Global Psychotrauma Screen (GPS): psychometric properties in two Internet-based studies

Adaptation and validation study of the Indonesian version of the Global Psychotrauma Screen in an undergraduate student population

BACKGROUND

The high incidence of potentially traumatic events (PTEs) in Indonesia warrants early identification of those with probable trauma-related disorders in order to tailor prevention and intervention for trauma-related symptoms.

OBJECTIVES

This study aims to adapt and validate a novel brief transdiagnostic screener, the Global Psychotrauma Screen (GPS), in Indonesian undergraduate students.

METHODS

An online survey was administered among Indonesian undergraduate students (N = 322). Exploratory factor analysis, reliability analyses, clinical validity analyses, and correlational analyses were performed to evaluate the construct validity, reliability, clinical validity, and convergent-divergent validity of the Indonesian GPS. Hierarchical multiple regression was conducted to assess the relationship between risk factors and trauma-related symptoms. The relationship between four categories of trauma-related symptom severity and social/work functioning was measured using Analysis of Covariance.

RESULTS

Exploratory factor analysis yielded a single-factor solution. The Indonesian GPS demonstrated good internal consistency, test-retest correlation, and absolute agreement, indicating good reliability. The Indonesian GPS also had an acceptable area under the curve, sensitivity, and specificity for a probable diagnosis of Post-Traumatic Stress Disorder (PTSD), Complex-PTSD (CPTSD), depression, and generalized anxiety disorder (GAD). We also established evidence for the convergent and divergent validity of GPS. The GPS risk factors (low psychological resilience, other stressful events, history of mental illness, and low social support) contributed to predicting trauma-related symptoms after controlling for gender, age, employment status, and faculty background. Additionally, in comparison to participants from the mild and low categories of GPS symptoms scores, participants from the severe and moderate category reported impaired lowered social/work functioning.

CONCLUSION

The current findings indicate that the Indonesian GPS is a valid and reliable transdiagnostic trauma screener for Indonesian undergraduate students. This first comprehensive validation of the GPS in Indonesia calls for more research in Lower-middle Income Countries (LMICs) as a way towards prevention and early intervention for trauma-related symptoms.

Sex and gender in psychotrauma research

Background: Posttraumatic stress disorder (PTSD) is two to three times more common in women than in men. To better understand this phenomenon, we need to know why men, women, and possibly individuals with other sex/gender identities respond differently to trauma. To stimulate sex and gender sensitive research, the European Journal of Psychotraumatology (EJPT) was the first journal to adopt a gender policy. In addition, a call for papers entitled Integrating and Evaluating Sex and Gender in Psychotrauma Research was announced.Objective: This special issue synthesizes the past five years of psychotrauma research with regard to sex/gender differences.Method: Seventy-seven articles were identified from EJPT archives, including five systematic reviews. These articles examined sex differences and/or gender differences in exposure to trauma, posttraumatic stress responses, or how sex and gender impacts (mental) health outcomes or treatment responses.Results: Findings from these studies outlined that: 1. sex and gender still need to be more clearly defined, also in relation to the context that codetermine trauma responses, like other 'diversity' variables; 2. in most studies, sex and gender are measured or reported as binary variables; 3. sex and gender are important variables when examining trauma exposure, responses to these events, symptoms trajectories, and mental and physical health outcomes across the life span; and 4. in PTSD treatment studies, including a meta-analysis and a systematic review, sex and gender were not significant predictors of treatment outcome.Conclusion: Future research must focus on sex and gender as important and distinct variables; they should include sex and gender in their statistical analyses plan to better clarify associations between these variables and (responses to) psychotrauma. To enhance reporting of comparable data across studies, we provide suggestions for future research, including how to assess sex and gender.

The Nature of Combat Stress Development During Military Operations and Psychotherapy in Extreme Situations

ABSTRACT

The purpose of the research work is the theoretical and empirical analysis of the study of the nature of combat stress in military personnel and the assessment of psychotherapeutic methods of providing psychological assistance in extreme situations. The authors used the following methods to achieve this goal: method of analysis and synthesis, hermeneutic method, testing method, comparative method, and generalization method. The results of the research work have revealed the meaning of traumatic stress, psychological trauma, and combat mental trauma, and explained the concept of combat stress and the dynamics of its growth. The findings identified the factors of posttraumatic stress syndrome and its prevalence, tracked down the dynamics of psychoemotional disorders, and revealed the importance of military psychological selection and determination of combat readiness. The authors established the main tasks of a staff psychologist in working with military personnel, conducted an empirical study of the nature of combat stress in the military, observed main psychotherapeutic tools for the prevention of negative mental states in combat conditions, and investigated self-regulation techniques of emotional, physical, and mental health. The practical significance of the scientific work lies in the modern coverage of the phenomenon of combat stress and the classification of effective psychotherapeutic methods that will ensure the sustainable psychological preparation of the soldiers for extreme situations.

Perceived Acceptability of Child Maltreatment as a Moderator of the Association Between Experiences of Child Maltreatment and Post-Traumatic Symptoms: A Cross-Cultural Study

Despite the well-documented link between child maltreatment (CM) and mental health, evidence suggests substantial variability in the post-traumatic sequelae of CM across cultures. The perceived acceptability of CM in one's community might moderate the association between CM and mental health, but little research has been conducted on it so far. This study examined how the perceived acceptability of CM may influence the relationship between CM experiences and post-traumatic symptoms in individuals from four different continents and if the pattern of associations is the same across countries. We recruited a sample of 478 adults from Cameroon (n = 111), Canada (n = 137), Japan (n = 108), and Germany (n = 122). We administered online questionnaires and performed multiple group moderation analyses for total CM, neglect, physical abuse, emotional maltreatment, sexual abuse, and exposure to domestic violence (DV). A significant positive main effect of CM on post-traumatic symptoms was found in the overall sample and in Cameroon; in Germany, only neglect and emotional maltreatment were positively associated to post-traumatic symptoms. Moderation effects were identified; the perceived acceptability of neglect in Cameroon and Germany and of exposure to DV in Cameroon had a dampening effect on the relationship between CM experiences and post-traumatic symptoms. Our findings confirm that CM experiences entail long-term post-traumatic sequelae that can vary across cultures and CM subtypes and further our understanding of this issue by showing that the perceived acceptability of CM may be an understudied moderator.

Childhood trauma histories in men and women assessed by the childhood attachment and relational trauma screen (CARTS) and the global psychotrauma screen (GPS): Results from the global collaboration on traumatic stress (GC-TS)

BACKGROUND

Whether there are biological sex differences in rates of childhood trauma exposure perpetrated by female versus male biological parents remains largely unknown. Moreover, the relative risk posed by various vulnerability factors for transdiagnostic mental health outcomes among females vs. males in adulthood has received insufficient attention.

OBJECTIVE

To compare biological sex differences in the long-term impact of childhood abuse and neglect on transdiagnostic mental health outcomes, especially comparing the outcomes of childhood maltreatment perpetrated by biological mothers vs. fathers.

PARTICIPANTS AND SETTING

3129 participants (2784 female [89 %]) were recruited online, the majority (82 %) of whom endorsed having a childhood trauma history and a high number of mental health problems.

METHODS

Online surveys were administered. Specifically, the Childhood Attachment and Relational Trauma Screen (CARTS) was completed as a relationally-contextualized screening measure of both positive and traumatic-neglectful experiences during childhood, comparing severity of perpetration by male vs. female biological parents. Further, the Global Psychotrauma Screen (GPS) was completed to assess the relative risk of five vulnerability factors, including childhood abuse and neglect, for long-term transdiagnostic mental health outcomes. Statistical analyses elucidate group differences between males and females primarily by way of t-tests and associated effect sizes (Cohen's d).

RESULTS

Biological sex differences were shown for childhood maltreatment perpetration by male vs. female biological parents, wherein responses to CARTS showed that females reported that their biological mothers exhibited less positivity (d = 0.21), less attachment security (d = 0.22), more negative feelings toward them (d = 0.28), were more emotionally abusive (d = 0.17), and held more negative relational beliefs about them (d = 0.24). Comparably, males reported that their biological fathers were more physically abusive (d = 0.15) and that they held more negative relational beliefs toward their fathers (d = 0.25). Risk factors including having a history of childhood trauma and neglect were associated with transdiagnostic mental health problems among both females (d = 0.57) and males (d = 0.46), with other risk factors evidencing similar results.

CONCLUSIONS

Childhood trauma and neglect is a risk factor for transdiagnostic mental health outcomes among both females and males, although the two biological sexes may exhibit different levels of risk of being maltreated by female and male biological parents. Specifically, females reported having more emotionally abusive biological mothers, while males reported having more physically abusive biological fathers.

Exploring transdiagnostic stress and trauma-related symptoms across the world: a latent class analysis

Background: Although trauma exposure is universally prevalent, the ways in which individuals respond to potentially traumatic events vary. Between-country differences have been identified as affecting the development and manifestation of transdiagnostic psychological symptoms, but it remains unclear how stress and trauma-related transdiagnostic symptoms and risk patterns differ based on geographic region.Objective: To explore whether there are distinct classes of stress and trauma-related transdiagnostic symptoms and to determine predictors of class membership in a global sample.Method: Participants (N = 8675) from 115 different countries were recruited online between 2020-2022 and completed the Global Psychotrauma Screen, which assesses stress and trauma exposure, related symptoms, and risk factors. A latent class analysis (LCA) was used to identify classes of stress and trauma-related symptoms per world region (African States, Asia-Pacific States, Eastern European States, Latin American and Caribbean States, Western European and Other States, and North America) and the total sample. Likelihood of class membership was assessed based on demographics, characteristics of the potentially traumatic event, and potential risk factors across the world regions.Results: Similar class compositions were observed across regions. A joint latent class analysis identified three classes that differed by symptom severity (i.e. high, moderate, low). Multinomial logistic regression analyses revealed several factors that conferred greater risk for experiencing higher levels of symptoms, including geographic region, gender, and lack of social support, among others.Conclusions: Stress and trauma-related symptoms seem to be similarly transdiagnostic across the world, supporting the value of a transdiagnostic assessment.

Psychological factors associated with vaccination hesitancy: an observational study of patients hospitalized for COVID-19 in a later phase of the pandemic in Italy

Introduction

Vaccination against SARS-CoV-2 has been used to reduce the severity of COVID-19 disease and the incidence of new cases. However, a significant proportion of people have shown vaccination hesitancy.

Methods

This study explored psychological factors related to vaccination hesitancy in a sample of Italian COVID-19 patients (N = 54), hospitalized during 2021, after vaccines had been made available and while the vaccination campaign was on-going. Consecutive patients, aged 18 or older, admitted to the hospital with a diagnosis of COVID-19 were assessed with a set of standardized measures.

Results

In our sample, 48.1% was not vaccinated and 7.4% died within 6months after hospitalization, with a preponderance of deaths among non-vaccinated patients. Non-vaccinated participants had higher resilience scores at the CD-RISC-10 scale than vaccinated ones (33.6 ± 5.50 vs 28.6 ± 6.61; t40.2=+ 2.94, p = 0.005). No statistically significant differences were found between the two groups for any other measures.

Discussion

Higher levels of resilience among non-vaccinated patients may reflect greater identity worth and self-esteem, in turn resulting in a decrease in vaccination likelihood. This finding may have important public health implications, as it indicates that specific psychological aspects, such as resilience, may result in vaccination hesitancy, with implications for hospitalization rates, and thus healthcare costs, as well as loss of lives.

Psychometric properties of the Global Psychotrauma Screen in the United States

Background

Prior research assessing the psychometric properties of the Global Psychotrauma Screen provided support for its internal consistency reliability, construct validity, convergent validity, and divergent validity in several international samples, but not specifically in a U.S. subsample.

Objective

The purpose of this study was to assess psychometric properties of the GPS in the U.S.

Method

This observational study included a convenience sample of individually recruited participants (N = 231) who completed an initial study with 126-item online questionnaire and a two-week follow-up study with GPS alone through the weblinks provided by the research team. Data analyzes included measuring internal consistency and test-retest reliability, exploratory and confirmatory factor analyzes (EFA and CFA), convergent and divergent validity, sensitivity, specificity, and severity of the GPS symptom items. Additional CFA was conducted with data (N = 947) from the GPS multinational research project, U.S. subsample.

Results

The results showed acceptable internal consistency and test-retest reliability, convergent validity, and divergent validity of the GPS. The construct validity results supported a three-factor structure of the GPS symptoms. The GPS domains showed acceptable sensitivity and specificity with the cut-off scores of 3 for PTSD and 5 for CPTSD domains; and the scores of 1 for the anxiety, depression, and insomnia domains respectively. The GPS risk factors predicted the GPS symptom severity.

Conclusions

This study provides new and additional evidence on the psychometric properties of the GPS which may help health care providers with the selection of an appropriate screening instrument for trauma-related transdiagnostic symptoms. The study limitations should be addressed in future research through the replication of EFA and CFA internationally with larger samples, and the inclusion of a reference standard for dissociation.

Importance of methodological considerations in documenting psychological trauma

The documentation of psychological trauma is obviously a challenge to clinicians while they are diving deep into remote events related to their clients or patients. The potential role of psychological trauma in the early developmental stages, and even the existence of adverse childhood experiences, is important to prove, yet it is difficult to do so. A diverse range of methods have been applied, all of which presumably benchmark a big therapeutic step; however, these enthusiastic methods frequently do not last for long. While hypnosis supporters, Freudian and Neo-Freudian disciples can be acute enough to enhance and uncover suppressed memories, modern psychiatry relies mostly on diversely structured interviews. Functional magnetic resonance and its related subtleties might help, but the questions that remain unanswered are numerous and confusing. Connecting early experiences with long-term memory while identifying psychological trauma its importance for the individual's growth trajectory; thus, it remains an intriguing issue.

Trauma and its consequences in Iran: cross-cultural adaption and validation of the Global Psychotrauma Screen in a representative sample

BACKGROUND

Potentially traumatic events may lead to the development of a wide range of adverse psychological responses, including symptoms of anxiety, depression, and (complex) posttraumatic stress disorder (PTSD). Despite the high prevalence of potentially traumatic events in Iran, there is no population data nor evidence-based instrument to screen for cross-diagnostic psychological responses to trauma. The Global Psychotrauma Screen (GPS) is a transdiagnostic self-report instrument for the detection of trauma-related symptoms, as well as risk and protective factors related to the impact of potentially traumatic events.

OBJECTIVE

The present study seeks to 1) translate and cross-culturally adapt the GPS in the Persian (Farsi) language and 2) examine the psychometric properties of the Persian GPS.

METHOD

The translation and adaptation were performed using the Sousa and Rojjanasrirat (2011) method. A pilot study (n = 30) was carried out to test the content validity and test-retest reliability of the GPS. Next, in a representative sample (n = 800) of residents of Kermanshah City, the GPS, the General Health Questionnaire (GHQ) and the PTSD Checklist for DSM-5 (PCL-5) were administered. Construct validity of the Persian GPS was assessed using exploratory and confirmatory factor analysis. Additionally, we evaluated the convergent validity and internal consistency of the GPS.

RESULTS

Exploratory and confirmatory factor analyses indicated a three-factor model as the best solution with factors representing 1) Negative Affect, 2) Core PTSD symptoms and 3) Dissociative symptoms. The GPS total symptom score had high internal consistency and high convergent validity with related measures. A GPS total symptom cut-off score of nine was optimal for indicating a probable PTSD diagnosis based on the PCL-5. About half (52%) of the current sample met criteria for probable PTSD.

CONCLUSIONS

The current findings suggest that the GPS can be effectively adapted for use in a non-Western society and, specifically, that the Persian GPS represents a useful, reliable and valid tool for screening of trauma-related symptoms in Iran.

Symptom networks of COVID-19-related versus other potentially traumatic events in a global sample

The potential mental health consequences of the coronavirus disease 2019 (COVID-19) pandemic are widely acknowledged; however, limited research exists regarding the nature and patterns of stress responses to COVID-19-related potentially traumatic events (PTEs) and the convergence/divergence with responses to other (non-COVID-19-related) PTEs. Network analysis can provide a useful method for evaluating and comparing these symptom structures. The present study includes 7034 participants from 86 countries who reported on mental health symptoms associated with either a COVID-19-related PTE (n = 1838) or other PTE (n = 5196). Using network analysis, we compared the centrality and connections of symptoms within and between each group. Overall, results show that the COVID-19-related network includes transdiagnostic symptom associations similar to networks tied to PTEs unrelated to the pandemic. Findings provide evidence for a shared centrality of depression across networks and theoretically consistent connections between symptoms. Network differences included stronger connections between avoidance-derealization and hypervigilance-depression in the COVID-19 network. Present findings support the conceptualization of psychological responses to pandemic-related PTEs as a network of highly interconnected symptoms and support the use of a transdiagnostic approach to the assessment and treatment of mental health challenges related to the COVID-19 pandemic.

Semantic adaptation of the Global Psychotrauma Screen for children and adolescents in the United States

Background: The review of trauma screening tools for children and adolescents indicates a need for developmentally and linguistically appropriate, globally applicable, free, and easily accessible trauma screening instruments. Objective: The aim of this study is to adapt the Global Psychotrauma Screen (GPS) for children and adolescents in the United States. Method: Using the modified Delphi method, this study included the GPS Expert Consensus (GPS-EC) and the GPS Stakeholder Consensus (GPS-SC) substudies. In the GPS-EC, ten reviewers who specialize in trauma services independently revised the GPS child and adolescent versions in four rounds. In the GPS-SC, a stratified minimum sample of children and adolescents (n = 24) and their parents (n = 24) were interviewed to collect feedback on the revised GPS versions. Results: In the GPS-EC Round 1, a low level of consensus was observed on the anxiety (restlessness) and depression (loss of interest) items. In Round 2, a high level of consensus was achieved on all but PTSD hypervigilance and detachment, and CPTSD self-concept items. Round 3 indicated a low level of consensus on the exposure and functioning items. Full consensus was achieved in Round 4 on all items. In the GPS-SC, children had more difficulties than adolescents with the exposure, dissociation, and risk-protection items. Conclusions: Based on the results of this study, the semantic adaptation process concluded with implementation of six decisions on the final GPS versions for children and adolescents: adding a non-binary gender choice for adolescents; removing the exposure section; using a full-sentence structure for children and a phrase structure for adolescents; retaining the two-part items on PTSD intrusion and avoidance, retaining self-blame but removing other-blame in the PTSD-blame item; providing specific descriptions of depersonalization and derealization in the dissociation items; and removing risk-protection and functioning items for children.

Mental health responses to COVID-19 around the world

Background: The mental health impact of the COVID-19 crisis may differ from previously studied stressful events in terms of psychological reactions, specific risk factors, and symptom severity across geographic regions worldwide. Objective: To assess the impact of COVID-19 on a wide range of mental health symptoms, to identify relevant risk factors, to identify the effect of COVID-19 country impact on mental health, and to evaluate regional differences in psychological responses to COVID-19 compared to other stressful events. Method: 7034 respondents (74% female) participated in the worldwide Global Psychotrauma Screen - Cross-Cultural responses to COVID-19 study (GPS-CCC), reporting on mental health symptoms related to COVID-19 (n = 1838) or other stressful events (n = 5196) from April to November 2020. Results: Events related to COVID-19 were associated with more mental health symptoms compared to other stressful events, especially symptoms of PTSD, anxiety, depression, insomnia, and dissociation. Lack of social support, psychiatric history, childhood trauma, additional stressful events in the past month, and low resilience predicted more mental health problems for COVID-19 and other stressful events. Higher COVID-19 country impact was associated with increased mental health impact of both COVID-19 and other stressful events. Analysis of differences across geographic regions revealed that in Latin America more mental health symptoms were reported for COVID-19 related events versus other stressful events, while the opposite pattern was seen in North America. Conclusions: The mental health impact of COVID-19-related stressors covers a wide range of symptoms and is more severe than that of other stressful events. This difference was especially apparent in Latin America. The findings underscore the need for global screening for a wide range of mental health problems as part of a public health approach, allowing for targeted prevention and intervention programs.