Invariance Testing Research Articles

Developmental Relations Between Peer Victimization, Emotional Symptoms, and Disability/Chronic Condition in Adolescence: Are Within- or Between-Person Factors Driving Development?

Although there is a link between peer victimization, emotional symptoms, and disability or chronic condition in adolescence, less is known about the role of stable, individual differences compared to developmental processes. The current study addressed this gap by examining developmental relations between peer victimization, emotional symptoms, and disability or chronic condition. Three waves of self-report panel data on Swedish adolescents at ages 13, 15, and 17 years (n = 734; 51.6% girls) were used. Data were analyzed using random-intercept cross-lagged panel models with invariance tests by sex, disability/chronic condition, and family affluence. Girls and adolescents with a disability or chronic condition showed more heterogeneity in the co-development of peer victimization and emotional symptoms, with girls being more prone than boys to developing emotional symptoms following peer victimization, and particularly in early adolescence. Girls and adolescents with a disability or chronic condition had elevated within-person levels of both peer victimization and emotional symptoms throughout adolescence. Theory and practice may need to pay additional attention to the role of sex, disability, and their intersection, as well as age, regarding the development of peer victimization and emotional symptoms.

Development and validation of the Transgender Adolescent Stress Survey–Minority Stress (TASS-MS)

ObjectiveThis study aimed to create and validate a novel measure of gender-related minority stress in transgender and non-binary adolescents (TNBA). TNBA face higher risks of varied behavioral health concerns compared to their cisgender peers, a disparity often attributed to the presence of minority stress due to discrimination. To date, no comprehensive measures of gender-related minority stress exist for use with TNBA.MethodThe present study recruited a U.S. national sample (N = 444, aged 12–17; 65.5% White, 9.5% Black, 9.5% Latine, 15.5% other ethnicity; 34.7% transmasculine, 17.3% transfeminine, 38.3% non-binary, 9.5% agender) of TNBA. An initial item pool was developed from life history calendars, a modified Delphi process, and cognitive interviews with TNBA. Analytic methods including principal components analysis, item response theory, measurement invariance testing, and reliability analyses were conducted to establish the final scale. Concurrent validity was established across behavioral outcomes (mental health, suicidal thoughts and behavior, substance use), and convergent and divergent validity compared the Transgender Adolescent Stress Survey–Minority Stress (TASS-MS) to existing measures of gender-related minority stress.ResultsThe TASS-MS and its subscales (disaffirmation, visibility and internalized transnegativity, family) were significantly associated with anxiety and depressive symptoms, PTSD symptoms, suicidal behaviors, non-suicidal self-injury, marijuana, and prescription drug use. The TASS-MS was moderately and weakly correlated with convergent and divergent measures, respectively, indicating specificity to minority stress.ConclusionThe TASS-MS is a reliable and valid measure for future research with TNBA. It is inclusive and usable by all gender minority adolescents, uses a standard simple scoring system, and assesses adolescent-specific stressors.

Validation of a brief food parenting measure for fathers: A test of factorial validity, measurement invariance, internal reliability, and concurrent validity.

Fathers are underrepresented in food parenting research partly due to the lack of succinct, theory-informed, and father-mother equivalent food parenting measurement tools. To address this, we 1) tested the factorial validity of a brief food parenting measure utilizing a subset of items from the Comprehensive Feeding Practices Questionnaire (CFPQ) to represent coercive control, structure, and autonomy support, 2) assessed the extent to which the brief tool works similarly in fathers and mothers (i.e., measurement invariance), and 3) evaluated its internal reliability and concurrent validity. Participants included 1,071 fathers of children aged 2-6 years and 487 of their co-parents (mothers) from the Fathers & Families study. Fathers and mothers responded to 16 CFPQ items, and fathers reported on children's diets. Confirmatory factor analysis (CFA) was used to test factorial validity. Multi-group CFA was used to examine measurement invariance across fathers and mothers. Internal reliability was examined using Cronbach's alpha and the Spearman-Brown coefficient. Concurrent validity was assessed utilizing multiple logistic regressions to examine associations between the three food parenting factors and children's intakes of fruit, vegetables, sugar-sweetened beverages (SSBs), and fast food. CFA confirmed a three-factor model with 11 items, including coercive control (four items), structure (five items), and autonomy support (two items). Multi-group CFA indicated measurement invariance across fathers and mothers. Internal reliability was established. Concurrent validity was strong for structure, but weaker for coercive control and autonomy support. Further refinements are encouraged to enhance items' utility in characterizing fathers' food parenting practices, including in different social and cultural contexts.

Psychometric properties and invariance testing of the Cannabis Refusal Self-Efficacy Scale in a Chilean sample

ABSTRACT Background: Cannabis refusal self-efficacy (CRSE), as the people´s belief about their capacity to resist cannabis, has been probed to predict cannabis use and related behaviors. The CRSE Questionnaire (CRSEQ) has 14 items grouped into Emotional Relief Self-Efficacy (6 items), Opportunistic Self-Efficacy (5 items), and Social Facilitation (3 items), forming a CRSE higher-order factor. Objective: To validate the CRSEQ for its use in the Chilean population. Method: The CRSEQ was administered to 1,275 individuals aged 12 to 77 (835 females). Confirmatory Factor Analysis was used to evaluate 14-item and 19-item models. Estimates of internal consistency, temporal stability, and convergent validity with cannabis use behaviors and reward sensitivity were obtained. Additionally, three multigroup invariance tests were conducted. Results: Both models exhibited good fit indices. The 14-item model showed χ2 (74) = 245.662, p < .001, CFI = .974, RMSEA = .047, indicating slightly better fit compared to the 19-item model, which showed χ2 (149) = 559.596, p < .001, CFI = .958, RMSEA = .051. Both models showed strong internal consistency (α = .80 to .96 for the 14-item model, α = .80 to .96 for the 19-item model), moderate to high temporal stability (ICCs 14-item model/ 19-item model: ERSE = .77/.78, OSE = .88/.89, SF = .82/.82), and significant convergent validity (correlations with cannabis use behaviors: .22 to .58). Conclusion: The better fit of the 14-item model makes it suitable for most applications. Convergent validity and multigroup invariance analyses confirmed the questionnaire’s equivalence across sex, age groups, and cannabis use problem status. This allows for meaningful comparisons of cannabis refusal self-efficacy between different demographic groups, facilitating its applicability in diverse settings such as educational institutions and substance use treatment centers.

Cross-cultural measurement invariance of the online learning readiness self-check (OLRSC) survey: a study across Turkish, Romanian, and Polish college students

This study examined the factorial composition and cultural invariance of the online learning readiness self-check (OLRSC) survey across Turkish (N = 212), Romanian (N = 207), and Polish (N = 235) college students. The results of confirmatory factor analyses (CFA) in individual samples supported the six-dimensional structure of online learning readiness while measurement invariance testing in a multi-group setting supported the metric and partial scalar invariance of the OLRSC survey. The latent means for the dimensions of online learning preparedness across the three groups were also examined in this study, revealing substantial differences. The results supported that the OLRSC is a psychometrically sound scale that can contribute to the scientific investigation of college students’ online learning readiness in the three nations. The findings not only extend the applicability of the OLRSC survey beyond its original U.S. context and atypical learners but also provide valuable insights for educators and policymakers striving to enhance online teaching and learning practices globally.

Cross-Cultural Validation of the Sexual Desire Inventory (SDI-2) in 42 Countries and 26 Languages

ABSTRACT Sexual desire is a complex construct with important implications for sexual functioning and well-being. In this research, we translated the Sexual Desire Inventory (SDI-2), a widely used scale for assessing sexual (desire), into 25 languages from English and used data from the International Sex Survey (ISS) to (a) investigate its psychometric properties (i.e. factorial structure, reliability, validity, and measurement invariance) and (b) explore the expression of sexual desire across different countries, genders, and sexual orientations. A total of 82,243 participants from 42 countries completed the SDI-2, along with other sexuality-related scales. Confirmatory factor analysis supported a three-factor solution for the SDI-2 (CFI = .980; RMSEA = .060), encompassing the domains of “Partner-related,” “Attractive-person-related,” and “Solitary” sexual desire. The reliability of the total score and subscales were excellent. Likewise, correlations with other sexuality-related variables were positive yet weak-to-moderate in effect size. Measurement invariance tests supported its use across countries, languages, genders, and sexual orientations. Analysis of SDI-2 scores according to these variables supported its ability to capture group-based differences in sexual desire. In sum, the SDI-2 constitutes a psychometrically robust measure for the assessment of sexual desire in non-clinical samples with utility in large-scale cross-cultural studies.

Examining the Factor Structure and Validity of the Depression Anxiety Stress Scale-21.

The prevalence of mental health disorders calls for valid and reliable instruments that are easy to administer and assess for clinicians and researchers. The Depression Anxiety Stress Scale-21 (DASS-21) is a commonly used instrument to assess psychological distress; however, model fit and internal reliability issues have been reported. Our objective was to assess the factorial and structural validity of the DASS-21. A confirmatory factor analysis (CFA) was conducted on the full sample (n = 1036) to assess the proposed three-factor DASS-21 using a priori cut-off values. Because model fit indices were not met, an exploratory factor analysis (EFA) was conducted to identify a parsimonious model. The resulting three-factor structure (i.e., DASS-9) was then assessed using CFA and multigroup invariance testing procedures. The proposed three-factor DASS-21 did not meet model fit criteria. The DASS-9 did meet recommended model fit criteria and was invariant between sex, injury status, mental health diagnosis, and activity level groups. Statistically different group means were found between mental health diagnosis and activity level groups, while no differences between sex or injury status groups were found. The current study provides support to use a condensed DASS-21 instrument, such as the DASS-9. Future research is necessary to establish the DASS-9 prior to its adoption in research and clinical practice. Additionally, there is a need to identify and review all condensed versions of the DASS-21, so individuals know which instrument can be used for clinical or research purposes.

The Chinese version of the physical activity questionnaire for adolescents: a psychometric validity, reliability, and invariance study

BackgroundThe Physical Activity Questionnaire for Adolescents (PAQ-A) is one of the most commonly used questionnaires for assessing adolescents’ levels of moderate to vigorous physical activity (PA). Although a Chinese version of the PAQ-A (comprising nine items) exists, it has been assessed for only internal consistency coefficients, test–retest reliability, and correlations with the GT3X + accelerometer. Therefore, this study aimed to evaluate the psychometric properties of the Chinese version of the PAQ-A among Chinese adolescents.MethodsThis study included three samples of 1,101 secondary school students (12–19 years old). The first sample consisted of 518 participants (50.4% males, 49.6% females) for correlation tests and exploratory factor analysis (EFA). The second sample consisted of 227 participants (55.75% males, 44.24% females) for confirmatory factor analysis (CFA), convergent validity, and sample size invariance tests. The third sample consisted of 356 participants (54.50% male, 45.50% female) for the internal consistency reliability test, invariance test (cross sample size, education level and gender), and t-test.ResultsPearson correlation analysis of the PAQ-A indicated that all the total-item correlations exceeded 0.2, indicating good consistency across the items. Subsequent EFA of the Chinese version of the PAQ-A revealed a two-factor structure. CFA subsequently validated this structure. One of the items exhibited a standardized loading below 0.4 and was excluded. The exclusion of this item resulted in increased standardized loadings for the remaining items, ranging from 0.40 to 0.82, which indicates improved fit indices. This adjustment underscores the questionnaire’s satisfactory convergent validity and robust discriminant validity. The overall Cronbach’s alpha was 0.821, with the values for the first and second factors being 0.757 and 0.716, respectively. The questionnaire demonstrated stable invariance across sample sizes and education levels and additionally showed partial scalar invariance across genders. A t-test revealed a significant difference between males and females, which aligns with previous findings. These findings supported the construct validity of the questionnaire.ConclusionThis study validated the Chinese version of the PAQ-A for assessing adolescent PA in China, with a two-factor structure improved by removing one item.

Validation and invariance testing of the English Short Physical activity enjoyment scale.

Enjoyment is recognized as a determinant of physical activity habits. The enjoyment of engaging in physical activity can be measured with the Physical Activity Enjoyment Scale (PACES). Later versions of this scale have been shortened to capture the component of subjective feeling, which has been validated using German-speaking samples. The aim of this study was to examine internal consistency, factorial validity, criterion-related validity, test-retest reliability, and measurement invariance (across gender and languages) in an English-speaking population. Data on physical activity enjoyment and self-reported physical activity were collected through an online survey with a test-retest design (n = 276,189 female, M = 42.55, SD = 16.81 years) conducted from September 2023 to December 2023. In addition, a German-speaking sample (n = 1017, 497 female, M = 29.77, SD = 13.54 years) was analyzed to assess measurement invariance with respect to language. McDonald's omega at time 1 was ω = 0.95. The confirmatory factor analysis supports the assumption of the unidimensional structure of PACES-S (χ2 = 19.8, df = 2, p < 0.05; CFI = 0.984; RMSEA = 0.180, 90% CI [0.113-0.256]), as the model fit can be estimated as good in view of the CFI value, while the sensitivity of the χ2 test is very high and the RMSEA may underestimate the model fit. Although the RMSEA value is higher than the conventional threshold, the small number of degrees of freedom may have a significant impact on this indicator. The criterion-related validity for light physical activity was r(107) = 0.26 (p < 0.05). The retest reliability was r(199) = 0.69 (p < 0.05). Further, the results supported measurement invariance across gender and partial measurement invariance across languages. Overall, the English PACES-S demonstrated good psychometric properties specifically for light intensity of physical activity, and can serve as an economical instrument to assess physical activity enjoyment.

Whose Family Communication Counts? Investigating the Validity of the Revised Family Communication Patterns Scale Across Racial Groups

ABSTRACT Using invariance testing techniques, this study investigated the validity of the Revised Family Communication Patterns (RFCP) scale across different racial groups in the United States. Data was collected from 644 individuals, with an even split between participants in four primary racial groups: Hispanic, Asian, Black, and White. Results revealed several inconsistencies in how the RFCP instrument functions across racial groups. Namely, the conformity subscale failed to establish metric or scalar invariance, which raises concerns about how the measure should be used in future research, especially with regard to within-group differences. In light of these findings, several recommendations are made for future research applications of the measure.

Developing a Scale Measuring Comprehensive Sex Education Attitudes in K-12 Schools (CSEA-K12)

ABSTRACT Comprehensive sex education (CSE) is linked to several favorable health outcomes yet is consistently underfunded and under-implemented. This is likely due to the perceived controversy of CSE, but research indicates that CSE in the K-12 system is widely supported in most areas of the U.S. Legislators, school board members, and funding agencies need a more thorough and accurate understanding of their communities’ attitudes toward CSE. An attitudinal scale for the general adult population could help generate research that would give these stakeholders the confidence they need to make decisions about CSE in their local areas. The current study created this needed scale using a structured 6-step process that integrated several methods establishing validity and reliability. Scale structure was tested using both exploratory and confirmatory factor analyses, in addition to invariance testing and validity checks. The scale performed similarly across several groups and met predictions for known-groups and predictive validity, while showing some evidence for convergent validity as well. However, although findings indicate that the one-factor model of the CSEA-K12 was the best fitting model, the fit was weaker than desired. Suggestions for future work further addressing internal consistency of the scale are noted.

Posttraumatic stress disorder in diverse populations: Testing for assessment bias in a nationally representative sample.

A growing body of research has emerged to characterize differences in posttraumatic stress disorder (PTSD) symptom presentations in individuals from diverse racial and ethnic groups. However, less research has examined if these observed differences can be attributed to bias within PTSD assessments. Knowledge about potential bias in PTSD assessment is essential for interpreting group differences. If PTSD assessments do not perform similarly across diverse demographic groups, then observed differences may be artificial products of inaccurate measurement, new assessments could be required for individuals from different demographic groups, and we would be unable to accurately detect PTSD treatment effects in patients from diverse groups. We evaluated PTSD assessment bias through tests of measurement invariance for the semistructured, clinician-administered AUDADIS-5 diagnostic assessment of participants in the National Epidemiologic Survey on Alcohol and Related Conditions-III. Participants included those who reported having experienced at least one potentially traumatic event in their lifetime (N = 23,936). Measurement invariance was assessed for participants who identified from several demographic groups (Asian, Native Hawaiian, or Pacific Islander; Hispanic; American Indian/Alaskan Native; and Black) compared to participants who identified as White (non-Hispanic). Overall, PTSD assessment was largely invariant across groups, while small amounts of measurement invariance were detected that can inform future research and clinical adaptations. This work validates prior research that relies on a common conceptualization of PTSD, and it provides several paths for future improvement in research and clinical practice. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Luck in high-stakes firm lottery allocation: A natural experimental test of Coasean efficiency and invariance in a prominent sport finance setting

The NBA Player-Draft is a prominent sport-finance setting, with large rents allocated to teams. Several properties make this setting ideal to study the Coase Theorem in a cartelized-firm setting, where the Theorem’s empirical credence and overall relevance to real-world financial settings continue to be questioned. Identification of a high-stakes, salient setting featuring exogenously-assigned property rights has proven elusive. While several studies examine the Coasean implications of professional sports league drafts, we find draft rights are endogenously-assigned. We cultivate, verify, specify, and examine an exogenously-assigned draft right—draft lottery luck—for the 2000–2015 NBA Drafts. Given its revealed exogeneity, we utilize variation in annual lottery luck as a natural experiment to study the Coase Theorem and find robust evidence for “instantaneous” Coasean efficiency (as in efficiency of the efficient market hypothesis) but also evidence that Coasean invariance, with respect to firm profits, fails. Secondary analysis reveals respective mechanisms and sport-financial implications.

The relationships between online program formatting, technology satisfaction, and course quality

This study aims to explore students’ perceived quality of graduate courses in relation to their satisfaction with the technological tools used in online master’s level courses. Invariance testing and structural equation modelling were used to demonstrate the validity of technology usage scales and effectively test links between course type, technology satisfaction, and course quality. The study participants included 364 graduate students enrolled at a large university in the Midwest who were taking blended and fully online courses. The participants responded to a scale regarding their experience with the course. Interestingly, program type (blended vs. fully online) did not significantly impact technology satisfaction or the perceived quality of the course, even after taking into account the technology satisfaction mediator on course quality. Program type is not related to course quality, although technology satisfaction does contribute to quality ratings. The implications for instructors suggest that the development of technology-centric activities is warranted to improve the quality of online education courses.

Application of DASS-21 in Chinese students: invariance testing and network analysis

BackgroundThe Depression Anxiety Stress Scale-21 Items (DASS-21) is commonly used to assess the mental health of students, but there is a need for further clarification regarding its equivalence, structure, and core items.MethodsWe conducted a confirmatory factor analysis (CFA) on a sample of 7943 Chinese students to examine the performance of the DASS-21 and assess measurement invariance. Additionally, we utilized network analysis to investigate the structure and centrality of students’ mental health.ResultsOur findings revealed a stable three-factor structure for the DASS-21, characterized by high correlations among depression, anxiety, and stress. The DASS-21 demonstrated strict invariance across genders and weak invariance across levels of education. Network analysis indicated that symptoms of depression, anxiety, and stress form clusters, with some symptoms exhibiting strong correlations with each other.ConclusionOur study highlights a substantial interrelation among depression, anxiety, and stress, revealing a structurally clustered pattern. Network analysis underscores the interconnectedness and centrality of these symptoms, recommending a shorter version of the DASS, and emphasizing the imperative for targeted interventions aimed at improving the psychological well-being of students.

The structured assessment of violence risk in youth demonstrates measurement invariance between Black and White justice-referred youths.

Identification and implementation of effective methods for reducing racial/ethnic bias and disparities in legal settings are paramount in the United States and other countries. One procedure originally thought to reduce bias in legal decisions is the use of risk assessment instruments, which is now being heavily scrutinized. Measurement invariance, a latent trait technique, is a robust method for assessing one form of bias. Measurement invariance involves determining whether risk items in an instrument appear to be functioning the same between racial or other groups. Thus, the present study examined measurement invariance of the Structured Assessment of Violence Risk in Youth (SAVRY) between non-Latino Black and White youths to examine racial bias. We expected the SAVRY to be invariant (lacking measurement bias) between Black and White youths. The sample included 687 Black and 361 White youths, and the study used a large, multistate data set of SAVRYs conducted by probation officers. We conducted measurement invariance testing in a series of hierarchical steps including testing configural and scalar invariance. The SAVRY demonstrated scalar invariance (equal thresholds for ratings from "low" to "moderate" and "moderate" to "high") for all items except one-community disorganization. The findings lend further credibility to the SAVRY, and the structured professional judgment approach, as a method to assess violence risk and case planning needs among youths involved in the legal system. These findings provide more confidence that significant differences in SAVRY risk level or items between Black and White youths are not based in measurement bias, with the exception of the community disorganization item. Potential fixes discussed include eliminating or deemphasizing this item in final risk level ratings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Development and Evaluation of an Out-of-Control Scale Measuring Global Contextual Stressors Across 20 Countries and Regions

Abstract: Stressful contexts like the COVID-19 pandemic precipitated remarkable socio-economic changes, exacerbating universal uncertainty and a pervasive loss of control. Improving mental health outcomes on the operational definition and measurement of related concepts. This study analyzed cross-sectional data from 20 countries and regions, collected between January 25 and November 10, 2021. Psychometric evaluation occurred in two stages: initially, item review and factor analysis with a 2,749 adult sample from Mainland of China and Hong Kong SAR; subsequently, confirmation of factor structure, measurement invariance testing, and advanced analyses with a 4,000 adult sample from 20 countries and regions. A six-item, single-factor structure was verified, confirming satisfactory factor loading, fit indices and consistency. Measurement invariance across geographies and groupings was also confirmed. Three Out-of-Control profiles representing low, medium, and high stress levels, were identified, with age, depression/anxiety symptoms, education, socio-economic status, and exposure to COVID-19-affected acquaintances significantly influencing affiliation. The item “I think I cannot control things that I previously could” was the most critical node. This newly validated scale represents a substantial advancement in measuring stress within the context of global health crises, thus enhancing comprehension of psychological responses. Continual evaluation of the scale’s effectiveness and accuracy is crucial.

Validation of the Parent-report Pandemic Anxiety Scale (PAS-P) in the context of COVID-19

To be able to develop effective policy and targeted support for children and young people, it is vital to develop and validate measures that enable us to understand what aspects of pandemics are associated with anxiety and stress across a wide age range. We examined the psychometric properties of the Pandemic Anxiety Scale– Parent-report (PAS-P), which measures levels of child and adolescent pandemic-related anxieties. Factor structure, reliability, and convergent and discriminant validity of the PAS-P was assessed in a convenience sample of parents/carers (N­ = 8410) over at three time points in 2020 when COVID-19 case rates and restrictions varied. Factor structure was identified via two exploratory factor analyses (EFAs; n = 5601 and n = 1005) and then tested using confirmatory factor analysis (CFA; n = 800), measurement invariance tests, and a longitudinal CFA (n = 1651). Two factors structure for disease and consequence anxiety were observed across both EFAs and were found to have good fit in the CFAs. The PAS-P demonstrated good internal consistency and discriminant validity, as well as partial scalar invariance in latent construct measurement across child age, gender, and time. The PAS-P is a robust parent-report measure of two distinct forms of pandemic-related anxiety, suitable for reporting on children and adolescents aged 4-16 years. Although the scale has been validated in the context of the COVID-19 pandemic, it is not limited to this specific pandemic and, with minor wording modifications, may be a reliable tool in other health epidemic contexts.

Model-Based Causal Feature Selection for General Response Types

Discovering causal relationships from observational data is a fundamental yet challenging task. Invariant causal prediction (ICP, Peters, Bühlmann, and Meinshausen) is a method for causal feature selection which requires data from heterogeneous settings and exploits that causal models are invariant. ICP has been extended to general additive noise models and to nonparametric settings using conditional independence tests. However, the latter often suffer from low power (or poor Type I error control) and additive noise models are not suitable for applications in which the response is not measured on a continuous scale, but reflects categories or counts. Here, we develop transformation-model (tram) based ICP, allowing for continuous, categorical, count-type, and uninformatively censored responses (these model classes, generally, do not allow for identifiability when there is no exogenous heterogeneity). As an invariance test, we propose tram-GCM based on the expected conditional covariance between environments and score residuals with uniform asymptotic level guarantees. For the special case of linear shift trams, we also consider tram-Wald, which tests invariance based on the Wald statistic. We provide an open-source R package tramicp and evaluate our approach on simulated data and in a case study investigating causal features of survival in critically ill patients. Supplementary materials for this article are available online, including a standardized description of the materials available for reproducing the work.

Posttraumatic stress disorder (PTSD) in a sample of patients evaluated for acute coronary syndrome: A factor analysis of the PTSD checklist for DSM-5 (PCL-5)

The PCL-5 is a psychometrically sound measure of Post-Traumatic Stress Disorder (PTSD) symptoms. Although the scale is commonly applied to past external traumas (e.g., combat, assault), PTSD symptoms have also been assessed about potentially life-threatening cardiovascular events that represent ongoing internal threats. To date, there is a paucity of studies that have examined the updated scale factor structure for PTSD in patients with suspected acute coronary syndromes (ACS). MethodsExploratory and confirmatory factor analyses (EFA, CFA) were conducted using PCL-5 data completed by 830 patients enrolled in the REactions to Acute Care and Hospitalization (REACH) study, an observational cohort study of patients recruited from the emergency department during evaluation for ACS. Follow-up measurement invariance tests were conducted on pre-selected models and on the best-fitting model identified by EFA to evaluate invariance across diagnosis (confirmed v. rule-out ACS), sex, and language. ResultsThe EFA identified a two-factor model with “Memories of Trauma” (MT) and “Cognitive Behavioral Symptoms” (CBS) factors offering a balanced fit and interpretability. In CFAs, the Anhedonia CFA model performed the best overall. Measurement invariance tests supported strong invariance across confirmed and ruled-out ACS, male and female sex, and English and Spanish language for all models. LimitationsOnly 34 % of the sample was diagnosed with ACS at discharge, which limits generalizability. ConclusionOur study contributes to the understanding of PTSD in the context of internal traumatic reminders and may guide future research and clinical practice by informing intervention targets to improve health and well-being after suspected ACS.