Posttraumatic Stress Disorder Class Research Articles

Complicated grief and posttraumatic stress after loss and separation under terror conditions.

The lives of people in conflict areas are often characterized by the experience of traumatic events frequently accompanied by loss and separation. These can equally trigger symptoms of posttraumatic stress disorder (PTSD) and complicated grief (CG). The aim of the present study was to investigate whether affected individuals could be assigned to distinct classes at symptom-cluster levels of these two disorders. Moreover, we aimed to identify event-related and sociodemographic predictors associated with membership in these pathological classes. Participants were Iraqi internally displaced persons (IDPs; N = 199) who fled their hometowns due to the ISIS conflict and reported having lost an important person within the past 5 years. Based on the PTSD Checklist for DSM-5 (PCL-5) and Inventory of Complicated Grief (ICG), a latent class analysis (LCA) was applied to examine different classes of symptom clusters. Multinomial logistic regression was used to determine which variables predicted assignment to these symptom classes. The impact of loss and separation among IDPs in Iraq manifested in CG symptoms in more than half of the affected population and was often accompanied by PTSD. LCA identified a low-symptoms class (17.6%), CG class (33.7%), PTSD class (12.1%), and comorbid PTSD+CG class (36.7%). The sudden or violent death of a loved one was identified as a distinguishing factor for PTSD. Furthermore, separation was associated with comorbidity. Aid agencies should take these specific factors into account to improve effective and economic aid delivery to IDPs continuously affected by terror.

Correction to Barbieri et al. (2022).

This study investigated ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) symptom profiles and their premigration, postmigration, and demographic predictors in a treatment-seeking sample of asylum-seekers in Agadez (Niger). Participants were 126 asylum-seekers hosted in a large, isolated reception camp in the desert surroundings of Agadez (humanitarian site) or in a number of small urban hosting facilities (cases de passages) who completed measures of trauma exposure and PTSD/CPTSD symptoms. Latent class analysis (LCA) was used to identify symptom profiles, and predictors of class membership were identified via multinomial logistic regression. More asylum seekers met the criteria for CPTSD (74.6%) than PTSD (19.8%) and no gender differences were observed. LCA results identified two distinct groups: (a) a CPTSD class (69.0%); and (b) a PTSD class (31.0%). Membership in the CPTSD class was significantly predicted by the early age of the first traumatic event, levels of functional impairment and reception conditions. Specifically, those in the CPTSD class were more likely to live in the humanitarian site compared with those in the PTSD class. This study supported the validity of the ICD-11 construct of CPTSD in an asylum-seeker sample living in a low-income country. Moreover, the findings suggest that not only premigration factors (i.e., the early age of the first trauma) but also postmigration stressors (i.e., precarious reception conditions in large, isolated facilities) are important predictors of CPTSD symptoms with important implications regarding reception policies and the prevention of trauma-related mental disorders in asylum seekers and refugees. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Complex PTSD in asylum-seekers living in a humanitarian setting in Africa: A latent class analysis.

Participants were 126 asylum-seekers hosted in a large, isolated reception camp in the desert surroundings of Agadez (humanitarian site) or in a number of small urban hosting facilities (cases de passages) who completed measures of trauma exposure and PTSD/CPTSD symptoms. Latent class analysis (LCA) was used to identify symptom profiles, and predictors of class membership were identified via multinomial logistic regression. More asylum seekers met the criteria for CPTSD (74.6%) than PTSD (19.8%) and no gender differences were observed. LCA results identified two distinct groups: (a) a CPTSD class (69.0%); and (b) a PTSD class (31.0%). Membership in the CPTSD class was significantly predicted by the early age of the first traumatic event, levels of functional impairment and reception conditions. Specifically, those in the CPTSD class were more likely to live in the humanitarian site compared with those in the PTSD class. This study supported the validity of the ICD-11 construct of CPTSD in an asylum-seeker sample living in a low-income country. Moreover, the findings suggest that not only premigration factors (i.e., the early age of the first trauma) but also postmigration stressors (i.e., precarious reception conditions in large, isolated facilities) are important predictors of CPTSD symptoms with important implications regarding reception policies and the prevention of trauma-related mental disorders in asylum seekers and refugees. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Can developmental trauma disorder be distinguished from posttraumatic stress disorder? A symptom-level person-centred empirical approach

ABSTRACT Background: Developmental Trauma Disorder (DTD) is a proposed childhood psychiatric diagnosis for psychopathological and developmental sequela of victimization and attachment trauma extending beyond posttraumatic stress disorder (PTSD). Objective: To determine whether a sub-group of trauma-impacted children is characterized by symptoms of DTD that extend beyond, or co-occur with, the symptoms of PTSD. Method: Person-centred Latent Class Analyses (LCA) were done with data from 507 children (ages 7–18 years, (M = 12.11, SD = 2/92); 49% female) referred to the study by mental health or paediatric clinicians. Results: A four class solution was optimal (LMR = 398.264, p < .001; Entropy = .93): (1) combined DTD + PTSD (n = 150); (2) predominant DTD (n = 156); (3) predominant PTSD (n = 54); (4) minimal symptoms (n = 147). Consistent with prior research, the DTD + PTSD class was most likely to have experienced traumatic emotional abuse and neglect (X2 (3) = 16.916 and 28.016, respectively, p < .001), and had the most psychiatric comorbidity (F(3, 502) = 3.204, p < .05). Predominant DTD class members were most likely to meet criteria for Oppositional Defiant Disorder (ODD) (X2(3) = 84.66, p < .001). Conclusion: Symptoms of DTD may occur with, or separately from, PTSD symptoms. Children with high DTD|+PTSD symptoms had extensive psychiatric comorbidity, while those with high DTD symptoms and minimal PTSD symptoms were highly likely to meet criteria for ODD. In clinical and research assessment and treatment of children with complex psychiatric comorbidity or disruptive behaviour problems, symptoms of DTD should be considered, both along with, and in the absence of, PTSD symptoms.

The validity of ICD-11 PTSD and complex PTSD in North Korean defectors using the International Trauma Questionnaire

ABSTRACT Background: The International Trauma Questionnaire (ITQ) is a self-report assessment focused on the core features of Post-Traumatic Stress Disorder (PTSD) and complex Post-Traumatic Stress Disorder (CPTSD). It is consistent with the organizing principles of the 11th revision to the WHO's International Classification of Diseases (ICD-11). Since the 1990s, the number of North Korean defectors (NKD) entering South Korea to escape human rights violations has been increasing rapidly, with 33,815 NKD settled by 2021. The South Korean government faces an important challenge in supporting NKD to successfully adapt and settle in South Korean society. NKD experience various traumatic events during the process of defecting and repatriation. Therefore, it is essential to understand the psychological disorders of NKD, especially PTSD and CPTSD. Objective: This study aimed to test the validity of the ITQ assessment and explore the differences in symptoms and quality of life between PTSD and CPTSD. Method: The study sample comprised 503 trauma-exposed NKD. Confirmatory factor analysis (CFA) and latent class analysis (LCA) were used to evaluate the validity of ITQ. One-way analysis of variances and post-hoc analyses revealed the difference in the Depression and Somatic Symptoms Scale (DSSS) and WHOQOL-BREF results among PTSD and CPTSD symptom LCA classes. Results: The CFA and LCA results supported the ICD-11 conceptualization of PTSD and CPTSD in NKD. The CFA results confirmed that both the first- and second-order models were statistically fit, but for community-dwelling NKD the first-order model had better model fit than the second-order model. The LCA findings revealed a four-class model with ‘PTSD’, ‘CPTSD’, ‘DSO’, and ‘low symptom’ classes. Compared to the PTSD class, CPTSD class had higher levels of depression and somatic symptoms and a lower quality of life. Conclusion: This study provided evidence that ITQ is a valid tool to assess PTSD or CPTSD in community-dwelling NKD.

Latent classes of posttraumatic stress disorder among survivors of the Bam Earthquake after 17 years

BackgroundThe purpose of this study was to identify latent classes of the severity of post-traumatic stress disorder (PTSD) among the survivors of the earthquake in Bam, south-eastern Iran, 17 years after the disaster. The most influential predictor variables of PTSD classes were also investigated.MethodsEight hundred survivors of the Bam earthquake who were at least four years old in that disaster were selected by multistage sampling. The PTSD Checklist-Civilian Version was used. Latent class analysis was performed to identify subgroups of people with different PTSD symptom profiles. Latent class regression analysis was used to explore the influence of demographic and traumatic variables on each class membership.ResultsWe found three latent classes of PTSD, with the following profiles emerging: Low Symptom (56.6% of the participants), Moderate Symptom (23.5%), and Severe Symptom (19.9%). Old age [OR = 2.20, 95% CI = (1.46, 3.32)], physical injury [OR = 1.95, 95% CI = (1.24, 3.06)], being trapped under the rubble [OR = 1.81, 95% CI = (1.15, 2.86)], and death of a family member [OR = 1.86, 95% CI = (1.12, 3.09)] were positive risk factors for PTSD and increased the chance of being in classes having more severe symptoms. Having a high educational level was a negative risk factor [OR = 0.86, 95% CI = (0.67, 1.11)].ConclusionsThe severity of PTSD 17 years after the earthquake shows that natural disasters such as earthquakes have long-term consequences, and earthquake survivors must have psychological support and long term health care.After any catastrophic earthquake, governments should establish psychology and psychotherapy centers for earthquake victims, and these centers should support earthquake victims for a sufficiently long time.

Posttraumatic Stress Disorder, Anxiety, and Depression Symptoms After Potentially Traumatic Events: Latent Classes and Cognitive Correlates.

People exposed to potentially traumatic events (PTEs) may develop distinct symptom patterns, which may require different therapeutic approaches. We aimed to identify classes of people exposed to PTEs based on the presence of posttraumatic stress disorder (PTSD) clusters, anxiety, and depression and to explore which cognitive factors (rumination, worry, and negative cognitions) are associated with class membership. Latent class analyses were conducted to identify subgroups of 258 PTE-exposed Spanish adults. A three-class solution emerged: a resilient class with low odds of all symptoms ( n = 188); a partial PTSD class, characterized by partial PTSD clusters, moderate anxiety, and low depression ( n = 36); and a high symptom class, characterized by high PTSD, moderate anxiety, and low depression ( n = 34). These classes related meaningfully to rumination, worry, and negative cognitions. Distinct symptom patterns of PTSD clusters, anxiety, and depression can be distinguished in people exposed to PTEs and relate to cognitive risk factors of psychopathology.

The latent structure of ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD in a general population sample from USA: A factor mixture modelling approach

The validity of ICD-11 Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD), as measured by the International Trauma Questionnaire (ITQ; Cloitre et al., 2018) has been supported in many factor analytic and mixture modelling studies. There is, however, a paucity of research investigating the latent structure of the ITQ using factor mixture modelling (FMM). FMM was applied to data collected from a nationally representative sample of U.S. adults (N = 1834). FMM results demonstrated strong support for a two-factor second-order model with four qualitatively distinct latent classes: a ‘PTSD class’, a ‘CPTSD class’, a ‘DSO’ (Disturbances in Self-Organisation) class and a ‘low symptoms class’. Sexual abuse increased likelihood of membership to the ‘CPTSD’ (OR = 3.22) and physical abuse decreased likelihood of membership to the ‘PTSD’ (OR=0.51). Trauma exposure in adulthood predicted ‘PTSD’ and ‘CPTSD’ class membership. The ‘CPTSD class’ was characterised by higher levels of psychopathological co-morbidities and poorer psychological wellbeing compared to all other classes. Results provide additional support for the validity of PTSD and CPTSD as measured by the ITQ.

Coping strategy utilization among posttraumatic stress disorder symptom severity and substance use co-occurrence typologies: A latent class analysis.

There is a lack of research on primary prevention of posttraumatic stress disorder (PTSD) symptoms and substance use among trauma-exposed populations. To guide the development of more effective prevention efforts, the current study sought to identify underlying coping mechanisms that impact PTSD-substance use co-occurrence. A person-centered analytic approach (latent class analysis) examined PTSD-substance use co-occurrence typologies (classes) and identified theoretically adaptive (e.g., active coping) and maladaptive (e.g., denial) coping strategies that differentiated between classes among a sample of 1,270 trauma-exposed participants (Mage = 20.71, 73.5% female, 45.7% White). Latent class analysis identified five distinct typologies, reflective of extant epidemiological and etiological work. Generally, behavioral disengagement and self-blame coping increased the likelihood of being in more severe PTSD-illicit substance use (e.g., cocaine) comorbidity classes. Positive reframing and planning differentiated between low and moderate illicit substance typologies with moderate PTSD severity. Venting, acceptance, and self-distraction differentiated between asymptomatic and moderate PTSD severity typologies with low illicit substance use. Findings identify general coping strategies associated with increased likelihood of being in more severe comorbidity typologies, as well as several unique coping strategies associated with risk of transitioning between low/moderate PTSD and illicit substance use classes. Relevant interventions (e.g., trauma psychoeducation, guilt-reduction therapy, psychological first aid) that may be targets for future prevention-oriented work are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Prolonged grief disorder, posttraumatic stress disorder, and depression following traffic accidents among bereaved Balinese family members: Prevalence, latent classes and cultural correlates

IntroductionQualitative studies have described the rather unique styles of Balinese people to adjust to adversity. No quantitative research assessing psychopathology among bereaved individuals has been performed yet. This study estimated the prevalence of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD) and depression among bereaved individuals after traffic deaths in Bali and the relations between subgroups sharing the same symptoms and cultural, socio-demographic characteristics and posttraumatic growth (PTG). MethodsIn this cross-sectional study, 301 participants participated in questionnaire-interviews assessing PGD, PTSD, depression, PTG and cultural and socio-demographic characteristics. On average, the time since loss was 16 months. The purpose of the rituals was examined by a thematic qualitative analysis. We performed latent class analyses and subsequently calculated the odds ratios between membership of classes and characteristics with a multivariate 3step analysis. ResultsPrevalence rates of PGD (0%), PTSD (1%) and moderate depression (2%) were low. Most participants followed the bereavement rituals characteristic for Balinese culture. The purpose of these rituals was mainly the expression of caring for the deceased. We found a large resilient class (76%) and two smaller classes, one characterized by elevated PGD symptoms (11%) and one by elevated PTSD symptoms (13%). Loss of close kin was associated with membership of the PTSD class. ConclusionsPrevalence rates of PGD, PTSD and depression in the Balinese community were remarkably low. Participants appeared to be quite homogeneous in following religious and cultural habits. Aspects of the Balinese culture might protect bereaved individuals for developing mental health issues and could be used for an informed refinement of bereavement rituals in other cultures.

Validation of posttraumatic stress disorder (PTSD) and complex PTSD in Chinese children as per the ICD-11 proposals using the International trauma questionnaire

ABSTRACT Background: Given that the validity of applying complex posttraumatic stress disorder (CPTSD) in nonclinical children remains unclear. Objectives: The current study aimed to explore the factor structure, discriminant validity, and risk factors of ICD-11 posttraumatic stress disorder (PTSD) and CPTSD using the International Trauma Questionnaire. Methods: A total of 3478 trauma-exposed Chinese children aged 9–12 years were included in this study. All participants were assessed for PTSD and CPTSD using the International Trauma Questionnaire (ITQ). Confirmatory factor analysis (CFA) was conducted to explore the factor structure of CPTSD in a sample of Chinese children. Latent class analysis (LCA) was employed to evaluate the discriminant validity of CPTSD symptoms. Multinomial logistic regression analyses determined associations between the different classes and traumatic events. Results: The CFA results showed that the first-order six-factor model was identified as the best-fitting model in Chinese children aged 9–12 years. Four different classes, CPTSD symptoms, PTSD symptoms, disturbances in self-organization (DSO) symptoms, and a low symptom class were found by LCA. Both prolonged interpersonal trauma and other types of trauma were risk factors for the CPTSD class and the PTSD class. Conclusions: The results of this study partially support the factorial validity and strongly support the discriminant validity of the ICD-11 proposals for PTSD and CPTSD in Chinese children, supporting the conceptualization of PTSD and CPTSD as sibling diagnoses based on the ICD-11. However, findings suggest the need for careful consideration of identified trauma types in the ICD-11 proposals.

PTSD and complex PTSD in treatment-seeking Danish soldiers: a replication of Folke et al. (2019) using the International Trauma Questionnaire

ABSTRACT Background: While empirical support for the ICD-11 distinction between posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) is growing, empirical research into the ICD-11 model of CPTSD in military populations is scarce and inconsistent. Objective: To replicate a study from our own group identifying distinct classes based on CPTSD symptoms using the International Trauma Questionnaire (ITQ) and to identify predictors and functional outcomes associated with a potential distinction between PTSD and CPTSD. Method: Formerly deployed treatment-seeking Danish soldiers (N = 294) completed the ITQ and self-report measures of traumatic life events prior to treatment. Latent profile analysis (LPA) was used to extract classes based on CPTSD symptoms. Results: LPA revealed four classes; (1) high CPTSD symptoms (‘CPTSD’, 28.7%); (2) high PTSD symptoms and lower DSO symptoms (‘PTSD’, 23.5%); (3) high DSO symptoms (‘DSO’, 17.3%); and (4) low symptoms (‘Low Symptoms’, 30.5%). In comparison to the PTSD-class, CPTSD-class membership was not predicted by traumatic events in adult life and in childhood. The CPTSD class was more often single/divorced/widowed compared to the PTSD class. Moreover, the CPTSD class more often used psychotropic medicine compared to the DSO-class and Low Symptoms-class. Conclusion: Using the ITQ, this study yields empirical support for the ICD-11 model of CPTSD within a clinical sample of veterans. The results replicate findings from our previous study that also identified distinct profiles of ICD-11 PTSD and CPTSD.

Evidence of distinct profiles of ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD in a South African sample

ABSTRACT Background: Both post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD) have been included in the 11th edition of the International Classification of Diseases (ICD-11). Although the validity of CPTSD has been controversial, a growing number of studies support the distinction between PTSD and CPTSD. However, the majority of this research has originated in high-income countries (HICs), whereas the prevalence of trauma experience associated with PTSD/CPTSD diagnosis is significantly higher in low- and middle-income countries (LMICs). Objective: This study assessed whether a sample from an LMIC setting produced distinct classes that reflect ICD-11 criteria for PTSD and CPTSD. Furthermore, this study investigated whether childhood trauma distinguished between PTSD and CPTSD. Method: International Trauma Questionnaire responses from a sample of South African university undergraduates were used as indicator variables in a latent class analysis (LCA). Chi-squared tests of independence and Kruskal–Wallis H tests were used to assess between-class differences. Results: The LCA identified four distinct classes: a PTSD class with elevated symptoms of PTSD, but low endorsement of disturbances in self-organization (DSO; symptoms that are specific to CPTSD); a CPTSD class with elevated symptoms of PTSD and DSO; a DSO class with low symptoms of PTSD, but elevated symptoms of DSO; and a Low class with low endorsements on all symptoms. Regarding childhood trauma, participants in the CPTSD class had more severe childhood abuse and neglect, specifically emotional abuse and neglect, than participants in the PTSD class. Conclusions: Findings were consistent with the distinction between PTSD and CPTSD symptom profiles in the ICD-11. Our findings support a similar qualitative distinction between PTSD and CPTSD in our LMIC context, as previously reported in HICs. This distinction is especially relevant in LMICs because of the significant number of individuals vulnerable to these disorders.

Patterns and predictors of PTSD in treatment-seeking African refugees and asylum seekers: A latent class analysis.

Despite the empirical and clinical relevance of understanding posttraumatic stress disorder (PTSD) heterogeneity in refugees and asylum-seekers, very few studies have examined the manner in which PTSD symptoms manifest in such populations. This study sought to investigate patterns and predictors of DSM-5 PTSD in a treatment-seeking sample of African refugees. Participants were 122 African refugees and asylum-seekers living in Italy who completed measures of trauma exposure and PTSD symptoms. Latent class analysis (LCA) was used to identify PTSD symptom profiles, and predictors of class membership were identified via multinomial logistic regression. Among participants, 79.5% had a probable diagnosis of PTSD. Three PTSD classes were identified by LCA: Pervasive (32.0%) with high probabilities of all symptoms, high-Threat (45.9%) with higher probabilities of intrusions and avoidance symptoms, moderate-Avoidance (22.1%) with high probability of thoughts/feelings avoidance. None of the examined variables (legal status, gender, age, education, months spent in Italy, number of traumatic events, employment) significantly predicted class membership with the relevant exception of reception conditions. Specifically, living in large reception centres (over 1,000 people) significantly predicted Pervasive PTSD class membership compared to high/Threat PTSD class and to moderate/Avoidance class. This study provides evidence for distinct patterns of PTSD symptomatology in refugees and asylum seekers. We identified three classes which present both qualitative and quantitative differences in symptoms: Pervasive class, high-Threat class and a new moderate class, characterised by avoidance symptoms. Reception conditions contributed to the emergence of the Pervasive PTSD profile characterised by the symptoms highest severity. These findings highlight that stressors in the post-migration environment, as inadequate reception conditions in large facilities, may have detrimental effect on refugees' mental health. We emphasise the importance for host countries to implement reception models that provide effective protection and integration to this vulnerable population.

The relationship between posttraumatic stress disorder, trauma centrality, interpersonal sensitivity and psychiatric co-morbidity among students in Kazakhstan: a Latent Class Analysis

Background Trauma can lead to trauma centrality and affect levels of interpersonal sensitivity and psychiatric co-morbidity. Whether a coexisting relationship between posttraumatic stress disorder (PTSD) and trauma centrality can influence levels of interpersonal sensitivity and psychiatric co-morbidity among university students from Kazakhstan is unknown. Aim To investigate the impact of the aforementioned co-existing relationship on interpersonal sensitivity and psychiatric co-morbidity among Kazakh university students. Methods 597 students (F = 428, M = 169) completed questionnaires measuring PTSD, psychiatric co-morbidity, interpersonal sensitivity, and trauma centrality. Results 28%, 32% and 40% met the criteria for full, partial and no-PTSD, respectively. Latent Class Analysis revealed a three-class solution: Class 1 (the altered-self group) with a low level of PTSD but a high level of trauma centrality, Class 2 (the traumatized-self group) with high levels of PTSD and trauma centrality and Class 3 (the low symptom group) with low levels of PTSD and trauma centrality. There were significant differences in the levels of interpersonal sensitivity and psychiatric co-morbidity across three classes. Conclusion There are individual differences in the display of posttraumatic stress disorder symptoms, and trauma centrality. These differences can influence interaction with others and psychological distress.

Complex posttraumatic stress disorder in Chinese young adults using the International Trauma Questionnaire (ITQ): A latent profile analysis

BackgroundThe ICD-11 includes posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as two distinct disorders. Several empirical studies have supported the distinction between PTSD and CPTSD in various trauma population and different culture backgrounds. However, research documenting qualitatively distinction between PTSD and CPTSD using the International Trauma Questionnaire (ITQ) in a large general population from non-English-speaking countries is limited. MethodsSelf-report measures were used to assess CPTSD, dissociation, depression, and posttraumatic growth in a sample of 1,760 Chinese college students who had experienced at least one traumatic event. Latent profile analysis was utilized to identify the number of classes based on the 18-item version of ITQ. ResultsA four-class solution (low symptoms, disturbance of self-organization, PTSD, CPTSD) was the most appropriate one in our study. Compared to the PTSD class, the CPTSD class was associated with more serious psychopathology symptoms. LimitationsSample characteristics in this study limit its generalizability to other population (e.g., low educational level, clinical sample). The type of traumatic event in predicting distinct classes should also be investigated in future studies. ConclusionsDistinction between PTSD and CPTSD as ICD-11 proposed was supported in a Chinese young adult sample. DSO symptoms might inhibit healing and recovery process, and subsequent intervention could consider treat CPTSD based on addressing DSO symptoms.

Comparison of latent typologies of posttraumatic stress disorder and depression symptoms across military personnel from India and the US

Research has identified heterogeneous subgroups of individuals based on posttraumatic stress disorder (PTSD) and depression symptoms. Using data collected from military personnel in India (N = 146) and U.S. (N = 194), we examined (1) the best-fitting latent class solution; (2) multi-group invariance of the class solution; and (3) construct validity of optimal class solution. Results indicated that the optimal 4-class solution differed in severity and severity/type in the India and U.S. samples respectively. With similarity in the optimal number of classes across cultural samples, the meaning/nature of classes differed. In the India sample, anxiety severity predicted the Low Severity Class vs. all other classes, and the Moderately High Severity/High Severity Classes vs. the Moderately Low Severity Class; number of traumas predicted the High Severity Class vs. other classes; and resilience predicted the Moderately Low Severity Class vs. the Moderately High Severity Class. In the U.S. sample, alcohol use predicted the High Severity Class vs. all other classes, and the High Depression-Low PTSD Class vs. the Low Severity Class; rumination significantly predicted the High Severity and High Depression-Low PTSD Classes vs. each of the High PTSD-Low Depression and Low Severity Classes. Thus, meaning and nature of PTSD-depression subgroups may vary culturally; hence, culturally-sensitive interventions need to account for this heterogeneity.

Validation of ICD-11 PTSD and complex PTSD in foster children using the International Trauma Questionnaire.

Objective ICD‐11 introduces post‐traumatic stress disorder (PTSD) and complex PTSD (CPTSD) as two distinct trauma‐related disorders. Using the International Trauma Questionnaire (ITQ) as disorder‐specific measure, this study is the first to examine the factorial and construct validity of ICD‐11 PTSD, CPTSD and the ITQs’ applicability in children.MethodsTwo hundred and eight Austrian foster children completed a set of standardized measures. Excluding participants who reported not having experienced any kind of trauma, a final sample of 136 children completed the ITQ. Factorial and construct validity of ICD‐11 CPTSD and psychometric properties of ITQ scales were assessed by factor analysis and latent class analysis.ResultsConfirmatory factor analysis supported the two‐factor higher‐order model of ICD‐11 CPTSD in children by high factor loadings and excellent model fit. Reliability and regression analysis evidenced psychometric adequacy and discriminant validity of ITQ scales. Latent class analysis substantiated construct validity of ICD‐11 CPTSD, identifying a CPTSD (22.8%), PTSD (31.6%) and low symptoms class (45.6%). The CPTSD class showed highest rates of childhood trauma, comorbid psychopathology and functional impairment.ConclusionFactorial and construct validity of ICD‐11 CPTSD was evidenced in children for the first time using precise descriptions of ICD‐11 symptom content, supporting the reliability and validity of the ITQ in children.

Association of Prospective Risk for Chronic PTSD Symptoms With Low TNFα and IFNγ Concentrations in the Immediate Aftermath of Trauma Exposure.

Although several reports have documented heightened systemic inflammation in posttraumatic stress disorder (PTSD), few studies have assessed whether inflammatory markers serve as prospective biomarkers for PTSD risk. The present study aimed to characterize whether peripheral immune factors measured in blood samples collected in an emergency department immediately after trauma exposure would predict later chronic development of PTSD. Participants (N=505) were recruited from a hospital emergency department and underwent a 1.5-hour assessment. Blood samples were drawn, on average, about 3 hours after trauma exposure. Follow-up assessments were conducted 1, 3, 6, and 12 months after trauma exposure. Latent growth mixture modeling was used to identify classes of PTSD symptom trajectories. Three distinct classes of PTSD symptom trajectories were identified: chronic (N=28), resilient (N=160), and recovery (N=85). Multivariate analyses of covariance revealed a significant multivariate main effect of PTSD symptom trajectory class membership on proinflammatory cytokines. Univariate analyses showed a significant main effect of trajectory class membership on plasma concentrations of proinflammatory tumor necrosis factor α (TNFα) and interferon-γ (IFNγ). Concentrations of proinflammatory TNFα and IFNγ were significantly lower in individuals in the chronic PTSD class compared with those in the recovery and resilient classes. There were no significant differences in interleukin (IL) 1β and IL-6 concentrations by PTSD symptom trajectory class. Anti-inflammatory and other cytokines, as well as chemokines and growth factor concentrations, were not associated with development of chronic PTSD. Overall, the study findings suggest that assessing the proinflammatory immune response to trauma exposure immediately after trauma exposure, in the emergency department, may help identify individuals most at risk for developing chronic PTSD in the aftermath of trauma.

The distribution of psychosis, ICD-11 PTSD and complex PTSD symptoms among a trauma-exposed UK general population sample

ABSTRACTBackground: Co-occurrence of psychosis and posttraumatic stress disorder (PTSD) symptoms has been demonstrated, but the ICD-11 marks a significant divergence in the formulation of PTSD with a focus on the core symptoms and the addition of complex PTSD (CPTSD).Objective: To evaluate the distribution of psychosis and traumatic stress symptoms using the ICD-11 conceptualisation of PTSD and CPTSD.Method: A latent class analysis was conducted on psychosis symptoms, PTSD and CPTSD among a random adult sample from the UK general population with a history of traumatic events (N = 1,051).Results: Six classes were identified; a low-symptom class, a PTSD-class, a CPTSD-class, a class characterized by disturbances in self-organization alone as well as two classes characterized by CPTSD and various levels of psychosis symptom endorsement. Cumulative childhood adversity predicted membership of the PTSD, CPTSD and comorbid classes in a dose-response manner with the strongest effects observed for classes characterised by comorbid symptoms.Conclusion: The present study confirms the co-occurrence of psychosis symptoms and ICD-11 PTSD and CPTSD. Psychosis symptoms did not emerge in isolation from traumatic stress symptoms, underpinning the need for a greater recognition of psychosis symptoms as part of the broader clinical picture among trauma-exposed populations.