Self-report Measures Of Psychopathology Research Articles

Low oxytocin levels are broadly associated with more pronounced psychopathology in anorexia nervosa with primarily restricting but not binge/purge eating behavior.

Anorexia nervosa (AN) is commonly associated with depression, anxiety, and deficits in socioemotional functioning. Basal levels of oxytocin, a neurohormone with antidepressant, anxiolytic, and prosocial properties, are low in women with AN. However, the relationship between oxytocin and psychopathology of AN/atypical AN has not been examined in individuals with primarily food restriction (AN/AtypAN-R) or those with restriction plus binge/purge behaviors (AN/AtypAN-BP) alone, which is important to further elucidate the neurobiology of different AN presentations. We investigated whether oxytocin levels are related to eating, affective, and socioemotional psychopathology in women with AN/AtypAN-R and separately AN/AtypAN-BP. In a cross-sectional study of 53 women with low-weight AN or atypical AN based on DSM-5 (AN/AtypAN-R: n=21, AN/AtypAN-BP: n=32), we obtained fasting serum oxytocin levels and self-report measures of psychopathology, including the Eating Disorder Examination-Questionnaire (EDE-Q), Beck Depression Inventory-IA (BDI), State-Trait Anxiety Inventory (STAI), and Toronto Alexithymia Scale (TAS-20). In individuals with AN/AtypAN-R, oxytocin levels were negatively associated with eating psychopathology (EDE-Q Global Score: r=-0.49, p=0.024), depressive and anxiety symptoms (BDI Total Score: r=-0.55, p=0.009; STAI Trait Score: r=-0.63, p=0.002), and socioemotional symptoms (TAS-20 Difficulty Identifying Feelings Score: r=-0.49, p=0.023). In contrast, in those with AN/AtypAN-BP oxytocin levels were negatively associated with depressive symptoms only (BDI Total Score: r=-0.52, p=0.049). These findings support the notion that AN/AtypAN-R and AN/AtypAN-BP might have divergent underlying neurobiology. Understanding these differences is crucial to develop targeted treatments for a population with high levels of chronicity, for which no specific pharmacological treatments are currently available. https://clinicaltrials.gov, identifier: NCT01121211.

Delay discounting in aging: The influence of cognitive and psychological variables.

Delay discounting (or temporal discounting) refers to the decrease of the subjective value of a reward as the time interval for receiving that reward increases. A recent meta-analysis showed that delay discounting appears to be similar across the lifespan as younger, middle-aged, and older adults prefer sooner rewards, despite smaller, over later rewards, even if larger. However further investigation is needed to understand the potential role of individual factors in delay discounting across the lifespan. The present study aimed to contribute to this debate, by investigating the influence of sociodemographic, neurocognitive, and psychological variables on delay discounting. For this purpose, 88 participants (30 younger, 30 middle-aged, and 28 older adults) aged between 19 and 73 years old completed the Monetary Choice Questionnaire (MCQ), a comprehensive battery of neurocognitive tests, and self-report measures of psychopathology. Results revealed no group differences in the rate of discounting. A well-established effect of the amount of the delayed reward was replicated, showing that medium rewards were less discounted than smaller rewards, and larger rewards had lower discounting rates than smaller and medium rewards-the magnitude effect. Regarding the influence of neurocognitive and psychological factors on delay discounting, better working memory, as assessed by the Corsi block-tapping task, significantly predicted larger magnitude effects. The findings of the current work are consistent with the results of previous studies, suggesting that temporal discounting is a stable function across the adult life span. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Inner Peace in a Global Crisis: A Case Study of Supported Spiritual Individuation in Acute Onset Phase of COVID-19.

Emerging-adult undergraduates (ages 18–25) are at increased risk for mental illness, exacerbated by the COVID-19 pandemic. Simultaneously, emerging adults face developmental tasks including identity development, finding meaning and purpose, and spiritual individuation. A case study approach is used to elucidate processes of undergraduates coping with collective trauma as a potential pathway to trauma-related spiritual growth via Awakened Awareness for Adolescents (AA-A) and emerging adults, a spiritual-mind-body wellness intervention. Awakened Awareness for Adolescents fosters enhanced spiritual perception to support spiritual individuation for improved mental health and well-being. Processes of spiritual individuation supported by AA-A during the COVID-19 pandemic from February to May 2020 are presented using students’ qualitative data and self-report measures of psychopathology, spiritual well-being, emotional regulation, and cognition. Shared cohort (N = 15) themes and one in-depth case (1) reveal ideographic processes of personal transformation and spiritual growth, (2) generate hypotheses around pathways of trauma-related spiritual growth and spiritual individuation for future research.

I am Worried: Do the PSWQ and PSWQ-A Display Measurement Invariance Across Four Racial Groups?

The issue of race within the context of psychological assessment is important, but often overlooked. Many self-report measures of psychopathology have been developed and validated using primarily White samples. Research regarding the Penn State Worry Questionnaire (PSWQ) and race has produced mixed results, which in turn may present challenges when comparing scores across racial groups. The current article sought to investigate the measurement invariance of the PSWQ and PSWQ-A (an abbreviated version) across four racial groups (White, Black, Asian, and Hispanic) in a sample of 2,489 undergraduate students. Confirmatory factor analysis of a one-factor structure illustrated poor fit across all racial groups for the full-length PSWQ. Two-factor and one-factor with method effects models of the full-length PSWQ each improved on the previous model fit, although the one-factor method effects model was limited by nonsalient factor loadings. Additionally, a separate confirmatory factor analysis indicated good fit for the PSWQ-A. Further analysis of the PSWQ-A suggested measurement invariance across all racial groups, as well as configural, metric, and scalar invariance. These findings advance the literature on the relationship between worry and race, suggesting that direct comparisons on the PSWQ-A between racial groups is appropriate.

Roles of age, gender and psychological difficulties in adolescent mentalizing

IntroductionAdolescence is a critical period for the development of mentalizing – the imaginative capacity to understand one's own and others' behaviour in terms of underlying mental states. Yet, factors and mechanisms underlying individual differences in adolescent mentalizing remain poorly understood. This exploratory study examined whether and how a) age and gender and b) psychological difficulties correlate with mentalizing performance in adolescents from the general population. Methods89 adolescents from Geneva, Switzerland (54 females, age 12–17 years) completed a computerized task of mentalizing and a self-report measure of psychopathology. ResultsMentalizing performance improved with age. Males showed lower scores on the mentalizing task and made more hypermentalizing errors than females. The main findings revealed a negative association between mentalizing performance and self-reported attention problems. Post-hoc analyses further demonstrated that self-reported attentional difficulties were particularly associated with weaker scores on items requiring mentalizing about intentions, while self-reported withdrawal/depression symptoms were particularly associated with weaker scores on items requiring mentalizing about emotions and thoughts. ConclusionThe present study highlights a negative association between attentional difficulties and mentalizing performance in community adolescents. Moreover, it provides preliminary evidence suggesting that age, gender and psychological difficulties can be distinctively associated with patterns of correct and incorrect mentalizing in community adolescents. Implications for future research and clinical practice are discussed.

Types of Smokers Who Seek Smoking Cessation Treatment According to Psychopathology

ABSTRACTPsychopathology and psychological distress have been shown to be related to poor smoking cessation outcomes and abstinence maintenance. Thus, it is important to identify individuals with high levels of psychopathology before undergoing smoking cessation treatment in order to increase their likelihood of success. Objective: The primary aim of the present study was to analyze whether we could classify smokers by using self-reported measures of psychopathology. In addition, a secondary aim was to examine if there were significant differences among the groups of smokers regarding sociodemographic information, nicotine dependence, and cessation rates at the end of treatment and at 6- and 12-month follow-ups. Methods: Participants were 281 smokers seeking smoking cessation treatment. Participants were classified into different smoking groups by using a 2-step cluster analysis based on baseline scores on the Restructured Clinical (RC) scales of the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF), Beck Depression Inventory-II (BDI-II), and State-Trait Anxiety Inventory (STAI). Results: Smokers were classified into 3 groups according to levels of psychopathology: Low (n = 158), Intermediate (n = 78), and High (n = 45). Smokers in the High Group were more likely to present higher levels of psychopathology and to continue smoking at the end of treatment when compared with the two other clusters. In addition, smokers classified in this group were more likely to be nicotine dependent and from a low social class. Conclusions: A subgroup of smokers can be easily identified through self-report measures of psychopathology. Furthermore, these individuals were more likely to continue smoking at the end of treatment. This suggests that this group with high levels of psychopathology might benefit from future interventions that are more intensive or cessation treatments targeted to their specific characteristics.

Are eating disorders "all about control?" The elusive psychopathology of nonfat phobic presentations.

There are a subset of individuals with eating disorders (EDs) who do not overevaluate body shape/weight (i.e., nonfat phobic ED; NFP-ED). According to the transdiagnostic cognitive-behavioral conceptualization of EDs, a need for control, in general, is hypothesized as the core psychopathology of NFP-EDs, with shape- and weight-related motivations for ED behavior merely superimposed in FP-ED presentations. This study tested the need for control as motivation for restriction in NFP-ED, using items aimed at assessing control from the Eating Disorder Examination (EDE) Restraint scale. Females ages 13-27years consecutively admitted to residential treatment completed the EDE, Eating Disorder Inventory-3 Drive for Thinness subscale (EDI-DFT), and other self-report measures of psychopathology. We included patients with DSM-5 EDs, but excluded patients with avoidant/restrictive food intake disorder. Twenty participants had NFP-ED (≤14 on EDI-DFT) and 124 had fatphobic ED (FP-ED; >14 on EDI-DFT). NFP-ED scored significantly lower than FP-ED on EDE Restraint scale shape/weight [χ2 (1)=10.73-35.62, p's<.01] and on control items [χ2 (1)=10.72-20.62, p's<.01], in addition to scoring lower on measures of general psychopathology and impairment. Findings suggest those with NFP-ED report lower psychopathology overall and the new EDE Restraint scale control items do not capture additional motivation for restriction beyond that captured in the original Restraint scale shape/weight items. Future research should examine whether this latter finding is due to a minimizing response style in NFP-ED, an incomplete capture of desire for control by the EDE assessment method, or indeed reflects that need for control does not motivate restriction in NFP-EDs.

Psychiatric Disorders and Function in Adolescents with Tetralogy of Fallot

To assess psychiatric disorders and function in adolescents with repaired tetralogy of Fallot (TOF) without and with a genetic diagnosis and to evaluate associations of functioning with medical factors, IQ, and demographics. Adolescents with TOF (n = 91) and 87 healthy referents completed a clinician-rated structured psychiatric interview, parent-/self-report measures of psychopathology, and brain magnetic resonance imaging. Twenty-three of the adolescents with TOF had a known genetic diagnosis. The prevalence of anxiety disorders did not differ significantly between adolescents with TOF without genetic diagnosis (n = 68) and referents. Adolescents with TOF and a genetic diagnosis showed an increased lifetime prevalence of anxiety disorder (43%) and lower global psychosocial functioning (median, 70; IQR, 63-75) compared with adolescents with TOF without genetic diagnosis (15% and 83; IQR, 79-87, respectively; P = .04 and <.001, respectively) and referents (6% and 85; IQR, 76-90, respectively; P = .001 and <.001, respectively). Adolescents with TOF without and with a genetic diagnosis had a higher lifetime prevalence of attention deficit-hyperactivity disorder (ADHD) than referents (19% and 39%, respectively, vs 5%; P = .04 and .002, respectively) and worse outcomes on parent-/self-report ratings of anxiety and disruptive behavior compared with referents. Risk factors for anxiety, ADHD, and lower psychosocial functioning for adolescents with TOF without a genetic diagnosis included older age, male sex, and low IQ. Medical variables were not predictive of psychiatric outcomes. Adolescents with TOF, particularly those with a genetic diagnosis, show increased rates of psychiatric disorder and dysfunction. Continued mental health screening and surveillance into young adulthood is warranted for adolescents with TOF.

Mental State Decoding in Adolescent Boys with Major Depressive Disorder versus Sex-Matched Healthy Controls

Background: Several adult depression studies have investigated mental state decoding, the basis for theory of mind, using the Reading the Mind in the Eyes Test. Findings have been mixed, but a comprehensive study found a greater severity of depression to be associated with poorer mental state decoding. Importantly, there has yet to be a similar study of adolescent depression. Converging evidence suggests that atypical mental state decoding may have particularly profound effects for psychosocial functioning among depressed adolescent boys. Sampling and Methods: Adolescent boys with major depressive disorder (MDD, n = 33) and sex-matched healthy controls (HCs, n = 84) completed structured clinical interviews, self-report measures of psychopathology and the Child Eyes Test (CET). Results: The MDD group performed significantly better than HCs on the CET overall (p = 0.002), underscored by greater accuracy for negatively valenced items (p = 0.003). Group differences on items depicting positive (p = 0.129) and neutral mental states (p = 0.081) were nonsignificant. Conclusions: Enhanced mental state decoding among depressed adolescent boys may play a role in the maintenance of and vulnerability to adolescent depression. Findings and implications are discussed. Limitations of this study include a reliance on self-report data for HC boys, as well as a lack of ‘pure' depression among the boys with MDD.

Convergent Validity of the Early Memory Index in Two Primary Care Samples

ABSTRACTKarliner, Westrich, Shedler, and Mayman (1996) developed the Early Memory Index (EMI) to assess mental health, narrative coherence, and traumatic experiences in reports of early memories. We assessed the convergent validity of EMI scales with data from 103 women from an urban primary care clinic (Study 1) and data from 48 women and 24 men from a suburban primary care clinic (Study 2). Patients provided early memory narratives and completed self-report measures of psychopathology, trauma, and health care utilization. In both studies, lower scores on the Mental Health scale and higher scores on the Traumatic Experiences scale were related to higher scores on measures of psychopathology and childhood trauma. Less consistent associations were found between the Mental Health and Traumatic Experiences scores and measures of health care utilization. The Narrative Coherence scale showed inconsistent relationships across measures in both samples. In analyses assessing the overall fit between hypothesized and actual correlations between EMI scores and measures of psychopathology, severity of trauma symptoms, and health care utilization, the Mental Health scale of the EMI demonstrated stronger convergent validity than the EMI Traumatic Experiences scale. The results provide support for the convergent validity of the Mental Health scale of the EMI.

The effectiveness of substance abuse treatment: development of a brief questionnaire

Background Practitioners need brief instruments to monitor outcomes in both treatment of drugs and alcohol addiction because they are useful to guide decision making in a short time.Objectives This study aims to develop a brief questionnaire, based on Client Evaluation of Self and Treatment, to evaluate the treatment effectiveness in drug and alcohol addiction treatment settings.Methods A cross-sectional study using a convenience sample (N = 608) recruited from Division for Intervention on Addictive Behaviours and Dependencies (DICAD – ARS North).Results The results show a new four-factor solution that accounted for 54.4% of the total variance and that provides the best fit to the data (c2/df = 1.72, CFI = .94, GFI = .91, RMSEA = .048 [.040-.057]; prmsea = .623). It also revealed a high internal consistency (a = .82). It was found a significant negative correlation (r = - .52, p < .01) between the final version of the instrument and a self report measure of psychopathology symptoms.Discussion This brief questionnaire, with good psychometric properties, can be useful to provide a viable and rapid feedback of treatment outcomes. Further studies should be performed to continue the evaluation of the reliability of this measure.

PTSD diagnostic validity in Veterans Affairs electronic records of Iraq and Afghanistan veterans.

Administrative planning and policy decisions frequently rely on diagnostic data extracted from large electronic databases. However, the accuracy of this diagnostic information is uncertain. The present study examined the degree to which various diagnoses of posttraumatic stress disorder (PTSD) within Department of Veterans Affairs (VA) electronic databases were concordant with PTSD diagnostic status determined by standardized diagnostic interview. We interviewed 1,649 veterans of the Iraq and Afghanistan wars using the PTSD Module of the Structured Clinical Interview for DSM-IV (SCID). Participants also completed other interview-based and self-report measures of psychopathology and provided consent to access their electronic medical records (EMRs). Concordance between database diagnosis and SCID diagnosis was 72.3% for current PTSD and 79.4% for lifetime PTSD. We observed associations between concordance status and combat exposure, PTSD symptom presentation, comorbid anxiety and depression, and psychosocial impairment. Veterans with false-negative PTSD diagnoses in the EMR were more likely to report lower levels of combat exposure, panic, and PTSD avoidance symptoms. Veterans with false-positive PTSD diagnoses in the EMR were more likely to report treatment seeking for emotional problems and less overall functional impairment. Although the majority of participants were concordant for PTSD status, over 25% of EMR diagnoses differed from those obtained in the diagnostic interview, with varying proportions of false positives and false negatives. Overall, those individuals with the most and least severe symptom presentations in the diagnostic interview were more likely to be accurately classified.

Effects of expressive writing on sexual dysfunction, depression, and PTSD in women with a history of childhood sexual abuse: results from a randomized clinical trial.

Women with a history of childhood sexual abuse (CSA) have high rates of depression, posttraumatic stress disorder, and sexual problems in adulthood. We tested an expressive writing-based intervention for its effects on psychopathology, sexual function, satisfaction, and distress in women who have a history of CSA. Seventy women with CSA histories completed five 30-minute sessions of expressive writing, either with a trauma focus or a sexual schema focus. Validated self-report measures of psychopathology and sexual function were conducted at posttreatment: 2 weeks, 1 month, and 6 months. Women in both writing interventions exhibited improved symptoms of depression and posttraumatic stress disorder (PTSD). Women who were instructed to write about the impact of the abuse on their sexual schema were significantly more likely to recover from sexual dysfunction. Expressive writing may improve depressive and PTSD symptoms in women with CSA histories. Sexual schema-focused expressive writing in particular appears to improve sexual problems, especially for depressed women with CSA histories. Both treatments are accessible, cost-effective, and acceptable to patients.

Deficits in emotion regulation associated with pathological gambling

The concept of emotion regulation features in many models of psychopathology and it has been proposed that individuals with poorly regulated emotions often engage in maladaptive behaviours to escape from or down-regulate their emotions, creating risk for a range of disorders. One such disorder may be pathological gambling. To our knowledge, no study had assessed the use of emotion-regulation strategies in this population. The goal of the present study was therefore to examine emotion-regulation difficulties among a sample of pathological gamblers (n= 56), a mixed clinical comparison group (n= 50), and a sample of healthy community controls (n= 49). Multivariate analysis of variance controlling for age. Participants were recruited from the community and a gambling treatment unit in Australia and completed clinical diagnostic interviews (ADIS-IV; SCIP), self-report measures of psychopathology (DASS-21), substance use (AUDIT), and emotion-regulation difficulties (DERS; ERQ). Pathological gamblers and the clinical comparison group reported significantly less use of reappraisal as an adaptive emotion-regulation strategy, and reported a greater lack of emotional clarity and more impulsivity than individuals in the healthy community comparison group. Pathological gamblers reported a greater lack of emotional awareness compared to the healthy control group and reported differences in access to effective emotion-regulation strategies compared to both comparison groups. The results support specific deficits of emotion regulation in pathological gamblers and emphasize the need to address these underlying vulnerabilities in addition to directly targeting gambling behaviours in therapy.

Structural brain abnormalities common to posttraumatic stress disorder and depression.

Posttraumatic stress disorder (PTSD) and major depression are reliably associated with reductions in brain volume in markedly similar areas. To our knowledge, no volumetric studies have directly contrasted these conditions. We investigated which, if any, grey matter reductions would be uniquely associated with each disorder. We also investigated more subtle independent effects: specifically, correlations between brain volume and self-report measures of psychopathology. We obtained structural magnetic resonance imaging scans from participants with PTSD, major depression and healthy controls exposed to trauma. Participants completed standardized self-report measures of anxiety and depression. We used voxel-based morphometry, applying the DARTEL algorithm within SPM5 to identify associated volumetric changes. We enrolled 24 patients with PTSD, 29 with major depression and 29 controls in our study. The clinical groups had regions of markedly smaller volume compared with the control group, particularly in prefrontal areas, but did not differ from each other. Greater self-reported anxiety was inversely related to volume in several areas, particularly the inferior temporal cortex, among patients with PTSD, but was associated with some volume increases in patients with major depression. Greater self-reported depression showed similar but weaker effects, being inversely related to brain volume in patients with PTSD but positively related to volume in the cuneus and precuneus of those with major depression. To maintain the representativeness of the sample, patients with PTSD were not excluded if they had typical comorbid conditions, such as depression. Patients were not all medication-free, but we controlled for group differences in antidepressant use in the analyses. We identified commonalities in areas of brain volume in patients with PTSD and those with major depression, suggesting that existing findings concerning reductions in prefrontal areas in particular may not be specific to PTSD but rather related to features of the disorder that are shared with other conditions, such as depression. More subtle differences between patients with PTSD and those with major depression were represented by distinct structural correlates of self-reported anxiety and depression.

Implementation and Outcome of Combining Interoceptive Exposure With Trauma-Related Exposure Therapy in a Patient With Combat-Related Posttraumatic Stress Disorder

Theoretical considerations and several case studies suggest that trauma-related exposure therapy (TRE), which is one of the leading treatments for posttraumatic stress disorder (PTSD), may be augmented by adding interoceptive exposure (IE) therapy. The patient is a retired veteran with chronic PTSD as the primary (most severe) disorder and comorbid major depressive disorder. Treatment consisted of four sessions of IE followed by eight sessions of TRE. Structured interviews and self-report measures of psychopathology are administered pretreatment, midtreatment (after completing IE and before commencing TRE), posttreatment, and at 3-, 6-, and 12-month follow-ups. IE is associated with decreases in PTSD symptoms and anxiety sensitivity. At posttreatment, there are further reductions in PTSD symptoms and several associated symptoms. There are also further gradual improvements over the follow-up assessments. Implications of these findings are discussed, with an emphasis on identifying potential benefits and limitations of using IE+TRE for combat-related PTSD.

Examining MMPI-2 F-family scales in PTSD-diagnosed veterans of Operation Enduring Freedom and Operation Iraqi Freedom.

Our study examined Minnesota Multiphasic Personality Inventory-2 (MMPI-2) F-family validity scales (F, Fb, F-K, Fp) in treatment-seeking veterans diagnosed with posttraumatic stress disorder (PTSD) related to Operation Enduring or Iraqi Freedom (OEF/OIF). Seventy-nine percent of veterans had F T scores over 65, 54% elevated F over 80 T; and 71% elevated Fb above 65 or 80. Fewer veterans elevated F-K ( 13; 22%) and Fp ( 100 T; 5%). Differences emerged between veterans with and without elevated ( 65 T) F scores on F-family validity scales, clinical scales, and self-report measures of psychopathology. Elevations for F-family validity scales at various cut points are reported.

The Italian version of the validated short TEMPS-A: The temperament evaluation of Memphis, Pisa, Paris and San Diego

Background TEMPS-A (Temperament Evaluation of the Memphis, Pisa, Paris and San Diego—Autoquestionnaire) is a new self-report measure of the affective temperament with depressive (D), cyclothymic (C), hyperthymic (H), irritable (I), and anxious (A) subscales. To date, the original 110-item version has been translated into 25 languages, and validated in many countries with different cultural backgrounds. This study presents the Italian brief, 39-item version of the questionnaire, more suited for studies in populations and currently validated in the U.S., and in a French translation. Methods A new version was prepared for this study via translation and back-translation of the original brief scale. A pilot sample of 18 to 30 year-old undergraduate students of both genders ( n = 440, males = 178) were invited to fill in the newly prepared brief version of TEMPS-A, as well as other self-report measures of psychopathology. Results Reliability as measured by Cronbach's α was good for all TEMPS-A subscales (> 0.70). Most of the temperament subscales were associated with each other, with stronger links between the Depressive, the Cyclothymic, the Irritable and the Anxious subscales. Across the sample, measures of psychopathology in the domain of general distress and dysphoria (GHQ-12), or in the delusion/hallucinatory psychotic-like dimension (PDI-21; LSHS-R), were positively linked to the scores of the TEMPS-A subscales. Based on z-scores above 2 SD, the rate of the depressive (6.4%) was the highest in this population, followed by the cyclothymic (5%), the irritable (4.8%) and zero for the anxious and hyperthymic. The irritable temperament was higher in males compared with females (7.3% vs. 3.1%). Limitations The study was limited to a young healthy volunteer sample. Data from clinical subjects will be necessary to fully appreciate the validity of this version. Conclusion In its extended 110-item version, the TEMPS-A has proved its value in various populations: due to its ease of administration, its short version is interesting to screen larger samples. That the anxious subscale (which pertains largely to anxious people worrying about their family's welfare) and the hyperthymic subscales are within the normal curve is possibly due to the highly desirable nature of these traits in Italy.

Pathways to PTSD, Part I: Children With Burns

The goal of this study was to develop a model of risk factors for posttraumatic stress disorder (PTSD) in a group of acutely burned children. Seventy-two children between the ages of 7 and 17 who were admitted to the hospital for an acute burn were eligible for study. Members of families who consented completed the Child PTSD Reaction Index, the Multidimensional Anxiety Scale for Children, and other self-report measures of psychopathology and environmental stress both during the hospitalization and 3 months following the burn. A path analytic strategy was used to build a model of risk factors for PTSD. Two pathways to PTSD were discerned: 1) from the size of the burn and level of pain following the burn to the child's level of acute separation anxiety, and then to PTSD, and 2) from the size of the burn to the child's level of acute dissociation following the burn, and then to PTSD. Together these pathways accounted for almost 60% of the variance in PTSD symptoms and constituted a model with excellent fit indices. These findings support a model of complex etiology for childhood PTSD in which two independent pathways may be mediated by different biobehavioral systems.

Complicated grief as a stress response disorder: evaluating diagnostic criteria in a German sample

Background Complicated grief has been described as a diagnosis candidate for DSM-V. On the basis of the stress response theory, Horowitz et al. [Am J Psychiatry 154 (1997) 904–10] characterized complicated grief as a combination of sustained intrusion, avoidance, and maladaptation symptoms following the loss of a close person. This study aimed at evaluating diagnostic criteria based on the stress response model of complicated grief. Methods We administered a symptom list derived from Horowitz et al.'s operationalization to a sample of bereaved persons and evaluated the psychometric properties of the symptom criteria and symptom category subscales. Using this symptom list and other self-report measures of psychopathology and normal grief reactions, we examined a German sample consisting of 75 participants who had lost either siblings, children, parents, or spouses, on average, 5.4 years prior to the study. Results Analyses confirmed the classification of symptoms into intrusion, avoidance, and failure-to-adapt categories with only minimal reordering (two symptom criteria). The symptom category subscales showed favourable psychometric characteristics, receiver operating characteristic (ROC) analyses indicated high diagnostic accuracy of the symptom criteria, and predictive validation revealed a meaningful correlational pattern to standard measures of divergent psychopathology and normal grief reactions. Conclusions The application of a stress response operationalization of complicated grief is supported.