Trauma-exposed Sample Research Articles

How well does the Index of Race-Related Stress-brief function in a trauma-exposed Black community sample? An item response theory examination of discrimination and difficulty parameters.

Race-related stress negatively impacts the mental health of Black Americans to a greater degree than other racialized groups. Additionally, trauma exposure is associated with more severe levels of posttraumatic stress disorder for individuals who also experience race-related stress. Therefore, an accurate assessment of race-related stress in a trauma-exposed sample of Black Americans is necessary to ensure the validity and reliability of empirical findings regarding race-related stress and intervention efficacy. The Index of Race-Related Stress (IRRS) is one of the most commonly used measures to assess race-related stress among Black Americans. Due to a lack of psychometric support for the abbreviated version of IRRS-brief (IRRS-B) on a trauma-exposed sample of Black Americans, our study aims to address this gap in literature. We used item response theory (IRT) to assess item difficulty, discrimination, and factor structure in a sample of trauma-exposed Black Americans (n = 226). We employed a multidimensional graded response model with corresponding items loaded on to the three previously established factors of the IRRS. The most discriminating items asked about observing harsh treatment of Black individuals, experiencing less courtesy in establishments, and being stared at as though you do not belong. The item with the lowest difficulty described negative media representation of Black individuals while the item with the highest difficulty described lack of positive media portrayals of Black Americans. These results indicate that items varied considerably in the degree to which they adequately captured race-related stress. Future research should use IRT with newly worded questions to further improve the assessment of race-related stress in Black Americans. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

How does it feel? An exploration of neurobiological and clinical correlates of alexithymia in trauma-exposed police-officers with and without PTSD

ABSTRACT Background: Alexithymia, an inability to recognise one’s emotions, has been associated with trauma-exposure and posttraumatic stress disorder (PTSD). Previous research suggests involvement of the oxytocin system, and socio-emotional neural processes. However, the paucity of neurobiological research on alexithymia, particularly in trauma-exposed populations, warrants further investigation. Objective: Explore associations between alexithymia, endogenous oxytocin levels, and socio-emotional brain function and morphometry in a trauma-exposed sample. Method: Dutch trauma-exposed police officers with (n = 38; 18 females) and without PTSD (n = 40; 20 females) were included. Alexithymia was assessed with the Toronto Alexithymia Scale (TAS-20). Endogenous salivary oxytocin was assessed during rest, using radioimmunoassay. Amygdala and insula reactivity to socio-emotional stimuli were assessed with functional MRI, amygdala and insula grey matter volume were derived using Freesurfer. Results: Alexithymia was higher in PTSD patients compared to trauma-exposed controls (F(1,70) = 54.031, p < .001). Within PTSD patients, alexithymia was positively associated with PTSD severity (ρ(36) = 0.497, p = .002). Alexithymia was not associated with childhood trauma exposure (β = 0.076, p = .509), police work-related trauma exposure (β = −0.107, p = .355), oxytocin levels (β = −0.164, p = .161), insula (β = −0.170, p = .158) or amygdala (β = −0.175, p = .135) reactivity, or amygdala volume (β = 0.146, p = .209). Insula volume was positively associated with alexithymia (β = 0.222, p = .016), though not significant after multiple testing corrections. Bayesian analyses supported a lack of associations. Conclusions: No convincing neurobiological correlates of alexithymia were observed with any of the markers included in the current study. Yet, the current study confirmed high levels of alexithymia in PTSD patients, independent of trauma-exposure, substantiating alexithymia’s relevance in the clinical phenotype of PTSD.

Associations between DSM-5 posttraumatic stress disorder Criterion E2 endorsement and selected self-destructive behaviors in recent-era veterans: A focus on disordered eating.

Revisions to the posttraumatic stress disorder (PTSD) criteria in the DSM-5 included a new criterion in the alterations in arousal and reactivity cluster (i.e., engagement in reckless and self-destructive behaviors; Criterion E2). Despite its clinical significance, little is known about how this symptom corresponds to engagement in specific direct and indirect self-harm behaviors. We examined associations between E2 and self-reported recent engagement in direct and indirect self-harm behaviors, including disordered eating, which is not included in the prototypical E2 symptom scope, in a trauma-exposed sample of 1,010 recent-era veterans (61.5% self-identified women, 38.5% self-identified men). We also tested whether gender moderated these associations. We repeated analyses in a subsample of participants with clinically elevated PTSD symptoms. Participants self-reported past-month PTSD symptoms (PCL-5) as well as past-month nonsuicidal self-injury, suicidal ideation, suicide planning, fasting, purging, binge eating, compulsive exercise, and problematic alcohol and drug use. We found no evidence for moderation by gender for any of the behaviors examined in the main sample. However, after controlling for gender and demographic covariates, weighted logistic regressions showed small, significant associations between E2 score and direct self-harm behaviors, substance use, purging, and binge eating, aORs = 1.30-1.91. Criterion E2 was linked to behaviors included in the typical symptom scope (self-directed violence, substance use) and those that are not (disordered eating behaviors). Comprehensive screening for self-destructive behaviors, including disordered eating, among veteran men and women who endorse Criterion E2 is indicated.

Relations between PTSD symptom clusters and pain in three trauma-exposed samples with pain.

Little is known about how the individual PTSD symptom clusters relate to intensity and interference of pain and whether these relationships differ across clinical groups. The present study examines relations between PTSD symptom clusters and pain in three trauma-exposed, unique clinical groups: 1) adults seeking treatment for chronic pain with current symptoms of PTSD, 2) trauma affected refugees seeking treatment for PTSD and chronic pain; and 3) individuals identified at admission to the emergency ward after whiplash injury. Network analysis was used to assess unique relations between pain intensity, pain interference, re-experiencing, avoidance, numbing, hyperarousal, depression, and anxiety separately in each sample. Links between PTSD clusters and pain were then compared within and between samples. No within-group differences were identified for the links between pain and any of PTSD clusters in the chronic pain and refugee groups. In the whiplash group, hyperarousal was more strongly related to pain than re-experiencing, avoidance, and numbing. Between group comparisons revealed a more pronounced relationship between hyperarousal and pain in the whiplash group, with no between-group differences between the chronic pain and refugee groups. The findings suggest that when depression and anxiety are accounted for, few unique associations are found between pain and the PTSD symptom clusters in trauma-exposed samples with pain, with the exception of a link between pain and hyperarousal in individuals with whiplash-related PTSD symptoms.

A comparison of ICD-11 and DSM-5 criteria of PTSD among Chinese trauma-exposed adolescent samples.

This study aimed at comparing the prevalence and comorbidity differences of PTSD according to ICD-11 and DSM-5 definitions across two Chinese adolescent trauma-exposed samples. A total of 1,201 students exposed to earthquake and 559 students from vocational schools exposed to potentially traumatic events were included in this study. The PTSD Checklist for DSM-5 was used to measure PTSD symptoms. The MDD and GAD subscales of the Revised Children's Anxiety and Depression Scale were used to measure major depression disorder (MDD) and generalized anxiety disorder (GAD) symptoms. No significant PTSD prevalence differences between ICD-11 and DSM-5 were found across the two samples. The differences regarding comorbidities between ICD-11 and DSM-5 definitions were not significant among these two samples. The results revealed that the ICD-11 and DSM-5 provided similar prevalence of PTSD and comorbidity rates with MDD and GAD in Chinese trauma-exposed adolescent samples. This study contributes to the current understanding of the similarities and differences using different PTSD criteria and informs the organization and application of these two globally applied PTSD criteria.

Dissociation in a developmental psychopathology framework: Predictors and outcomes among a clinical sample of trauma-impacted adolescents.

A confirmatory factor analysis (CFA) of the Adolescent Dissociative Experiences Scale (A-DES) that found a best-fitting three-factor model for a trauma-exposed sample was recently replicated; however, a post hoc bifactor CFA model fit the data better and identified a strong general factor. Only the general factor was associated with cumulative trauma exposure, but this association was small. Structural equation modeling (SEM) and regression analyses were applied to the best-fitting three-factor bifactor model of dissociation found in the same sample of 1,157 treatment-seeking adolescents, most with high levels of trauma exposure, to further elucidate dissociation's construct validity and dimensionality. The general factor was positively yet differentially associated with psychosocial outcomes. A dissociation by age interaction emerged for internalizing problems, demonstrating that the positive association was stronger for older participants. Also, an age of trauma exposure onset by dissociation interaction emerged predicting depression, such that later trauma onset produced a stronger association between dissociation and depression. Traumas occurring in later adolescence may confer greater risk of dissociation. Differential psychosocial outcomes also reinforce why approaching dissociation from a developmental psychopathology lens is important, enhancing the model's generalizability. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychometric evaluation of the multiscale dissociation inventory (MDI): A replication and extension in two trauma-exposed samples

Dissociation, defined as a disruption in the normal integration of mental processes, involves a wide range of symptoms that can occur following exposure to traumatic events. The accurate assessment of dissociative symptoms in trauma survivors is important both for understanding the link between dissociation and trauma and for developing effective treatments for posttraumatic dissociation. In the present study, we conducted a psychometric evaluation of the 30-item Multiscale Dissociation Inventory (MDI; Briere, 2002) in two trauma-exposed samples (367 community adults; 448 undergraduate students). We examined the MDI's (a) internal consistency; (b) convergent and discriminant validity, using measures of trauma-related dissociation, posttraumatic stress disorder, childhood trauma, depression, anxiety, physical aggression, well-being, appetite, and achievement; and (c) factor structure, using exploratory structural equation modeling (ESEM). In both samples, the MDI demonstrated high internal consistency and strong convergent and discriminant validity. ESEM replicated the 5-factor structure of the MDI (Disengagement, Identity Dissociation, Emotional Constriction, Memory Disturbance, and Depersonalization/Derealization) and identified one factor (Memory Disturbance) and several items that may benefit from further construct validation and/or refinement. We discuss considerations for future research and use of the MDI in trauma-exposed populations.

Measuring post-traumatic stress disorder and complex post-traumatic stress disorder using the International Trauma Questionnaire: results from a Hungarian clinical and non-clinical sample

ABSTRACT Background: The 11th revision of the International Classification of Diseases (ICD-11) simplified the description of post-traumatic stress disorder (PTSD) and also introduced a new trauma-related diagnosis called complex post-traumatic stress disorder (CPTSD). CPTSD is linked to earlier, prolonged interpersonal trauma, and is characterized by a broader range of symptoms, in addition to the core PTSD symptoms. The International Trauma Questionnaire (ITQ) has been developed to assess the new diagnostic criteria. Objectives: The primary aim of our study was to test the factor structure of the ITQ in a clinical and a non-clinical Hungarian sample. We also examined whether the degree of traumatization or the type of trauma experienced was associated with meeting the criteria for PTSD or CPTSD, or with the severity of PTSD or disturbances in self-organization (DSO) symptoms, in both samples. Method: A trauma-exposed heterogeneous clinical sample (N = 176) and a non-clinical sample (N = 229) filled out the ITQ and a modified version of the Life Events Checklist (LEC-5). The factor structure of the ITQ was tested by examining the model fit of seven competing confirmatory factor analysis models. Results: A two-factor second-order model with a second-order PTSD factor (measured by three first-order factors) and a DSO factor (measured directly by six symptoms) had the best fit to the data in both samples if an error correlation was allowed between negative self-concept items. Those in the clinical group who reported more interpersonal and childhood trauma experienced more PTSD and DSO symptoms. Also, there were significant, positive, and weak associations between the total number of different traumas and PTSD and DSO factor scores in both samples. Conclusion: ITQ was found to be a reliable tool to differentiate between PTSD and CPTSD, two related but distinct constructs in a clinical and a non-clinical trauma-exposed sample in Hungary.

A psychometric evaluation of the International Trauma Questionnaire (ITQ) in a trauma-exposed college sample

IntroductionThe International Trauma Questionnaire (ITQ) is a well-validated measure of ICD-11 PTSD and CPTSD. However, further validation is needed in other samples and using external correlates representing a broader range of psychopathology. ObjectiveWe first examined the internal consistency of the ITQ, and then examined its convergent and discriminant validity with a wide variety of external correlates, including PTSD, childhood trauma, dissociation, somatization, anxiety, anxiety related disorders, depression, mania, paranoia, schizophrenia, borderline features, antisocial features, drug use, alcohol use, aggression, suicidal ideation, stress, interpersonal functioning, and treatment rejection. MethodUsing data from a trauma-exposed sample of college students (N = 246), we evaluated internal consistency via Cronbach's alpha and MacDonalad's omega, and convergent and discriminant validity via Pearson correlations and follow-up z tests using the Meng-Rosenthal-Rubin (1992) procedure to assess differences between the PTSD and DSO scales of the ITQ. ResultsThe ITQ has strong internal consistency reliability as indicated by Cronbach's alpha and MacDonald's omega. Patterns of convergent and discriminant validity fell broadly in hypothesized patterns, supporting the distinction between ICD-11 PTSD and CPTSD. All significant contrast analyses showed that correlations with external criterion variables were greater for ITQ DSO as compared to ITQ PTSD. ConclusionsOur results indicate that the ITQ is a psychometrically sound measure of ICD-11 PTSD and CPTSD. As indicated by the differential pattern in convergent and discriminant validity with a broad range of external correlates, the scale readily distinguishes PTSD and DSO as distinct constructs.

A path to post-trauma resilience: a mediation model of the flexibility sequence

ABSTRACT Background: Psychological resilience has grown in popularity as a topic of study in psychotraumatology research; however, this concept remains poorly understood and there are several competing theories of resilience. Objective: This study sought to assess the support for one proposed theory of resilience: the flexibility sequence. Method: This study use secondary data analysis of panel survey data (N = 563). Participants were aged 18 years or over and based in the UK. A series of sequential mediation models was used to test the flexibility sequence theory as a proposed pathway of resilience on mental health outcomes (post-traumatic stress disorder, anxiety, and depression) among a trauma-exposed sample from the UK. Results: The ‘feedback’ component of the proposed flexibility sequence components was associated with reduced symptom severity with all outcomes, whereas ‘context sensitivity’ and ‘repertoire’ were significantly associated only with depression as an outcome. When indirect mediation pathways were modelled via the flexibility sequence, statistically significant effects were observed for all outcomes under investigation. Conclusions: These findings support the theorized flexibility sequence pathway of resilience, suggesting that the combination of these skills/processes performs more favourably as a framework of resilience than any in isolation. Further research into more elaborate associations and feedback loops associated with this pathway is warranted.

What can we learn about polytrauma typologies by comparing population-representative to trauma-exposed samples: A Nepali example

BackgroundPotentially traumatic events (PTEs) are common and associated with detrimental outcomes over the life-course. Previous studies exploring the causes and consequences of PTE-exposure profiles are often from high-income settings and fail to explore the implications of sample selection (i.e., population-representative versus PTE-restricted). MethodsAmong individuals in the Nepal Chitwan Valley Family Study, latent class analyses (LCA) were performed on 11 self-reported PTEs collected by the Nepali version of the World Mental Health Consortium's Composite International Diagnostic Interview 3.0 from 2016 to 2018, in a population-representative sample (N = 10,714), including a PTE-restricted subsample (N = 9183). Multinomial logistic regressions explored relationships between sociodemographic factors and class membership. Logistic regressions assessed relationships between class membership and psychiatric outcomes. ResultsOn average, individuals were exposed to 2 PTEs in their lifetime. A five-class solution showed optimal fit for both samples; however, specific classes were distinct. No single sociodemographic factor was universally associated with PTE class membership in the population-representative sample; while several factors (e.g., age, age at incident PTE, education, marital status, and migration) were consistently associated with class membership in the PTE-subsample. PTE class membership differentiated psychiatric outcomes in the population-representative sample more than the PTE-subsample. LimitationsPrimary limitations are related to the generalizability to high-income settings, debate on LCA model fit statistic usage for final class selection, and cross-sectional nature of data collection. ConclusionsAlthough population-representative samples provide information applicable to large-scale, population-based programming and policy, PTE-subsample analyses may provide additional nuance in PTE profiles and their consequences, important for specialized prevention efforts.

Graded response item response theory in scaling suicidal thoughts and behaviors among trauma-exposed women with substance use disorders.

Objective: The co-occurrence of substance use disorders (SUD) and trauma-exposure is a risk factor for suicidal thoughts and behaviors (STB). However, traditional methods of measurement for suicidal thoughts and behaviors are limited by an overreliance on dichotomous (i.e., yes or no) and averaged/summed scale score measurements. Further, among trauma-exposed individuals with SUD, it remains unclear which specific demographic factors, types of SUDs, and trauma sequelae (e.g., posttraumatic stress disorder [PTSD] symptom clusters) may be associated with elevated STB. The present study utilized item response theory to (a) generate empirically derived STB severity scores and, (b) examine which demographic factors, SUD diagnoses, and DSM-IV PTSD symptom clusters are associated with suicidality in a trauma-exposed sample with SUDs. Method: Female trauma-exposed participants with SUDs (N = 544) were recruited from community substance use treatment facilities in the National Drug Abuse Treatment Clinical Trials Network (CTN). Clinician-administered interviews assessed STB, SUDs, and PTSD symptoms. Results: Results indicated that the unidimensional item response theory (IRT) model used to estimate latent STB severity scores fit well, with strong local reliability at higher levels of latent STB severity. Regression predictors of elevated STB severity included younger age, opioid dependence, and higher PTSD reexperiencing symptoms. Conclusions: Clinicians are advised to screen for and target opioid use disorders and reexperiencing symptoms when addressing suicidal thoughts and behavior in trauma-exposed individuals with SUDs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Longitudinal PTSD network structure: measuring PTSD symptom networks over 5 years.

Network modeling has been applied in a range of trauma-exposed samples, yet results are limited by an over reliance on cross-sectional data. The current analyses used posttraumatic stress disorder (PTSD) symptom data collected over a 5-year period to estimate a more robust between-subject network and an associated symptom change network. A PTSD symptom network is measured in a sample of military veterans across four time points (Ns = 1254, 1231, 1106, 925). The repeated measures permit isolating between-subject associations by limiting the effects of within-subject variability. The result is a highly reliable PTSD symptom network. A symptom slope network depicting covariation of symptom change over time is also estimated. Negative trauma-related emotions had particularly strong associations with the network. Trauma-related amnesia, sleep disturbance, and self-destructive behavior had weaker overall associations with other PTSD symptoms. PTSD's network structure appears stable over time. There is no single 'most important' node or node cluster. The relevance of self-destructive behavior, sleep disturbance, and trauma-related amnesia to the PTSD construct may deserve additional consideration.

Systematic Review and Meta-analysis: Prevalence of Posttraumatic Stress Disorder in Trauma-Exposed Preschool-Aged Children.

ObjectiveTrauma exposure is common in preschool-aged children. Understanding the psychological impact of such exposure and the prevalence of posttraumatic stress disorder (PTSD) in this population is important for provision of appropriate and timely intervention. This pre-registered (PROSPERO: CRD41019133984) systematic review and meta-analysis examined the prevalence of PTSD in trauma-exposed preschool-aged children.MethodLiterature searches were conducted of PubMed (Medline), PsycINFO and PILOTS, alongside reference lists of relevant reviews. Studies were selected if they comprised trauma-exposed samples with a mean age of less than 6.5 years, and PTSD was assessed using standardized interviews at least 1-month post trauma. Information on sample characteristics, trauma exposure, PTSD measurement, and diagnostic criteria were extracted. For studies that applied more than one PTSD diagnostic algorithm, the most age-appropriate criteria were used to estimate pooled prevalence estimate across studies. A random-effects model was used for meta-analysis.ResultsEighteen studies were included (N = 1941). The pooled PTSD prevalence was 21.5% (95% CI = 13.8%-30.4%) when using the most developmentally appropriate diagnostic algorithm that was available. When focusing on the subset of studies that reported both standard adult criteria and age-appropriate criteria (k = 12), a pooled estimate of 4.9% (95% CI = 2.5%-8.0%) was obtained for standard adult criteria (DSM-IV), and 19.9% (95% CI = 12.1%-29.0%) was obtained for age-appropriate criteria (PTSD-AA). Prevalence was 3-fold higher following interpersonal and repeated trauma exposure, compared to non-interpersonal or single-event trauma, respectively. Higher prevalence was found when age-appropriate diagnostic tools were used. There was significant heterogeneity across studies and a lack of studies conducted in low-income countries and applying age-appropriate diagnostic algorithms.ConclusionPreschool-aged children are vulnerable to developing PTSD following trauma exposure. Younger children show prevalence trends similar to those of older youths and adults following different types of trauma. Age-appropriate diagnostic criteria are essential to ensure that appropriate identification and early support are provided.

Quality of life, emotion regulation, and dissociation: Evaluating unique relations in an undergraduate sample and probable PTSD subsample.

Previous research has documented a strong association between emotion regulation (ER) and quality of life (QoL). Nevertheless, extant studies have not tested this association in participants meeting diagnostic criteria for posttraumatic stress disorder nor accounted for other explanatory variables statistically. Our primary objective was to evaluate the unique relations among ER dimensions and QoL while controlling for dissociation, neuroticism, and PTSD symptoms statistically. Our secondary aim was to test the hypothesis that the correlation between PTSD symptoms and dissociation will be greater in a sample with clinically elevated PTSD compared with a nonclinical sample. Data were collected from an unselected undergraduate sample (N = 502) and a subsample of participants with probable PTSD (N = 53) using self-report measures. Analyses revealed that increased general emotional dysregulation, dissociation, PTSD symptoms, blaming others, neuroticism, and impulsivity were uniquely related to poor QoL in the overall sample whereas increased dissociation, impulsivity, and blaming others were uniquely related to poor QoL in the probable PTSD subsample. We found evidence for a moderate correlation between PTSD symptoms and dissociation in the probable PTSD subsample, but this correlation was not significantly greater than the correlation between the two variables in the overall sample. ER dimensions (e.g., dissociation, blaming others, impulsivity) may represent novel treatment targets for tailored psychosocial interventions promoting QoL in the general population and individuals with PTSD. Future longitudinal studies with a larger trauma-exposed sample are necessary to replicate and extend our findings. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Longitudinal hair cortisol in low-income young children: A useful biomarker of behavioral symptom change?

Early childhood is a developmental period characterized by significant plasticity, heterogeneity in behaviors and biological functioning. Yet, cumulative cortisol secretion, as measured by hair cortisol, has not been examined longitudinally in relation to change in behavioral problems in young children. The current study examined cross-sectional and longitudinal associations between hair cortisol and changes in behavior problems in a combined sample (N = 88) of two groups of young children from low-income families: 1) A trauma-exposed sample that participated in Child-Parent Psychotherapy (CPP) (n = 43; Mean Age = 4.31, SD = 1.16; 53% Female; 77% Hispanic), and 2) A community sample of children from families experiencing high stress (n = 45; Mean Age = 3.20, SD = 0.29; 67% Female; 58% Hispanic). Cortisol was assayed from hair collected from children at baseline and, on average, one year later. Mothers completed the Child Behavior Checklist at the same time hair samples were collected. Baseline hair cortisol in children was not associated with maternally-reported child behavioral problems at baseline and did not predict change in behavior problems over time. In contrast, increases in cortisol were associated with greater improvement in child behavior problems (b = −2.98, p < 0.05), controlling for group status and relevant covariates. Subgroup analyses showed that cortisol change across one year significantly differed between the two groups (p = 0.043): on average, community children exhibited a decrease, whereas CPP children demonstrated no change. Hair cortisol concentration was similarly related to improvements in mother-reported behavior problems across both CPP and community groups over time. In summary, there were no cross-sectional associations with hair cortisol, whereas increases were associated with improved child well-being. Findings demonstrate an important link between this increasingly common biomarker and child health, but suggest that changes over time may be more informative than cross-sectional associations.

The impact of aversive context on early threat detection in trauma exposed individuals and associations with post-traumatic stress symptoms.

Introduction:Prolonged attentional bias to threat (AB) is associated with posttraumatic stress symptoms (PTSS). However, it is unclear whether this relationship extends to early threat detection (elicited by masked stimuli) and/or varies if AB is measured during an aversive context.Methods:Two trauma-exposed samples of either intervention-seekers (N = 50) or community members (N = 98) completed a masked dot-probe task to measure early AB to angry faces in safe vs. aversive contexts (i.e., during threat of aversive noises).Results:Linear mixed effects models showed that an aversive context increased the orienting responses in both samples; however, PTSS did not moderate these effects in either sample.Limitations:Sample size and heterogeneity of trauma-type may have impacted effect of PTSS on AB.Conclusion:These results highlight the importance of assessing AB in varying contexts and examining generalizability across populations. Given prior research, the results also suggest that increased AB in PTSS may only be present for later attentional processes rather than early threat detection, at least with behavioral methods.

Investigating centrality in PTSD symptoms across diagnostic systems using network analysis*

ABSTRACT Background: The posttraumatic stress disorder (PTSD) diagnosis has been widely debated since it was introduced into the diagnostic nomenclature four decades ago. Recently, the debate has focused on consequences of having two different descriptions of PTSD: 20 symptoms belonging to four symptom clusters in the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5), and three symptoms clusters in the 11th edition of the International Classification of Diseases (ICD-11) most often operationalized by six symptoms in the International Trauma Questionnaire (ITQ) (2017) and Hansen, Hyland, Armour, Shevlin, & Elklit (2015). Research has provided support for both models of PTSD, but at the same time indicates differences in estimated prevalence rates of PTSD (Hansen et al., 2015, 2017). A growing body of research has modelled PTSD both theoretically and statistically as a network of interacting symptoms (Birkeland, Greene, & Spiller, 2020), yet it remains more unclear how the two diagnostic systems perform regarding which symptoms are more central/interconnected. Objectives and methods: We estimated two 23-item Gaussian Graphical Models to investigate whether ICD-11 or DSM-5 PTSD symptoms are more central in two trauma-exposed samples: a community sample (N = 2,367) and a military veteran sample (N = 657). PTSD DSM-5 was measured with the PTSD checklist-5 (PCL-5) and the PTSD ICD-11 was measure by the ITQ PTSD subscale. Results: Five of the six most central symptoms estimated via the expected influence centrality metric across the two samples were identical and represented symptoms from both diagnostic systems operationalized by the PCL-5 and the ITQ. Conclusions: The results of the present study underline that symptoms from both diagnostic systems hold central positions. The implications of the results are discussed from the perspectives of an indexical (i.e. the diagnostic systems reflect both shared and different aspects of PTSD) and a constitutive view (i.e., the diagnostic systems represent different disorders and the results cannot be reconciled per se) of mental health diagnoses (Kendler, 2017).

Prevalence of Posttraumatic Stress Disorder in Preschool Children: A Systematic Review and Meta-Analysis

Background: Trauma exposure is common in preschool children. Understanding the psychological impact of such exposure and the prevalence of posttraumatic stress disorder (PTSD) in this population is important for provision of appropriate and timely intervention. This pre-registered (PROSPERO:CRD41019133984) systematic review and meta-analysis examined the prevalence of PTSD in trauma-exposed preschool-aged children. Methods: Literature searches were conducted of PubMed (Medline), PsycINFO and PILOTS, alongside reference lists of relevant reviews. Studies were selected if they comprised trauma-exposed samples with a mean age less than 6.5 years, and PTSD was assessed using standardised interviews at least one month post-trauma. Information on sample characteristics, trauma-exposure, PTSD measurement and diagnostic criteria were extracted. For studies that applied more than one PTSD diagnostic algorithm, the most age-appropriate criteria were used to estimate pooled prevalence estimate across studies. A random-effects model was used for meta-analysis. Findings: Eighteen studies were included (N=1946). Pooled PTSD prevalence was 20·4% (95% CI 11·9 – 30·5%). Prevalence was three-fold higher following interpersonal and repeated trauma exposure, compared to non-interpersonal or single-event trauma, respectively. Higher prevalence was found when age-appropriate diagnostic tools were utilised. There was significant heterogeneity across studies and a lack of studies conducted in low-income countries and applying age-appropriate diagnostic algorithms. Interpretation: Preschool-aged children are vulnerable to developing PTSD following trauma exposure. Younger children show similar prevalence trends to older youth and adults following different types of trauma. Age-appropriate diagnostic criteria are essential to ensure appropriate identification and early support is provided. Funding Statement: Tim Dalgleish was funded by the UK Medical Research Council (Grant Reference: SUAG/043 G101400) and by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0211-24045). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Declaration of Interests: None.

The mediating effect of rumination between posttraumatic stress disorder symptoms and anger reactions.

The relationship between posttraumatic stress disorder (PTSD) and anger is well established. However, further investigation into the underlying mechanisms of this PTSD-anger relationship is needed. Rumination, a construct with a known association to PTSD symptoms, theoretically may mediate this PTSD-anger relationship. We conducted a mediational model using self-report measures of PTSD symptoms, rumination, and anger reactions from a nonclinical, trauma-exposed sample (N = 339) through Amazon's Mechanical Turk. Rumination mediated overall PTSD symptoms and anger reactions, controlling for age and gender identity. Further analyses examined this mediating role between PTSD subscale scores and anger. Rumination mediated all PTSD subscales and anger when modeled separately. After adjusting for other PTSD symptoms, only 2 subscales' relationship with anger remained mediated by rumination: negative alterations in cognitions/mood and physiological arousal. Rumination should be assessed in the context of PTSD and anger symptoms, specifically physiological arousal and negative moods/cognitions symptoms in PTSD. (PsycInfo Database Record (c) 2020 APA, all rights reserved).