Skip to main content
×
Home
    • Aa
    • Aa

Diagnostic alterations for post-traumatic stress disorder: examining data from the National Comorbidity Survey Replication and National Survey of Adolescents

  • Jon D. Elhai (a1), Julian D. Ford (a2), Kenneth J. Ruggiero (a3) and B. Christopher Frueh (a4)
Abstract
Background

Two alternative models of post-traumatic stress disorder (PTSD) appear to represent the disorder's latent structure better than the traditional Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) three-factor PTSD model. The present study examines the impact of using these structural models for the diagnosis of lifetime PTSD while retaining the DSM-IV PTSD's six-symptom diagnostic requirement.

Method

Data were gathered from large-scale, epidemiological datasets collected with adults (National Comorbidity Survey Replication) and adolescents (National Survey of Adolescents). Two alternative, empirically supported four-factor models of PTSD were compared with the DSM-IV three-factor PTSD diagnostic model.

Results

Results indicated that the diagnostic alterations resulted in substantially improved structural validity, downward adjustments of PTSD's lifetime prevalence (roughly 1 percentage point decreases in adults, 1–2.5 percentage point decreases in adolescents), and equivalent psychiatric co-morbidity and sociodemographic associations.

Conclusions

Implications for modifying PTSD diagnostic criteria in future editions of DSM are discussed.

Copyright
Corresponding author
*Address for correspondence: J. D. Elhai, Ph.D., Disaster Mental Health Institute, The University of South Dakota, 414 East Clark Street – SDU 114, Vermillion, South Dakota57069-2390, USA. (Email: jonelhai@gmail.com)
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

G Andrews , L Peters (1998). The psychometric properties of the Composite International Diagnostic Interview. Social Psychiatry and Psychiatric Epidemiology 33, 8088.

GJG Asmundson , JA Stapleton , S Taylor (2004). Are avoidance and numbing distinct PTSD symptom clusters? Journal of Traumatic Stress 17, 467475.

JJ Broman-Fulks , KJ Ruggiero , BA Green , DG Kilpatrick , CK Danielson , HS Resnick , BE Saunders (2006). Taxometric investigation of PTSD: Data from two nationally representative samples. Behavior Therapy 37, 364380.

BJ Cox , N Mota , I Clara , GJG Asmundson (2008). The symptom structure of posttraumatic stress disorder in the National Comorbidity Replication Survey. Journal of Anxiety Disorders 22, 15231528.

KN DuHamel , J Ostrof , T Ashman , G Winkel , EA Mundy , TM Keane , BJ Morasco , SMJ Vickberg , K Hurley , J Burkhalter , R Chhabra , E Scigliano , E Papadopoulos , C Moskowitz , W Redd (2004). Construct validity of the Posttraumatic Stress Disorder Checklist in cancer survivors: analyses based on two samples. Psychological Assessment 16, 255266.

JD Elhai , MJ Gray , AR Docherty , TB Kashdan , S Kose (2007). Structural validity of the Posttraumatic Stress Disorder Checklist among college students with a trauma history. Journal of Interpersonal Violence 22, 14711478.

JD Elhai , AL Grubaugh , TB Kashdan , BC Frueh (2008). Empirical examination of a proposed refinement to DSM-IV posttraumatic stress disorder symptom criteria using the National Comorbidity Survey Replication data. Journal of Clinical Psychiatry 69, 597602.

A Elkit , M Shevlin (2007). The structure of PTSD symptoms: A test of alternative models using confirmatory factor analysis. British Journal of Clinical Psychology 46, 299313.

DB Flora , PJ Curran (2004). An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. Psychological Methods 9, 466491.

BC Frueh , JD Elhai , DG Kaloupek (2004). Unresolved issues in the assessment of trauma exposure and posttraumatic reactions. In Posttraumatic Stress Disorder: Issues and Controversies (ed. G. M. Rosen ), pp. 6384. Wiley: New York.

JM Haro , S Arbabzadeh-Bouchez , TS Brugha , G De Girolamo , ME Guyer , R Jin , JP Lepine , F Mazzi , B Reneses , G Vilagut , NA Sampson , RC Kessler (2006). Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health Surveys. International Journal of Methods in Psychiatric Research 15, 167180.

L Hu , PM Bentler (1998). Fit indices in covariance structural modeling: Sensitivity to underparameterized model misspecification. Psychological Methods 3, 424453.

L Hu , PM Bentler (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling 6, 155.

RC Kessler , P Berglund , WT Chiu , O Demler , S Heeringa , E Hiripi , R Jin , BE Pennell , EE Walters , A Zaslavsky , H Zheng (2004). The US National Comorbidity Survey Replication (NCS-R): design and field procedures. International Journal of Methods in Psychiatric Research 13, 6992.

RC Kessler , P Berglund , O Demler , R Jin , KR Merikangas , EE Walters (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593602.

RC Kessler , TB Ustun (2004). The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research 13, 93121.

DG Kilpatrick , R Acierno , B Saunders , HS Resnick , CL Best , PP Schnurr (2000). Risk factors for adolescent substance abuse and dependence: data from a national sample. Journal of Consulting and Clinical Psychology 68, 1930.

DW King , GA Leskin , LA King , FW Weathers (1998). Confirmatory factor analysis of the Clinician-Administered PTSD Scale: evidence for the dimensionality of posttraumatic stress disorder. Psychological Assessment 10, 9096.

ED Krause , S Kaltman , LA Goodman , MA Dutton (2007). Longitudinal factor structure of posttraumatic stress symptoms related to intimate partner violence. Psychological Assessment 19, 165175.

JR Landis , GG Koch (1977). The measurement of observer agreement for categorical data. Biometrics 33, 159174.

RJ McNally (2003). Progress and controversy in the study of posttraumatic stress disorder. Annual Review of Psychology 54, 229252.

LA McWilliams , BJ Cox , GJG Asmundson (2005). Symptom structure of posttraumatic stress disorder in a nationally representative sample. Journal of Anxiety Disorders 19, 626641.

BO Muthén (1984). A general structural equation model with dichotomous, ordered categorical, and continuous latent variable indicators. Psychometrika 49, 115132.

JA Naifeh , JD Elhai , TB Kashdan , AL Grubaugh (2008). The PTSD Symptom Scale's latent structure: an examination of trauma-exposed medical patients. Journal of Anxiety Disorders 22, 13551368.

PA Palmieri , GN Marshall , TL Schell (2007 a). Confirmatory factor analysis of posttraumatic stress symptoms in Cambodian refugees. Journal of Traumatic Stress 20, 207216.

PA Palmieri , FW Weathers , J Difede , DW King (2007 b). Confirmatory factor analysis of the PTSD Checklist and the Clinician-Administered PTSD Scale in disaster workers exposed to the World Trade Center Ground Zero. Journal of Abnormal Psychology 116, 329341.

AE Raftery (1995). Bayesian model selection in social research. Sociological Methodology 25, 111163.

GM Rosen , SO Lilienfield (2008). Posttraumatic stress disorder: an empirical evaluation of core assumptions. Clinical Psychology Review 28, 837868.

GM Rosen , RL Spitzer , PR McHugh (2008). Problems with the post-traumatic stress disorder diagnosis and its future in DSM V. British Journal of Psychiatry 192, 34.

JL Schafer , JW Graham (2002). Missing data: our view of the state of the art. Psychological Methods 7, 147177.

JA Schinka , LM Brown , AR Borenstein , JA Mortimer (2007). Confirmatory factor analysis of the PTSD Checklist in the elderly. Journal of Traumatic Stress 20, 281289.

LJ Simms , D Watson , BN Doebbeling (2002). Confirmatory factor analyses of posttraumatic stress symptoms in deployed and nondeployed veterans of the Gulf War. Journal of Abnormal Psychology 111, 637647.

RL Spitzer , MB First , JC Wakefield (2007). Saving PTSD from itself in DSM-V. Journal of Anxiety Disorders 21, 233241.

D Watson (2005). Rethinking the mood and anxiety disorders: a quantitative hierarchical model for DSM-V. Journal of Abnormal Psychology 114, 522536.

RJ Wirth , MC Edwards (2007). Item factor analysis: current approaches and future directions. Psychological Methods 12, 5879.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords: