Abstract
BackgroundBetter understanding of acute stress responses is important for revision of DSM-5. However, the latent structure and relationship between different aspects of acute stress responses haven’t been clarified comprehensively. Bifactor item response model may help resolve this problem.ObjectiveThe purpose of this study is to develop a statistical model of acute stress responses, based on data from earthquake rescuers using Acute Stress Response Scale (ASRS). Through this model, we could better understand acute stress responses comprehensively, and provide preliminary information for computerized adaptive testing of stress responses.MethodsAcute stress responses of earthquake rescuers were evaluated using ASRS, and state/trait anxiety were assessed using State-trait Anxiety Inventory (STAI). A hierarchical item response model (bifactor model) was used to analyze the data. Additionally, we tested this hierarchical model with model fit comparisons with one-dimensional and five-dimensional models. The correlations among acute stress responses and state/trait anxiety were compared, based on both the five-dimensional and bifactor models.ResultsModel fit comparisons showed bifactor model fit the data best. Item loadings on general and specific factors varied greatly between different aspects of stress responses. Many symptoms (40%) of physiological responses had positive loadings on general factor, and negative loadings on specific factor of physiological responses, while other stress responses had positive loadings on both general and specific factors. After extracting general factor of stress responses using bifactor analysis, significant positive correlations between physiological responses and state/trait anxiety (r = 0.185/0.112, p<0.01) changed into negative ones (r = −0.177/−0.38, p<0.01).ConclusionOur results demonstrated bifactor structure of acute stress responses, and positive and negative correlations between physiological responses and stress responses suggested physiological responses could have negative feedback on severity of stress responses. This finding has not been convincingly demonstrated in previous research.
Highlights
As the number of traumatic events, disasters both natural and manmade, has increased in recent years, acute stress responses (ASR) to these events have become an important research topic in disaster medicine [1,2]
The purpose of this study is to develop a statistical model of acute stress responses, based on data from earthquake rescuers using Acute Stress Response Scale (ASRS)
In accordance with guidelines provided by the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) published by the American Psychiatric Association in 1994 [8], many studies about post-traumatic stress disorder (PTSD) prediction have limited the scope stress responses to those associated with the diagnostic category of acute stress disorder (ASD)
Summary
As the number of traumatic events, disasters both natural and manmade, has increased in recent years, acute stress responses (ASR) to these events have become an important research topic in disaster medicine [1,2]. People affected by traumatic events can demonstrate quite different acute responses. It is essential for our understanding of the link between ASR and PTSD to first develop a more comprehensive view of the stress response itself. Common responses can be classified according to four categories: cognitive, emotional, behavioral, and physiological. In accordance with guidelines provided by the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) published by the American Psychiatric Association in 1994 [8], many studies about PTSD prediction have limited the scope stress responses to those associated with the diagnostic category of acute stress disorder (ASD). The latent structure and relationship between different aspects of acute stress responses haven’t been clarified comprehensively.
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