBJECTIVE This study aimed to identify the factorial validity of the ICD-11 CPTSD and its distinctive symptom classes in Korean adults with ACE from a representative community sample and examine the risk factors and clinical symptoms that distinguish the CPTSD symptom classes. METHODS We conducted a cross-sectional retrospective study with the International Trauma Questionnaire data from 800 adult general population with ACE histories. A confirmatory factor analysis, latent class analysis, analysis of variance and multinomial logistic regression were conducted. RESULTS Results of confirmatory factor analysis supported a six-factor correlation model, while a two-factor higher-order model with PTSD and disturbances in self-organization (DSO) as correlated constructs also showed excellent fit. A latent class analysis identified six classes, including a distinctive ICD-11 CPTSD and PTSD, additionally a DSO with sense of threat, a DSO, an emotion dysregulation, and a low symptom class, showing distinguished features in ACE patterns, lifetime trauma, depression, somatization, panic disorder, and subtypes of dissociation. CONCLUSIONS The factorial and discriminant validity of ICD-11 CPTSD for Korean ACE survivors were confirmed. Recognizing the pervasive impact of patterns of ACEs and lifetime trauma would be helpful in access to and delivery of appropriate mental health services. Variation in symptom presentations of CPTSD and the role of dissociation should be of concern, that it may bring complicated life outcomes to people with ACEs.
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Affiliation(s)
- Hyunjung Choi
- Department of Psychology, Chungbuk National University, Cheongju, South Korea.
| | - Wooyeol Lee
- Department of Psychology, Chungbuk National University, Cheongju, South Korea
| | - Philip Hyland
- Department of Psychology, Maynooth University, Maynooth, Co. Kildare, Ireland
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Abstract
Background: Globally, professional firefighters are often exposed to traumatic events and are at high risk of developing posttraumatic stress disorder (PTSD) symptoms. Objective: With the publication of the 11th edition of the International Classification of Diseases (ICD-11) there arose a need for research based on the new diagnostic criteria, and the associated disorder, Complex PTSD (CPTSD). Method: Participants were 1300 former or present firefighters from the UK. Prevalence rates of PTSD and CPTSD were estimated using International Trauma Questionnaire in accordance with ICD-11 criteria, and service related and personal trauma exposure were also assessed using an anonymous online questionnaire. Multinomial logistic regression was performed to assess how service and personal trauma exposure predicted PTSD and CPTSD. Results: CPTSD criteria were met by 18.23% (95% CI 16.13-20.33%) and PTSD criteria were met by 5.62% (95% CI 4.37-6.87%) of the sample. Experiencing higher levels of service-related trauma significantly increased the risk for both PTSD and CPTSD, and nonwork related trauma uniquely predicted CPTSD but not PTSD. Conclusions: This study provided the first examination of the new ICD-11 criteria for PTSD and CPTSD in a large sample of firefighters, and CPTSD was more common than PTSD. Exposure to multiple different types of trauma increased the odds of PTSD and CPTSD.
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Affiliation(s)
- John Langtry
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Marcin Owczarek
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Donal McAteer
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Laurence Taggart
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Christina Gleeson
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Catherine Walshe
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, Northern Ireland
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Choi H, Kim N, Lee A. ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD among organized violence survivors in modern South Korean history of political oppression. Anxiety Stress Coping 2020; 34:203-214. [PMID: 33141629 DOI: 10.1080/10615806.2020.1839889] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Construct and discriminant validity of the ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) has been examined worldwide. However, little is known about CPTSD in Korean population who are suffering with long-term responses of organized violence in their context. DESIGN This study conducted a cross-sectional survey to assess the construct and discriminant validity of the ICD-11 PTSD and CPTSD using the Korean International Trauma Questionnaire (ITQ) among organized violence survivors of past political oppression (from 1940s to 2010s) in South Korea. METHOD A total of 236 survivors and families completed the survey including the ITQ. A confirmatory factor analysis and a multinomial logistic regression were conducted. RESULTS A second-order eight-factor, the ICD-11 CPTSD model, best described the structure of CPTSD. Compared to the non-diagnosed group, having above median score of cumulative trauma was a risk factor for PTSD [Odds ratio (OR) = 3.18] and CPTSD (OR = 3.27). Having above median score of cumulative social stressors increased the risk of CPTSD, relative to PTSD (OR = 4.84), and to the non-diagnosed group (OR = 7.79). CONCLUSIONS The ITQ seemed applicable to the Korean culture, showing a valid construct and meaningfully distinguishing ICD-11 PTSD and CPTSD.
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Affiliation(s)
- Hyunjung Choi
- Department of Psychology, Chungbuk National University, Cheongju, South Korea
| | - Nagyeong Kim
- Department of Psychology, Chungbuk National University, Cheongju, South Korea
| | - Ahyeon Lee
- Department of Psychology, Chungbuk National University, Cheongju, South Korea
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11
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Tian Y, Wu X, Wang W, Zhang D, Yu Q, Zhao X. Complex posttraumatic stress disorder in Chinese young adults using the International Trauma Questionnaire (ITQ): A latent profile analysis. J Affect Disord 2020; 267:137-143. [PMID: 32063565 DOI: 10.1016/j.jad.2020.02.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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] [Received: 11/28/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The ICD-11 includes posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as two distinct disorders. Several empirical studies have supported the distinction between PTSD and CPTSD in various trauma population and different culture backgrounds. However, research documenting qualitatively distinction between PTSD and CPTSD using the International Trauma Questionnaire (ITQ) in a large general population from non-English-speaking countries is limited. METHODS Self-report measures were used to assess CPTSD, dissociation, depression, and posttraumatic growth in a sample of 1,760 Chinese college students who had experienced at least one traumatic event. Latent profile analysis was utilized to identify the number of classes based on the 18-item version of ITQ. RESULTS A four-class solution (low symptoms, disturbance of self-organization, PTSD, CPTSD) was the most appropriate one in our study. Compared to the PTSD class, the CPTSD class was associated with more serious psychopathology symptoms. LIMITATIONS Sample characteristics in this study limit its generalizability to other population (e.g., low educational level, clinical sample). The type of traumatic event in predicting distinct classes should also be investigated in future studies. CONCLUSIONS Distinction between PTSD and CPTSD as ICD-11 proposed was supported in a Chinese young adult sample. DSO symptoms might inhibit healing and recovery process, and subsequent intervention could consider treat CPTSD based on addressing DSO symptoms.
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Affiliation(s)
- Yuxin Tian
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Xinchun Wu
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, Beijing Normal University, Beijing 100875, China.
| | - Wenchao Wang
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Di Zhang
- Education and Counseling Center of Psychological Health, Ocean University of China, Qingdao, Shandong 266100, China
| | - Qingyun Yu
- Counseling Center of Mental Health Education, Jingchu University of Technology, Jingmen, Hubei 448000, China
| | - Xianzi Zhao
- Department of psychology, College of Education, Hebei Normal University, Shijiazhuang, Hebei 050024, China
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Ho GWK, Hyland P, Shevlin M, Chien WT, Inoue S, Yang PJ, Chen FH, Chan ACY, Karatzias T. The validity of ICD-11 PTSD and Complex PTSD in East Asian cultures: findings with young adults from China, Hong Kong, Japan, and Taiwan. Eur J Psychotraumatol 2020; 11:1717826. [PMID: 32128045 PMCID: PMC7034426 DOI: 10.1080/20008198.2020.1717826] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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] [Received: 09/11/2019] [Revised: 11/28/2019] [Accepted: 01/03/2020] [Indexed: 12/12/2022] Open
Abstract
Background: The ICD-11 classifies posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as two distinct diagnoses. Few studies have tested the validity of ICD-11 CPTSD in non-Western settings, particularly in Asia. Objective: This study assessed the factorial, concurrent, and discriminant validity of CPTSD symptoms with four samples of young adults from mainland China, Hong Kong, Japan, and Taiwan. Method: Young adults aged 18-24 years were recruited by convenience sampling and provided their data anonymously online. Study measures included the International Trauma Questionnaire (ITQ) to measure PTSD and CPTSD, and measures of childhood adversity, depression, anxiety, age, and sex. Confirmatory factor analysis (CFA) was performed for each sample to evaluate the validity of two CPTSD measurement models. Structural equation modelling (SEM) was used to determine the multivariate associations between study variables for the full sample. Results: A total of 1,346 young adults completed the survey. CFA showed both models of CPTSD examined fit the data well across all four samples. SEM findings showed that number of childhood adversities significantly associated with both PTSD and CPTSD factors; depression significantly associated with CPTSD factors but not PTSD, whereas anxiety significantly associated with both. Conclusions: Study findings provide evidence for PTSD and CPTSD as separate and valid diagnoses in Asia. More cross-cultural comparisons are needed to understand whether risks for either condition differ by geographical or sociocultural norms.
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Affiliation(s)
- Grace W K Ho
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Mark Shevlin
- School of Psychology, Ulster University, Derry, Northern Ireland
| | - W T Chien
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sachiko Inoue
- Department of Nursing Science, Okayama Prefectural University, Soja, Japan
| | - Pei J Yang
- Graduate Institute of Social Work, National Chengchi University, Taipei, Taiwan
| | - Fei H Chen
- Department of Social Work, Chaoyang University of Technology, Taichung, Taiwan
| | - Athena C Y Chan
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK.,NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK
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Abstract
OBJECTIVE ICD-11 introduces post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) as two distinct trauma-related disorders. Using the International Trauma Questionnaire (ITQ) as disorder-specific measure, this study is the first to examine the factorial and construct validity of ICD-11 PTSD, CPTSD and the ITQs' applicability in children. METHODS Two hundred and eight Austrian foster children completed a set of standardized measures. Excluding participants who reported not having experienced any kind of trauma, a final sample of 136 children completed the ITQ. Factorial and construct validity of ICD-11 CPTSD and psychometric properties of ITQ scales were assessed by factor analysis and latent class analysis. RESULTS Confirmatory factor analysis supported the two-factor higher-order model of ICD-11 CPTSD in children by high factor loadings and excellent model fit. Reliability and regression analysis evidenced psychometric adequacy and discriminant validity of ITQ scales. Latent class analysis substantiated construct validity of ICD-11 CPTSD, identifying a CPTSD (22.8%), PTSD (31.6%) and low symptoms class (45.6%). The CPTSD class showed highest rates of childhood trauma, comorbid psychopathology and functional impairment. CONCLUSION Factorial and construct validity of ICD-11 CPTSD was evidenced in children for the first time using precise descriptions of ICD-11 symptom content, supporting the reliability and validity of the ITQ in children.
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Affiliation(s)
- A. Haselgruber
- Unit of PsychotraumatologyFaculty of PsychologyUniversity of ViennaViennaAustria
| | - K. Sölva
- Unit of PsychotraumatologyFaculty of PsychologyUniversity of ViennaViennaAustria
| | - B. Lueger‐Schuster
- Unit of PsychotraumatologyFaculty of PsychologyUniversity of ViennaViennaAustria
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Vallières F, Ceannt R, Daccache F, Abou Daher R, Sleiman J, Gilmore B, Byrne S, Shevlin M, Murphy J, Hyland P. ICD-11 PTSD and complex PTSD amongst Syrian refugees in Lebanon: the factor structure and the clinical utility of the International Trauma Questionnaire. Acta Psychiatr Scand 2018; 138:547-557. [PMID: 30357808 DOI: 10.1111/acps.12973] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [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: 10/04/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Support for ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) is growing; however, few studies include refugees or examine the clinical utility of PTSD/CPTSD classifications. This study sought to provide the first evaluations of (i) the factor structure of ICD-11 PTSD/CPTSD amongst refugees in the Middle East; and (ii) the clinical utility of the International Trauma Questionnaire (ITQ) to identify PTSD/CPTSD in a humanitarian context. METHOD Participants were 112 treatment-seeking Syrian refugees living in Lebanon. Factorial validity was assessed using confirmatory factor analysis (CFA) based on responses to the ITQ. Clinical utility of the ITQ was assessed through semi-structured interviews with six Lebanese psychotherapists. RESULTS Complex PTSD (36.1%) was more common than PTSD (25.2%), and no sex or age differences were observed at the prevalence or symptomatic levels. CFA results supported a two-factor higher-order model consistent with ICD-11 PTSD/CPTSD. Qualitative findings indicated that the ITQ is generally positively regarded, with some limitations and suggested modifications noted. CONCLUSION This is the first study to support the ICD-11 PTSD/CPTSD amongst refugees in the Middle East and the clinical utility of the ITQ in a humanitarian context. Findings support the growing evidence for the cross-cultural applicability of ICD-11 PTSD/CPTSD.
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Affiliation(s)
- F Vallières
- Centre for Global Health, University of Dublin, Trinity College, Dublin 2.,School of Psychology, University of Dublin, Trinity College, Dublin 2, Ireland
| | - R Ceannt
- Centre for Global Health, University of Dublin, Trinity College, Dublin 2
| | - F Daccache
- International Medical Corps Lebanon, Beirut, Lebanon
| | - R Abou Daher
- International Medical Corps Lebanon, Beirut, Lebanon
| | - J Sleiman
- International Medical Corps Lebanon, Beirut, Lebanon
| | - B Gilmore
- Centre for Global Health, University of Dublin, Trinity College, Dublin 2.,School of Psychology, University of Dublin, Trinity College, Dublin 2, Ireland
| | - S Byrne
- School of Psychology, University of Dublin, Trinity College, Dublin 2, Ireland
| | - M Shevlin
- Psychology Research Institute, Ulster University, Londonderry, UK
| | - J Murphy
- Psychology Research Institute, Ulster University, Londonderry, UK
| | - P Hyland
- Centre for Global Health, University of Dublin, Trinity College, Dublin 2.,School of Business, International Financial Services Centre, National College of Ireland, Dublin 1, Ireland
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