Testing competing factor models of the latent structure of post-traumatic stress disorder and complex post-traumatic stress disorder according to ICD-11

被引:15
|
作者
Murphy, Siobhan [1 ]
Elklit, Ask [1 ]
Dokkedahl, Sarah [1 ]
Shevlin, Mark [2 ]
机构
[1] Univ Southern Denmark, Natl Ctr Psychotraumatol, Odense, Denmark
[2] Ulster Univ, Psychol Res Inst, Derry, North Ireland
关键词
ICD-11; PTSD; CPTSD; ITQ; CFA; EMOTION DYSREGULATION; PROPOSED CHANGES; CHILDHOOD ABUSE; PTSD; VALIDITY; IMPACT; SAMPLE; TRAUMA; MALTREATMENT; RELIABILITY;
D O I
10.1080/20008198.2018.1457393
中图分类号
B849 [应用心理学];
学科分类号
040203 ;
摘要
With the publication of the International Statistical Classification of Diseases and Related Health Problems, 11th edition (ICD-11) due for release in 2018, a number of studies have assessed the factorial validity of the proposed post-traumatic stress disorder (PTSD) and complex (CPTSD) diagnostic criteria and whether the disorders are correlated but distinct constructs. As the specific nature of CPTSD symptoms has yet to be firmly established, this study aimed to examine the dimension of affect dysregulation as two separate constructs representing hyper-activation and hypo-activation. Seven alternative models were estimated within a confirmatory factor analytic framework using the International Trauma Questionnaire (ITQ). Data were analysed from a young adult sample from northern Uganda (n=314), of which 51% were female and aged 18-25years. Forty per cent of the participants were former child soldiers (n=124) while the remainder were civilians (n=190). The prevalence of CPTSD was 20.8% and PTSD was 13.1%. The results indicated that all models that estimated affective dysregulation as distinct but correlated constructs (i.e. hyper-activation and hypo-activation) provided satisfactory model fit, with statistical superiority for a seven-factor first-order correlated model. Furthermore, individuals who met the criteria for CPTSD reported higher levels of war experiences, symptoms of anxiety and depression, and somatic problems than those with PTSD only and no diagnosis. There was also a much larger proportion of former child soldiers that met the criteria for a CPTSD diagnosis. In conclusion, these results partly support the factorial validity of the ICD-11 proposals for PTSD and CPTSD in a non-Western culture exposed to mass violence. These findings highlight that more research is required across different cultural backgrounds before firm conclusions can be made regarding the factor structure of CPTSD using the ITQ. Planteamiento: Con la publicacion de la 11 edicion de la Clasificacion Internacional de Enfermedades que se publicara en 2018, varios estudios han evaluado la validez factorial de los criterios de diagnostico propuestos del trastorno por estres postraumatico (TEPT) y trastorno por estres postraumatico complejo (TEPT-C) y si los trastornos estan correlacionados pero son constructos distintos.Objetivo: Debido a que la naturaleza especifica de los sintomas de TEPT-C aun no se ha establecido con firmeza, este estudio establecio como objetivo examinar la dimension de la desregulacion afectiva como dos constructos separados que representan la hiperactivacion y la hipoactivacion.Metodos: Se estimaron siete modelos alternativos dentro de un marco analitico factorial confirmatorio usando el Cuestionario Internacional de Trauma (ITQ, por sus siglas en ingles). Los datos se analizaron a partir de una muestra de adultos jovenes del norte de Uganda (n = 314), de los cuales el 51% eran mujeres y tenian entre 18 y 25 anos. El cuarenta por ciento de los participantes eran ex ninos soldados (N = 124) mientras que el resto eran civiles (N = 190).Resultados: La prevalencia del TEPT-C fue del 20.8% y la del TEPT fue del 13.1%. Los resultados indicaron que todos los modelos que estimaron la desregulacion afectiva como constructos distintos proporcionaron un ajuste satisfactorio del modelo con superioridad estadistica para un modelo correlacionado de primer orden de siete factores. Ademas, las personas que cumplieron con los criterios del TEPT-C indicaron niveles mas altos de experiencias de guerra, sintomas de ansiedad y depresion, y problemas somaticos que aquellos con solo TEPT y sin diagnostico. Tambien hubo una proporcion mucho mayor de ex ninos soldados que cumplieron con los criterios para un diagnostico de TEPT-C.Conclusiones: Estos resultados respaldan parcialmente la validez factorial de las propuestas de la CIE-11 para el TEPT y el TEPT-C en una cultura no occidental expuesta a la violencia masiva. Estos hallazgos resaltan que se requiere mas investigacion en diferentes contextos culturales antes de poder llegar a conclusiones firmes con respecto a la estructura factorial de TEPT-C utilizando el ITQ.
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页数:11
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