Abstract
While the factor structure of post-traumatic stress disorder (PTSD) symptoms has been investigated among various traumatized populations in Western and high-income countries, knowledge regarding the validity of factor structure of PTSD among culturally diverse populations in low-and-middle-income countries is limited. The current study examined the factor structure and cultural invariance of PTSD in 521 Iraqi and 993 Syrian war-affected displaced people who were living in the Kurdistan Region of Iraq. Results from confirmatory factor analyses demonstrated that alternative factor models for PTSD, including a new model derived from this population (anhedonia and affect model) resulted in a better fit than the current DSM V models. Taken together, the results showed that a good fit, as well as the measurement invariance of PTSD factors, could be obtained by applying the anhedonia and hybrid model. This study provides further support for the anhedonia and hybrid model of PTSD and fills an important gap in knowledge about the validity of PTSD symptom clusters among Arab and Kurdish populations.
Highlights
Post-traumatic stress disorder (PTSD) is a common psychological disorder worldwide (Atwoli et al, 2015)
In the current study, we aimed to examine the factor structure of PTSD symptoms among Iraqi and Syrian displaced people who are living in the Kurdistan Region of Iraq (KRI)
Using epidemiology data about violence and mental health among Iraqi and Syrian displaced people, the current study examined the factor structure and cultural invariance of the DSM-V and six alternative models for PTSD
Summary
Post-traumatic stress disorder (PTSD) is a common psychological disorder worldwide (Atwoli et al, 2015). According to the World Health Organization’s (WHO) mental health surveys, estimates of lifetime prevalence rates range between 3.9 and 5.6% (Koenen et al, 2017). While these numbers document the burden of PTSD, the estimated frequency of PTSD among refugees and war-affected populations in low- and middle-income countries (LMIC) is many times higher than in populations that live in peace (Fazel et al, 2005; Steel et al, 2009). Since the concept of PTSD and related assessment instruments were developed and tested mainly in peaceful high-income countries, from a global perspective, it is of the upmost importance to test the validity of the criteria among culturally diverse, heavily affected populations. According to the United Nations High Commissioner for Refugees (UNHCR), from the start of the Arab Spring events in early 2011 until the end of 2017, more than three
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