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Demirchyan A, Khachadourian V, Armenian HK, Goenjian AK. The course, trajectories and predictors of depression 23 years after the 1988 Spitak earthquake in Armenia: A prospective cohort study. Psychiatry Res 2022; 313:114640. [PMID: 35598565 DOI: 10.1016/j.psychres.2022.114640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/04/2022] [Accepted: 05/14/2022] [Indexed: 11/19/2022]
Abstract
There is a scarcity of long-term studies of depression after natural disasters. This prospective epidemiologic study evaluated the course of depression and factors associated with it among survivors 23-years post-earthquake. A geographically stratified subsample of 725 adults exposed to the Spitak earthquake was assessed for depression using DSM-III-R criteria in 1991 and 2012. Additionally, an adapted CES-D-16 scale was used to assess depressive symptoms in 2012. A fitted multi-nominal logistic regression model identified predictors of different trajectories of depression. For the whole group, the rate of clinical depression dropped from 51.5% in 1991 to 31.7% in 2012. Earthquake intensity and experiencing strong fear at baseline were strongly associated with chronic (depressed at both assessments, 18.1%) and recovered (depressed only in 1991, 33.5%) depression trajectories compared with the healthy group, with odds ratios (OR) over 4.0 and 3.0, respectively. Predictors distinguishing chronic depression included earthquake-related nuclear-family deaths (OR=3.79), chronic illnesses at baseline (OR=1.24), and social support (OR=0.91). Predictors of the late-onset trajectory (depressed only in 2012, 13.5% of the cohort) included post-earthquake trauma (OR=1.42), socioeconomic status (OR=0.45), and social support (OR=0.86). The factors associated with the different trajectories of depression provide guidance for planning more effective mental health interventions after disasters.
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Affiliation(s)
- Anahit Demirchyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia.
| | - Vahe Khachadourian
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Haroutune K Armenian
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Armen K Goenjian
- UCLA/Duke University National Center for Child Traumatic Stress, Department of Psychiatry and Biobehavioral Sciences, UCLA, CA, USA; Collaborative Neuroscience Network, CA, USA
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Carlozzi NE, Sander AM, Choi SW, Wu Z, Miner JA, Lyden AK, Graves C, Sen S. Improving outcomes for care partners of persons with traumatic brain injury: Protocol for a randomized control trial of a just-in-time-adaptive self-management intervention. PLoS One 2022; 17:e0268726. [PMID: 35679283 DOI: 10.1371/journal.pone.0268726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 03/29/2022] [Indexed: 01/08/2023] Open
Abstract
Informal family care partners of persons with traumatic brain injury (TBI) often experience intense stress resulting from their caregiver role. As such, there is a need for low burden, and easy to engage in interventions to improve health-related quality of life (HRQOL) for these care partners. This study is designed to evaluate the effectiveness of a personalized just-in-time adaptive intervention (JITAI) aimed at improving the HRQOL of care partners. Participants are randomized either to a control group, where they wear the Fitbit® and provide daily reports of HRQOL over a six-month (180 day) period (without the personalized feedback), or the JITAI group, where they wear the Fitbit®, provide daily reports of HRQOL and receive personalized self-management pushes for 6 months. 240 participants will be enrolled (n = 120 control group; n = 120 JITAI group). Outcomes are collected at baseline, 1-, 2-, 3-, 4-, 5- & 6-months, as well as 3- and 6-months post intervention. We hypothesize that the care partners who receive the intervention (JITAI group) will show improvements in caregiver strain (primary outcome) and mental health (depression and anxiety) after the 6-month (180 day) home monitoring period. Participant recruitment for this study started in November 2020. Data collection efforts should be completed by spring 2025; results are expected by winter 2025. At the conclusion of this randomized control trial, we will be able to identify care partners at greatest risk for negative physical and mental health outcomes, and will have demonstrated the efficacy of this JITAI intervention to improve HRQOL for these care partners. Trial registration: ClinicalTrial.gov NCT04570930; https://clinicaltrials.gov/ct2/show/NCT04570930.
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Boyd JE, Cameron DH, Shnaider P, McCabe RE, Rowa K. Sensitivity and specificity of the Posttraumatic Stress Disorder Checklist for DSM-5 in a Canadian psychiatric outpatient sample. J Trauma Stress 2022; 35:424-433. [PMID: 34791713 DOI: 10.1002/jts.22753] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 04/09/2021] [Revised: 07/02/2021] [Accepted: 07/28/2021] [Indexed: 11/07/2022]
Abstract
The Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5) is a widely used, self-report measure that is employed to assess PTSD symptom severity and determine the presence of probable PTSD in various trauma-exposed populations. The PCL-5 is often administered in clinical settings as a screening tool for PTSD, with a suggested cutoff score of 33 indicating a probable PTSD diagnosis. Recent research indicates that a higher cutoff may be required in psychiatric samples. In the present study, we aimed to determine the sensitivity and specificity of the PCL-5 in a Canadian outpatient psychiatric sample and establish an optimal cutoff score for detecting probable PTSD in this sample. Participants were 673 individuals who reported a history of trauma exposure and were assessed using a semistructured interview and self-report measures. Individuals diagnosed with PTSD (N = 193) reported a mean PCL-5 score of 56.57, whereas individuals without PTSD (N = 480) reported a mean score of 33.56. A score of 45 was determined to be the optimal cutoff score in this sample, balancing sensitivity and specificity while detecting a probable diagnosis of PTSD. Consistent with findings in other psychiatric samples, these findings indicate that in an outpatient psychiatric sample with a history of exposure to a variety of trauma types, a higher cutoff score is required to determine probable PTSD. In addition, given the estimated rate of false positives even with a higher cutoff, follow-up diagnostic assessments are recommended.
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Affiliation(s)
- Jenna E Boyd
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Duncan H Cameron
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Philippe Shnaider
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Karen Rowa
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Patel AR, Newman E, Richardson J. A pilot study adapting and validating the Harvard Trauma Questionnaire (HTQ) and PTSD checklist-5 (PCL-5) with Indian women from slums reporting gender-based violence. BMC Womens Health 2022; 22:22. [PMID: 35090450 PMCID: PMC8795349 DOI: 10.1186/s12905-022-01595-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/04/2022] [Indexed: 01/07/2023] Open
Abstract
Background Despite high rates of gender-based violence (GBV) in India, culturally sensitive measures that examine universal and culturally relevant trauma reactions are lacking. Although the Harvard Trauma Questionnaire (HTQ) has been used in India, no study has adapted the measure in full for use with this population. Similarly, the PTSD checklist-5 (PCL-5) has not yet been validated in India. This study describes the adaptation, validation, and results from the adapted HTQ, and embedded PCL-5, for Indian women from slums reporting GBV. Method This study used the adaptation framework proposed by the HTQ measure developers. The adapted HTQ contained a (1) trauma screen relevant for stressors faced by Indian women from slums, (2) description of the index trauma, (3) description of any ongoing stressors, (4) universal trauma reactions (i.e., PTSD measured by the PCL-5), and culturally relevant trauma reactions (i.e., idioms of distress measured by a scale developed for the study). This measure was piloted on 111 women from Indian slums in face-to-face interviews. Trauma characteristics, types of ongoing stressors, and psychometric properties of the PCL-5 and idioms of distress scale were explored. These scales were validated against measures of depression (PHQ-9), anxiety (GAD-7), and somatic complaints (PHQ-15). Results The majority of participants (77%) reported physical beatings, 18% reported unwanted sexual touch, and 28.8% reported infidelity as the primary emotional abuse. Further, 96.7% of GBV was perpetrated by partner or family member and over half reported ongoing stressors (e.g., poverty-related strain). The PCL-5 embedded in the HTQ yielded good internal consistency (Cronbach’s alpha = .88) as did the idioms of distress scale with deletion of one item (Cronbach’s alpha = .80). Both scales were externally valid, yielding large correlations with depression, anxiety, and somatic complaints (rs between .54 and .80, ps < .05). Discussion This is the first study to develop a comprehensive measure of trauma exposure with universal and culturally relevant trauma reactions in India. This study also enhances HTQ usage in India by delineating all the steps in the adaptation process. Results can inform the development of trauma-focused interventions for Indian women from slums. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01595-3.
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Affiliation(s)
- Anushka R Patel
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74135, USA. .,Department of Psychiatry and Behavioral Sciences, Trauma Recovery Center, University of California San Francisco, 2727 Mariposa St, San Francisco, CA, 94110, USA.
| | - Elana Newman
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74135, USA
| | - Julia Richardson
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74135, USA
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Sun N, You Y, Yang D, Jiang ZX, Xia T, Zhou QG, Zhu DY. Neuronal nitric oxide synthase in dorsal raphe nucleus mediates PTSD-like behaviors induced by single-prolonged stress through inhibiting serotonergic neurons activity. Biochem Biophys Res Commun 2021; 585:139-145. [PMID: 34801934 DOI: 10.1016/j.bbrc.2021.11.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/12/2021] [Indexed: 12/27/2022]
Abstract
The pathogenesis of post-traumatic stress disorder (PTSD) remains largely unclear. A large body of evidence suggests that the abnormal level of serotonin (5-HT) is closely related to the onset of PTSD. Several reports reveal that nitric oxide (NO) affects extracellular 5-HT levels in various brain regions, but no consistent direction of change was found and the underlying mechanisms remain unknown. The most of serotonergic neurons in dorsal raphe nucleus (DRN), a major source of serotonergic input to the forebrain, co-expresses neuronal nitric oxide synthase (nNOS), a synthase derived nitric oxide (NO) in the central nervous system. Here, we found that the excessive expression of nNOS and thereby the high concentration of NO followed by single-prolonged stress (SPS) caused suppression of the activity of DRN 5-HT neurons, inducing PTSD-like phenotype including increased anxiety-like behaviors, enhanced contextual fear memory, and fear generalization. Our study uncovered an important role of DRN nNOS-NO pathway in the pathology of PTSD, which may contribute to new understanding of the molecular mechanism of PTSD.
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Affiliation(s)
- Nan Sun
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China; Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application, Xuzhou Medical University, Xuzhou, 221004, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou, 221004, China
| | - Yue You
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application, Xuzhou Medical University, Xuzhou, 221004, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou, 221004, China
| | - Di Yang
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China
| | - Zhi-Xin Jiang
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China
| | - Tian Xia
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China
| | - Qi-Gang Zhou
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China
| | - Dong-Ya Zhu
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China; Institution of Stem Cells and Neuroregeneration, Nanjing Medical University, Nanjing, 211166, China.
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Kaysen D, Rhew IC, Bittinger J, Bedard-Gilligan M, Garberson LA, Hodge KA, Nguyen AJ, Logan DE, Dworkin ER, Lindgren K. Prevalence and Factor Structure of PTSD in DSM-5 Versus DSM-IV in a National Sample of Sexual Minority Women. J Interpers Violence 2021; 36:NP12388-NP12410. [PMID: 31833796 PMCID: PMC7292760 DOI: 10.1177/0886260519892960] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The impact of changes to posttraumatic stress disorder (PTSD) diagnostic criteria from Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) to Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) within diverse communities is unclear. Young adult sexual minority women are at high risk for interpersonal violence and other forms of trauma exposure compared with heterosexual populations and sexual minority men. They are also at heightened risk of PTSD. As a result, young adult sexual minority women are a key population of interest when examining the impact of diagnostic criteria changes. The goal of the current study was to evaluate the impact of changes to PTSD diagnostic criteria in sexual minority women. Using an online survey, we administered both the original PTSD Symptom Checklist-S (based on DSM-IV criteria) and a version adapted to assess DSM-5 criteria to a national, nonclinical sample of young adult sexual minority women (N = 767). The DSM-5 symptom criteria fit the data well in confirmatory factor analysis. Current PTSD prevalence was higher under the DSM-5 diagnostic algorithm compared with DSM-IV (18.6% vs. 22.9%; d = 0.15). Compared with DSM-IV, associations between PTSD and depression were stronger using DSM-5 criteria, whereas associations between PTSD and high-risk drinking were reduced. Findings suggest that changes to PTSD diagnostic criteria do not have a major impact on prevalence of PTSD among sexual minority women but may have some impact on observed comorbidities.
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Goenjian AK, Steinberg AM, Walling D, Bishop S, Karayan I, Pynoos R. 25-year follow-up of treated and not-treated adolescents after the Spitak earthquake: course and predictors of PTSD and depression. Psychol Med 2021; 51:976-988. [PMID: 31931901 PMCID: PMC8161430 DOI: 10.1017/s0033291719003891] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/29/2019] [Accepted: 12/06/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is a paucity of long-term prospective disaster studies of the psychological sequelae among survivors. METHODS At 1½ and 25 years after the Spitak earthquake, 142 early adolescents from two cities were assessed: Gumri (moderate-severe exposure) and Spitak (very severe exposure). The Gumri group included treated and not-treated subjects, while the Spitak group included not-treated subjects. Instruments included: DSM-III-R PTSD-Reaction Index (PTSD-RI); DSM-5 PTSD-Checklist (PCL); Depression Self-Rating Scale (DSRS); and Center for Epidemiological Studies-Depression Scale (CES-D). RESULTS (1) Between 1½ and 25 years, PTSD rates and mean scores decreased significantly in the three groups (over 50%). However, at 25 years 9.1-22.4% met DSM-5 PTSD criteria. (2) At 1½ years, the Spitak group had higher PTSD-RI (p < 0.001) and DSRS scores (p < 0.001) compared to the Gumri-not-treated group. At 25 years, the Spitak group that had experienced fewer post-earthquake adversities (p < 0.03), had a greater decrease in PTSD-RI scores (p < 0.02), and lower CES-D scores (p < 0.01). (3) Before treatment, PTSD-RI and DSRS scores did not differ between the Gumri-treated and not-treated groups. At 25-years, the Gumri-treated group showed a greater decrease in PTSD-RI scores (p < 0.03), and lower mean PTSD-RI (p < 0.02), PCL (p < 0.02), and CES-D (p < 0.01) scores. (4) Predictors of PTSD symptom severity at 25-years included: home destruction, treatment, social support, post-earthquake adversities, and chronic medical illnesses. CONCLUSION Post-disaster PTSD and depressive symptoms can persist for decades. Trauma-focused treatment, alleviation of post-disaster adversities, improving the social ecology, and monitoring for chronic medical illnesses are essential components of recovery programs.
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Affiliation(s)
- Armen K. Goenjian
- Department of Psychiatry and Biobehavioral Sciences, UCLA/Duke University National Center for Child Traumatic Stress, University of California, Los Angeles, Los Angeles, CA, USA
- Collaborative Neuroscience Network, Garden Grove, CA, USA
- Psychiatric Outreach Program, Armenian Relief Society, Long Beach, CA, USA
| | - Alan M. Steinberg
- Department of Psychiatry and Biobehavioral Sciences, UCLA/Duke University National Center for Child Traumatic Stress, University of California, Los Angeles, Los Angeles, CA, USA
| | - David Walling
- Collaborative Neuroscience Network, Garden Grove, CA, USA
| | - Sheryl Bishop
- School of Nursing, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Ida Karayan
- Psychiatric Outreach Program, Armenian Relief Society, Long Beach, CA, USA
| | - Robert Pynoos
- Department of Psychiatry and Biobehavioral Sciences, UCLA/Duke University National Center for Child Traumatic Stress, University of California, Los Angeles, Los Angeles, CA, USA
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Mat Salleh MN, Ismail H, Mohd Yusoff H. Reliability and validity of a post-traumatic checklist-5 (PCL-5) among fire and rescue officers in Selangor, Malaysia. JHR 2020. [DOI: 10.1108/jhr-11-2019-0243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PurposeThis study is to establish the validity and reliability of Malay version of Post-traumatic Check List-5 (MPCL-5) among the fire and rescue officers in the state of Selangor, Malaysia.Design/methodology/approachA cross-sectional study was conducted, which involved 100 firefighters from the state of Selangor, Malaysia. Construct validity, internal consistency, and concurrent validity were performed and analyzed using Statistical Package for Social Sciences (SPSS) version 20. Concurrent validity was tested with validated Malay version of Trauma Screen Questionnaire (TSQ-M).FindingsOverall internal consistency reliability was a 0.960 and individual construct Cronbach's alpha ranged from 0.827 to 0.926. The model, which consists of four constructs with 20 items, demonstrated the presence of acceptable loading factors. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) are 0.81, 0.65, 0.31 and 0.95 respectively at an optimum cut-off score of 35.Research limitations/implicationsThe Post Traumatic Check List 5 (PCL-5) is the latest tool based on DSM-5 developed recently and still having limited studies on the psychometric properties of the tool in local population and the findings produced are comparable with the results from validation from previous studies. The study limitations are population samples used are considering the minimum numbers of sample for each item for factor analysis and the concurrent validation was tested with the TSQ-M instead of the Clinician Administered PTSD Scale for DSM-5 (CAPS-5).Practical implicationsThe study suggested that MPCL-5 is acceptable to be used to measure post-traumatic stress disorder in local populations.Originality/valueThere are limited known validation studies for PCL-5 in local populations and this is the first study done among fire and rescue officers in Malaysia. The results are comparable with findings from previous studies and therefore MPCL-5 are valid and reliable for PTSD screening.
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Teale Sapach MJN, Carleton RN. Can words be worse than stones? Understanding distressing social events and their relationship with social anxiety. J Anxiety Disord 2020; 72:102225. [PMID: 32361168 DOI: 10.1016/j.janxdis.2020.102225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/16/2019] [Revised: 03/07/2020] [Accepted: 04/08/2020] [Indexed: 10/24/2022]
Abstract
Research on the relationship between distressing social events and social anxiety has focused on antagonistic social events (i.e., peer victimization, cyberbullying) in adolescent samples. There is little research examining such relationships in adults, and less examining the relationship between non-antagonistic distressing social events (i.e., accidental embarrassing events) and social anxiety. The current investigation utilized a retrospective design to examine how different distressing social events may be associated with posttraumatic stress-like reactions, which may relate to social anxiety in early adulthood. Characteristics of distressing social events (i.e., betrayal, presence of an antagonist) were explored as possible influences on the severity of stress responses. Community participants (n = 271; ages 18-25) completed online questionnaires measuring social anxiety and reactions to distressing social events. Antagonistic and non-antagonistic distressing social events were both related to social anxiety. Relationships between the frequencies of any distressing social events and social anxiety were mediated by reactions akin to posttraumatic stress. Responses to distressing social events were not influenced by the presence of an antagonist or betrayal. The results suggest that non-antagonistic distressing social events can be as distressing as antagonistic distressing social events and contribute to expanding evidence that reactions to distressing social events may resemble reactions to life-threatening events.
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Affiliation(s)
| | - R Nicholas Carleton
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
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Carvalho T, da Motta C, Pinto-Gouveia J. Portuguese version of the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Comparison of latent models and other psychometric analyses. J Clin Psychol 2020; 76:1267-1282. [PMID: 31975500 DOI: 10.1002/jclp.22930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This psychometric study explores the Portuguese version of the Posttraumatic Stress Disorder (PTSD) Checklist (PCL-5). It aims to clarify the best-fitting latent structure among competing PTSD models (Diagnostic and Statistical Manual of Mental Disorders-fifth edition [DSM-5], Dysphoria, Dysphoric Arousal, Anhedonia, Externalizing Behavior, And Hybrid models) and its implications for PTSD measurement. METHOD Psychometric analyses were conducted in a sample from the general population of firefighters (N = 446), except the temporal stability, which was tested in a subsample of 100 participants. RESULTS The models presented significant differences in a global fit. The Hybrid model presented the best-fitting structure, but the DSM-5 model showed more favorable reliability and convergent validity in Confirmatory Factor Analyses. The DSM-5 model also proved to be internally consistency, temporally stable, and presented convergent validity. CONCLUSION The Portuguese version of PCL-5 is reliable and valid. The findings suggest the appropriateness of the DSM-5 model to assess PTSD symptomatology, encouraging its use in clinical, and research settings.
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Affiliation(s)
- Teresa Carvalho
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.,Instituto Superior Miguel Torga, Coimbra, Portugal
| | - Carolina da Motta
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - José Pinto-Gouveia
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
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Teale Sapach MJN, Horswill SC, Parkerson HA, Asmundson GJG, Carleton RN. Centrality of Traumatic Events: Double Edged Sword or Matter of Valence? Cogn Ther Res 2018. [DOI: 10.1007/s10608-018-9983-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Ross J, Kaliská L, Halama P, Lajčiaková P, Armour C. Examination of the latent structure of DSM-5 posttraumatic stress disorder symptoms in Slovakia. Psychiatry Res 2018; 267:232-239. [PMID: 29940453 DOI: 10.1016/j.psychres.2018.06.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [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: 11/29/2017] [Revised: 03/29/2018] [Accepted: 06/11/2018] [Indexed: 12/16/2022]
Abstract
The latent structure of posttraumatic stress disorder (PTSD) has been widely discussed, with the majority of studies in this area being conducted in the US. The current study aimed to extend this area of research by comparing seven existing PTSD factor models in a sample of 754 trauma-exposed university students from Slovakia, where similar research has not been conducted yet. The sample was predominantly female (83.69%), with a mean age of 22.68 years. The comparison of competing models revealed that the Anhedonia model, consisting of six inter-correlated factors of reexperiencing, avoidance, negative affect, anhedonia, dysphoric arousal and anxious arousal, provided the best fit. Several factors of the Anhedonia model also showed differential relationships with the external variables of anxiety and depression. The study contributes to the limited literature on the latent structure of PTSD in Eastern Europe.
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Affiliation(s)
- Jana Ross
- Psychology Research Institute, Ulster University, Coleraine, Northern Ireland, UK.
| | - Lada Kaliská
- Department of Psychology, Faculty of Education, Matej Bel University, Banská Bystrica, Slovakia
| | - Peter Halama
- Department of Psychology, Faculty of Arts, Trnava University in Trnava, Trnava, Slovakia
| | - Petra Lajčiaková
- Department of Psychology, Faculty of Arts and Letters, Catholic University in Ružomberok, Slovakia
| | - Cherie Armour
- Psychology Research Institute, Ulster University, Coleraine, Northern Ireland, UK.
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Abstract
Although the prevalence of exposure to potentially traumatic events and associated outcomes among children is well documented, widespread trauma screening remains limited. This study provides additional data supporting the psychometrics of the Child Trauma Screen (CTS), a free, brief, empirically derived measure that was intended as a trauma screen for use across child-serving systems. Participants were an ethnically diverse sample of 187 children aged 6-18 years recruited from an urban children's community mental health clinic. At intake, children and their caregivers completed the CTS and other standardized measures of posttraumatic stress disorder, externalizing behavior, anxiety, and depression. Results indicated that the CTS had strong properties on both child and caregiver reports, including internal consistency (Cronbach's α = .78 for both), convergent validity (r = .83 and r = .86), divergent validity (mean across measures and reporters, r = .31; range r = .01-.70), and criterion validity (sensitivity = 0.83 and 0.76; specificity = 0.95 and 0.79, correct classification 89.3% and 81.4%). Suggested cut points and recommendations for using the CTS as a trauma screen are provided. This study provides further empirical support for the use of the CTS as a brief trauma screening measure and provides recommendations for further research.
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Affiliation(s)
- Jason M Lang
- Child Health and Development Institute, Farmington, Connecticut, USA.,Department of Psychiatry, UCONN Health, Farmington, Connecticut, USA.,Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Christian M Connell
- The Consultation Center, Division of Prevention and Community Research, Yale School of Medicine, New Haven, Connecticut, USA
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14
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Abstract
This population-based longitudinal study examined the rates and predictors of posttraumatic stress disorder (PTSD) among 725 differentially exposed survivors of the 1988 Spitak earthquake in Armenia, 23 years after the event. Participants had been previously evaluated in 1991. Evaluations included assessment of current PTSD (based on DSM-5 criteria), and a variety of potential risk and protective factors. For the whole sample, the rate of PTSD attributed to the earthquake decreased from 48.7% in 1991 to 11.6% in 2012 (p < .001). A "dose of exposure" pattern persisted, and 15.7% of participants who were in Spitak (high exposure) and 6.6% of participants who were in Kirovagan (low exposure) during the earthquake met the criteria for PTSD (p = .003). Additionally, in 2012, another 9.9% of participants met PTSD criteria due to post-earthquake traumas, which is a 5-fold increase from pre- to postearthquake (p < . 001). Factors positively associated with PTSD included earthquake-related job loss, exposure to post-earthquake traumas, depression at baseline, and chronic illness since the earthquake. Factors inversely associated with PTSD included housing assistance within two years after the earthquake, support of family and/or friends, and to a lesser degree, higher education and high living standard. These variables accounted for 23.1% of the variance in current PTSD severity scores. These findings indicate that PTSD rates subside significantly after a catastrophic disaster, although earthquake-related PTSD persists among a subgroup of exposed individuals. Predictors of PTSD identified in this study provide guidance for planning acute and longer-term postdisaster public mental health recovery programs.
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Affiliation(s)
- Armen K Goenjian
- UCLA/Duke University National Center for Child Traumatic Stress, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
| | - Vahe Khachadourian
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Haroutune Armenian
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Anahit Demirchyan
- American University of Armenia Center for Health Services Research and Development, Yerevan, Armenia
| | - Alan M Steinberg
- UCLA/Duke University National Center for Child Traumatic Stress, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
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15
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Lisieski MJ, Eagle AL, Conti AC, Liberzon I, Perrine SA. Single-Prolonged Stress: A Review of Two Decades of Progress in a Rodent Model of Post-traumatic Stress Disorder. Front Psychiatry 2018; 9:196. [PMID: 29867615 PMCID: PMC5962709 DOI: 10.3389/fpsyt.2018.00196] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [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] [Received: 11/08/2017] [Accepted: 04/25/2018] [Indexed: 12/21/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is a common, costly, and often debilitating psychiatric condition. However, the biological mechanisms underlying this disease are still largely unknown or poorly understood. Considerable evidence indicates that PTSD results from dysfunction in highly-conserved brain systems involved in stress, anxiety, fear, and reward. Pre-clinical models of traumatic stress exposure are critical in defining the neurobiological mechanisms of PTSD, which will ultimately aid in the development of new treatments for PTSD. Single prolonged stress (SPS) is a pre-clinical model that displays behavioral, molecular, and physiological alterations that recapitulate many of the same alterations observed in PTSD, illustrating its validity and giving it utility as a model for investigating post-traumatic adaptations and pre-trauma risk and protective factors. In this manuscript, we review the present state of research using the SPS model, with the goals of (1) describing the utility of the SPS model as a tool for investigating post-trauma adaptations, (2) relating findings using the SPS model to findings in patients with PTSD, and (3) indicating research gaps and strategies to address them in order to improve our understanding of the pathophysiology of PTSD.
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Affiliation(s)
- Michael J Lisieski
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - Andrew L Eagle
- Department of Physiology, Michigan State University, East Lansing, MI, United States
| | - Alana C Conti
- Research and Development Service, John D. Dingell Veterans Affairs Medical Center, Detroit, MI, United States.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Israel Liberzon
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States.,Mental Health Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Shane A Perrine
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
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16
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Mordeno IG, Hall BJ. DSM-5-based latent PTSD models: Assessing structural relations with GAD in Filipino post-relocatees. Psychiatry Res 2017; 258:1-8. [PMID: 28964957 DOI: 10.1016/j.psychres.2017.09.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [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: 04/18/2017] [Revised: 08/12/2017] [Accepted: 09/22/2017] [Indexed: 12/28/2022]
Abstract
An increasing number of studies investigated the latent factor structure of posttraumatic stress disorder (PTSD) symptomatology following the new fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). To date, there is no consensus on the best representation of PTSD. This study examined six latent PTSD models in a sample of Filipino post-disaster relocatees (N = 523). Further investigation on the relationship of the best-fitting model to generalized anxiety disorder (GAD) in the latent level was conducted. The seven-factor hybrid model consisting of intrusion, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal, was the best fitting model. Latent associations between the factors in the hybrid model and GAD suggest there are core and transdiagnostic features of PTSD. These findings have implications for understanding the underlying mechanism of PTSD and can inform the development of trauma-related interventions, particularly among post-disaster relocatees.
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Affiliation(s)
- Imelu G Mordeno
- College of Education, Mindanao State University, Iligan Institute of Technology, Philippines
| | - Brian J Hall
- Global and Community Mental Health Research Group, Faculty of Social Sciences (E21), University of Macau, Avenida da Universidade, Taipa, Macau, Hong Kong Special Administrative Region; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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17
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Alhalal E, Ford-Gilboe M, Wong C, AlBuhairan F. Reliability and validity of the Arabic PTSD Checklist Civilian Version (PCL-C) in women survivors of intimate partner violence. Res Nurs Health 2017; 40:575-585. [PMID: 29130548 DOI: 10.1002/nur.21837] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 07/27/2017] [Accepted: 09/14/2017] [Indexed: 11/11/2022]
Abstract
Although intimate partner violence (IPV) survivors are at high risk for developing posttraumatic stress disorder (PTSD), PTSD has been considered a disorder specific to Western culture. There is a lack of reliable and valid measures of PTSD symptomology available in the Arab world, and there is still no clear evidence about the underlying factor structure of PTSD symptomology in the context of IPV. Thus, in the present study we investigated the construct validity (factor structure), internal consistency, and concurrent validity of a translated version of the PTSD Checklist Civilian Version (PCL-C) in a sample of 299 Saudi women who had experienced IPV. Four competing models (DSM-IV, Emotional Numbing, Dysphoria, and Dysphoric Arousal) were specified and estimated using confirmatory factor analysis (CFA). The five-factor Dysphoric Arousal model provided superior fit with the data compared to the alternative models, supporting construct validity of the Arabic PCL-C. The factor loadings for the five-factor Dysphoric Arousal model ranged from .31 to .83. A relatively high correlation between the Arabic PCL-C and Arabic Center for Epidemiologic Studies-Depression (CES-D) Scale (r = .78, p < .05) provided evidence of concurrent validity. The total scale also demonstrated internal consistency reliability (α = .89). Overall, the study supports the Dysphoric Arousal model in representing PTSD symptoms among IPV survivors, the reliability and validity of the Arabic version of PCL-C, and the cross-cultural applicability of PTSD symptoms.
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Affiliation(s)
- Eman Alhalal
- Nursing College, King Saud University, Riyadh, Saudi Arabia
| | - Marilyn Ford-Gilboe
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Carol Wong
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Fadia AlBuhairan
- Population Health Research, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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18
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Reichenheim ME, Oliveira AG, Moraes CL, Coutinho ES, Figueira I, Lobato G. Reappraising the dimensional structure of the PTSD Checklist: lessons from the DSM-IV-based PCL-C. ACTA ACUST UNITED AC 2017; 40:154–162. [PMID: 29069251 PMCID: PMC6900771 DOI: 10.1590/1516-4446-2017-2239] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/24/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The dimensional structure of posttraumatic stress disorder (PTSD) has been extensively debated, but the literature is still inconclusive and contains gaps that require attention. This article sheds light on hitherto unvisited methodological issues, reappraising several key models advanced for the DSM-IV-based civilian version of the PTSD Checklist (PCL-C) as to their configural and metric structures. METHODS The sample comprised 456 women, interviewed at 6-8 weeks postpartum, who attended a high-complexity facility in Rio de Janeiro, Brazil. Confirmatory factor analysis (CFA) and exploratory structural equation models (ESEM) were used to evaluate the dimensional structure of the PCL-C. RESULTS The original three-factor solution was rejected, along with the four-factor structures most widely endorsed in the literature (PTSD-dysphoria and PTSD-numbing models). Further exploration supported a model comprised of two factors (re-experience/avoidance and numbing/hyperarousal). CONCLUSION These findings are at odds with the dimensional structure proposed in both DSM-IV and DSM-5. This also entails a different presumption regarding the latent structure of PTSD and how the PCL should be operationalized.
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Affiliation(s)
- Michael E Reichenheim
- Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - Aline G Oliveira
- Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - Claudia L Moraes
- Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil.,Programa de Mestrado em Saúde da Família, Universidade Estácio de Sá, Rio de Janeiro, RJ, Brazil
| | - Evandro S Coutinho
- Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil.,Departamento de Epidemiologia, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Ivan Figueira
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Gustavo Lobato
- Instituto Fernandes Figueira, Fiocruz, Rio de Janeiro, RJ, Brazil
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19
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Arbona C, Fan W, Schwartz J, Pao C, Tran JK, Buser S. Measurement and Structural Invariance of Posttraumatic Stress Disorder Symptoms in Hispanic and Caucasian Firefighters: A Bias-Corrected Bootstrap Confidence Intervals Approach. Assessment 2017; 26:209-222. [DOI: 10.1177/1073191116685805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study compared across Hispanic and Caucasian firefighters the relative fit of the four-factor Emotional Numbing and Dysphoria posttraumatic stress disorder models to the more recently proposed Dysphoric Arousal five-factor model. As hypothesized, the Dysphoric Arousal five-factor model emerged as the best fitting model within each ethnic group and it also showed measurement invariance between groups (configural invariance). Results of multigroup confirmatory factor analyses and a bias-corrected bootstrap confidence intervals analytic approach indicated that the five factor model also demonstrated invariance in factor loadings (metric invariance) and item-level intercepts (scalar invariance) across the two ethnic groups. Results indicate that the Dysphoric Arousal five factor model captures similar psychological constructs across Caucasian and English-speaking Hispanic firefighters. Therefore, observed factor scores are comparable across ethnic groups and can be combined when examining predictors of posttraumatic stress disorder severity.
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Affiliation(s)
| | | | | | | | - Jana K. Tran
- Firefighter Support Network, Houston Fire Department, Houston, TX, USA
| | - Sam Buser
- Firefighter Support Network, Houston Fire Department, Houston, TX, USA
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20
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Arbona C, Fan W, Noor N. Factor structure and external correlates of posttraumatic stress disorder symptoms among African American firefighters. Psychol Res Behav Manag 2016; 9:201-9. [PMID: 27563263 PMCID: PMC4986676 DOI: 10.2147/prbm.s113615] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study compared the relative goodness of fit of three well-established factorial models of posttraumatic stress disorder (PTSD) symptoms among 477 African American male firefighters in a large city in the US. The compared models were the two four-factor emotional numbing and dysphoria models and a five-factor dysphoric arousal model. The study also examined the convergent and discriminant validity of PTSD symptom clusters in relation to depression and alcohol dependence symptoms. Both the emotional numbing and dysphoric arousal PTSD models provided a superior fit to the data compared to the dysphoria model. Findings also indicated a good fit for factor models that included PTSD, depression, and alcohol dependence latent factors, which provides support for the specificity of PTSD symptom clusters. Depression symptoms were more strongly correlated with PTSD symptom clusters than alcohol dependence. In the dysphoric arousal model, depression and alcohol dependence were equally related to the emotional numbing and dysphoric arousal clusters; however, both depression and alcohol dependence were more highly correlated with dysphoric arousal than with anxious arousal. Even though the emotional numbing and dysphoric arousal models demonstrated a superior fit to the data, the four-factor dysphoria model may provide a more parsimonious representation of PTSD's latent structure than the five-factor dysphoric arousal model. In conclusion, this study extends support for the well-established PTSD symptom factor models among African Americans, a population with whom these models had not been examined earlier.
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Affiliation(s)
- Consuelo Arbona
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
| | - Weihua Fan
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
| | - Nausheen Noor
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
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21
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Asmundson GJG, LeBouthillier DM, Parkerson HA, Horswill SC. Trauma-Exposed Community-Dwelling Women and Men Respond Similarly to the DAR-5 Anger Scale: Factor Structure Invariance and Differential Item Functioning. J Trauma Stress 2016; 29:214-20. [PMID: 27166826 DOI: 10.1002/jts.22098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 09/20/2015] [Revised: 01/24/2016] [Accepted: 03/02/2016] [Indexed: 11/08/2022]
Abstract
Anger is associated with the development of posttraumatic stress disorder (PTSD) and with poor treatment outcomes. The Dimensions of Anger Reactions Scale-5 (DAR-5) has demonstrated preliminary evidence of unitary factor structure and sound psychometric properties. Gender-based differences in psychometric properties have not been explored. The current study examined gender-based factor structure invariance and differential item functioning of the DAR-5 and gender differences in PTSD symptoms as a function of anger severity using a community sample of adults who had been exposed to trauma. Data were collected from 512 trauma-exposed community-dwelling adults (47.9% women). Confirmatory factor analyses, Mantel-Haenszel χ(2) tests and a comparison of characteristic curves, and 2-way analyses of variance, respectively, were used to assess gender-based factor structure invariance, gender-based response patterns to DAR-5 items, and gender differences in PTSD symptoms as a function of anger. The unitary DAR-5 factor structure did not differ between men and women. Significant gender differences in the response pattern to the DAR-5 items were not present. Trauma-exposed individuals with high anger reported greater overall PTSD symptoms (p < .001), regardless of gender. The DAR-5 can be used to assess anger in trauma-exposed individuals without concern of gender biases influencing factor structure or item functioning. Findings further suggested that the established relationship between anger and PTSD severity did not differ by gender.
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Affiliation(s)
| | | | - Holly A Parkerson
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Samantha C Horswill
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
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22
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Soberón C, Crespo M, Del Mar Gómez-Gutiérrez M, Fernández-Lansac V, Armour C. Dimensional structure of DSM-5 posttraumatic stress symptoms in Spanish trauma victims. Eur J Psychotraumatol 2016; 7:32078. [PMID: 27974133 PMCID: PMC5156862 DOI: 10.3402/ejpt.v7.32078] [Citation(s) in RCA: 16] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 11/15/2016] [Accepted: 11/18/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Confirmatory factor analytic studies have shown that posttraumatic stress disorder (PTSD) symptoms included in the fifth edition of the Diagnostic and Statistical Manual Disorders (DSM-5) may be better explained by two 6-factor models (the Externalizing Behaviours model and the Anhedonia model) and a 7-factor Hybrid model. The latter model comprises the symptom clusters of intrusion, avoidance, negative affect, anhedonia, externalizing behaviours, and anxious and dysphoric arousal. This model has received empirical support mainly in American samples. Of note, there have been a limited number of studies conducted on samples from other countries. OBJECTIVE This study aimed to examine the underlying dimensionality of DSM-5 PTSD symptoms in a Spanish clinical sample exposed to a range of traumatic events. METHOD Participants included 165 adults (78.8% females) seeking treatment in trauma services in the Madrid area (Spain). PTSD was assessed using the Global Assessment of Posttraumatic Stress Scale 5, a Spanish self-report instrument assessing posttraumatic symptoms according to the DSM-5 criteria. Confirmatory factor analyses were conducted in Mplus. RESULTS Both the 7-factor Hybrid model and the 6-factor Anhedonia model demonstrated good and equivalent fit to the data. CONCLUSIONS The findings of this study replicate and extend previous research by providing support for both the 7-factor Hybrid model and the 6-factor Anhedonia model in a clinical sample of Spanish trauma survivors. Given equivalent fit for these two models and the fewer number of latent factors in the Anhedonia model, it was selected as optimal in a traumatized Spanish sample. Implications and future research directions are discussed.
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Affiliation(s)
- Carmen Soberón
- Department of Clinical Psychology, Complutense University, Madrid, Spain
| | - María Crespo
- Department of Clinical Psychology, Complutense University, Madrid, Spain;
| | | | | | - Cherie Armour
- Psychology Research Institute, University of Ulster, Coleraine, Northern Ireland
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23
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Khachadourian V, Armenian HK, Demirchyan A, Goenjian A. Loss and psychosocial factors as determinants of quality of life in a cohort of earthquake survivors. Health Qual Life Outcomes 2015; 13:13. [PMID: 25890107 PMCID: PMC4336679 DOI: 10.1186/s12955-015-0209-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 01/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the existing evidence of a long lasting effect of disaster related experiences on physical and psychological health, few studies have evaluated long-term quality of life (QOL) outcomes of disaster survivors and the factors associated with such outcomes. METHODS 23 years after the 1988 Spitak earthquake in Armenia, the associations of demographic characteristics, trauma exposure and psychosocial variables on QOL were explored among a cohort of 725 exposed individuals. The EQ-5D-5 L instrument was applied to measure QOL of participants. Multivariate linear and ordinal logistic regressions were applied to evaluate the determinants of QOL and its underlying five domains (mobility, self-care, usual activity, pain/discomfort, and anxiety/depression). RESULTS Older age, current depression, post-traumatic stress disorder and anxiety symptoms were negatively associated with QOL. Additionally, those with severe losses (who did not receive any financial/material aid) had significantly poorer QOL outcomes, with higher odds of mobility difficulties (OR = 1.86, p < 0.05), self-care difficulties (OR = 2.85, p < 0.05), and mood problems (OR = 2.69, p < 0.05). However, those with severe earthquake related losses who received financial/material aid reported less self-care difficulties (OR = 0.21, p < 0.05) usual activity difficulties (OR = 0.40, p < 0.05), and mood problems (OR = 0.44, p < 0.05). Finally, each unit increase in current social support score was found to be significantly associated with a better QOL outcome and better self-reported outcomes across all underlying domains of QOL. CONCLUSIONS These findings suggest that earthquake related loss and concurrent psychopathology symptoms can have adverse impact on the QOL of survivors. They also indicate that well-targeted post-disaster financial/material aid and social support should be considered as means for improving the long-term QOL outcomes of disaster survivors.
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Affiliation(s)
- Vahe Khachadourian
- School of Public Health, American University of Armenia, Yerevan, Armenia.
| | - Haroutune K Armenian
- Department of Epidemiology, Fielding School of Public Health, UCLA, Los Angeles, CA, USA.
| | - Anahit Demirchyan
- School of Public Health, American University of Armenia, Yerevan, Armenia.
| | - Armen Goenjian
- Department of Psychiatry and Biobehavioral Sciences, UCLA/Duke University National Center for Child Traumatic Stress, UCLA, Los Angeles, CA, USA.
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