Abstract
BackgroundThe validity of applying the construct of post-traumatic stress disorder (PTSD) across cultures has been the subject of contention. Although PTSD symptoms have been identified across multiple cultures, questions remain whether the constellation represents a coherent construct with an interpretable factor structure across diverse populations, especially those naïve to western notions of mental disorder. An important additional question is whether a constellation of Complex-PTSD (C-PTSD) can be identified and if so, whether there are distinctions between that disorder and core PTSD in patterns of antecedent traumatic events. Our study amongst West Papuan refugees in Papua New Guinea (PNG) aimed to examine the factorial structure of PTSD based on the DSM-IV, DSM-5, ICD-10 and ICD-11 definitions, and C-PTSD according to proposed ICD-11 criteria. We also investigated domains of traumatic events (TEs) and broader psychosocial effects of conflict (sense of safety and injustice) associated with the factorial structures identified.MethodsCulturally adapted measures were applied to assess exposure to conflict-related traumatic events (TEs), refugees’ sense of safety and justice, and symptoms of PTSD and C-PTSD amongst 230 West Papuan refugees residing in Port Morseby, PNG.ResultsConfirmatory factor analysis (CFA) supported a unitary construct of both ICD-10 and ICD-11 PTSD, comprising the conventional symptom subdomains of intrusion, avoidance, and hyperarousal. In contrast, CFA did not identify a unitary construct underlying C-PTSD. The interaction of witnessing murders and sense of injustice was associated with both the intrusion and avoidance domains of PTSD, but not with the unique symptom clusters characterizing C-PTSD.ConclusionsOur findings support the ICD PTSD construct and its three-factor structure in this transcultural refugee population. Traumatic experiences of witnessing murder associated with a sense of injustice were specifically related to the intrusion and avoidance domains of PTSD. The unitary nature of C-PTSD across cultures remains in question.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-015-0480-3) contains supplementary material, which is available to authorized users.
Highlights
The validity of applying the construct of post-traumatic stress disorder (PTSD) across cultures has been the subject of contention
There is a pressing need to examine whether a common factorial structure can be identified underlying the PTSD construct when tested across culturally diverse populations, amongst communities exposed to conflict and persecution who have had no or minimal exposure to western concepts of mental disorder or services providing treatment for traumatic stress
Coherent factors emerged for the individual domains of the proposed ICD-11 category of C-PTSD, our analysis failed to identify a unitary higher order factor underlying the constellation as a whole
Summary
The validity of applying the construct of post-traumatic stress disorder (PTSD) across cultures has been the subject of contention. PTSD symptoms have been identified across multiple cultures, questions remain whether the constellation represents a coherent construct with an interpretable factor structure across diverse populations, especially those naïve to western notions of mental disorder. Concerns have been raised about the tendency for the PTSD category to be applied to persons exposed to an ever-widening range of commonday life experiences such as exposure to severe illness, accidents and severe work stresses [3]. There is a pressing need to examine whether a common factorial structure can be identified underlying the PTSD construct when tested across culturally diverse populations, amongst communities exposed to conflict and persecution who have had no or minimal exposure to western concepts of mental disorder or services providing treatment for traumatic stress
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