Skip to main content Accessibility help
×
Home

Latent structure of the proposed ICD-11 post-traumatic stress disorder symptoms: Implications for the diagnostic algorithm

  • David Forbes (a1), Emma Lockwood (a1), Mark Creamer (a1), Richard A. Bryant (a2), Alexander C. McFarlane (a3), Derrick Silove (a4), Angela Nickerson (a2) and Meaghan O'Donnell (a5)...

Abstract

Background

The latent structure of the proposed ICD-11 post-traumatic stress disorder (PTSD) symptoms has not been explored.

Aims

To investigate the latent structure of the proposed ICD-11 PTSD symptoms.

Method

Confirmatory factor analyses using data from structured clinical interviews administered to injury patients (n = 613) 6 years post-trauma. Measures of disability and psychological quality of life (QoL) were also administered.

Results

Although the three-factor model implied by the ICD-11 diagnostic criteria fit the data well, a two-factor model provided equivalent, if not superior, fit. Whereas diagnostic criteria based on this two-factor model resulted in an increase in PTSD point prevalence (5.1% v. 3.4%; z = 2.32, P<0.05), they identified individuals with similar levels of disability (P = 0.933) and QoL (P = 0.591) to those identified by the ICD-11 criteria.

Conclusions

Consistent with theorised reciprocal relationships between re-experiencing and avoidance in PTSD, these findings support an alternative diagnostic algorithm requiring at least two of any of the four re-experiencing/avoidance symptoms and at least one of the two hyperarousal symptoms.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Latent structure of the proposed ICD-11 post-traumatic stress disorder symptoms: Implications for the diagnostic algorithm
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Latent structure of the proposed ICD-11 post-traumatic stress disorder symptoms: Implications for the diagnostic algorithm
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Latent structure of the proposed ICD-11 post-traumatic stress disorder symptoms: Implications for the diagnostic algorithm
      Available formats
      ×

Copyright

Corresponding author

David Forbes, Australian Centre for Posttraumatic Mental Health, Level 3/161 Barry St, Carlton, Victoria 3053, Australia. Email: dforbes@unimelb.edu.au

Footnotes

Hide All

This study was supported by an Australian National Health and Medical Research Council (NHMRC) Program Grant (568970).

Declaration of interest

R.A.B. served on the DSM-5 PTSD/Trauma/Dissociative Work Group.

Footnotes

References

Hide All
1 Maercker, A Brewin, CR Bryant, RA Cloitre, M Reed, GM van Ommeren, M et al. . Proposals for mental disorders specifically associated with stress in the International Classification of Diseases-11. Lancet 2013; 381: 1683–5.
2 Brewin, C. World Health Organization Preparation for ICD-11: Clinical Utility of Diagnostic Criteria for Trauma Related Disorders, Part 1 – Diagnosing PTSD from three core elements. Presented at 28th Annual Meeting of the International Society for Traumatic Stress Studies, 1-3 November 2012, Los Angeles, USA (http://www.istss.org/Expert_Training_ISTSS_Conferences/5920.htm).
3 Floyd, FJ Widaman, KF. Factor analysis in the development and refinement of clinical assessment instruments. Psychol Assess 1995; 7: 286–99.
4 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th edn) (DSM-5). APA, 2013.
5 Elhai, J Miller, ME Ford, JD Biehn, TL Palmieri, PA Frueh, BC. Posttraumatic stress disorder in DSM-5: estimates of prevalence and symptom structure in a nonclinical sample of college students. J Anxiety Disord 2012; 26: 58–64.
6 Miller, MW Wolf, EJ Kilpatrick, D Resnick, H Holowka, BP Keane, DW et al. . The prevalence and latent structure of proposed DSM-5 posttraumatic stress disorder symptoms in U.S. national and veteran samples. Psychol Trauma 2012; 5: 501–12.
7 Brown, T. Confirmatory Factor Analysis. Guilford Press, 2006.
8 Kline, RB. Principles and Practice of Structural Equation Modelling (3rd edn). Guilford Press, 2010.
9 Bryant, RA O’Donnell, ML Creamer, M McFarlane, AC Clark, CR Silove, D. The psychiatric sequelae of traumatic injury. Am J Psychiatry 2010; 167: 312–20.
10 American Congress of Rehabilitation Medicine. Definition of mild traumatic brain injury. J Head Trauma Rehabil 1993; 8: 86–7.
11 Baker, SP O’Neil, B Haddon, W Long, WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974; 14: 187–96.
12 Blake, DD Weathers, F Nagy, LM Kaloupek, DG Gusman, FD Charney, DS et al. . The development of a clinician administered PTSD scale. J Trauma Stress 1995; 8: 75–90.
13 Weathers, FW Keane, TM Davidson, J. Clinician-administered PTSD scale: a review of the first ten years of research. Depress Anxiety 2001; 13: 132–56.
14 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM-IV). APA, 1994.
15 Sheehan, DV Lecrubier, Y Harnett-Sheehan, K Amorim, P Janavs, J Weiller, E et al. . The Mini International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview. J Clin Psychiatry 1998; 59 (suppl 20): 22–33.
16 World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO, 1992.
17 WHODAS Group. World Health Organization Disability Assessment Schedule II. WHO, 2000.
18 Perini, SJ Slade, T Andrews, G. Generic effectiveness measures: sensitivity to symptom change in anxiety disorders. J Affect Disord 2006; 90: 123–30.
19 Andrews, G Kemp, A Sunderland, M Von Korff, M Ustun, T. Normative data for the 12 item WHO disability assessment schedule 2.0. PLoS One 2009; 4: e8343.
20 WHOQOL Group. Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment. Psychol Med 1998; 28: 551–8.
21 WHOQOL Group. WHOQOL-BREF: Introduction, Administration, Scoring and Generic Version of the Assessment. World Health Organization, 1996.
22 Hawthorne, G Herrman, H Murphy, B. Interpreting the WHOQOL-Brèf: preliminary population norms and effect sizes. Soc Indic Res 2006; 77: 37–59.
23 Barker-Collo, S Theadom, A Ameratunga, S Jones, K Jones, A Starkey, N et al. . Prevalence and predictors of post-traumatic stress disorder in adults one year following traumatic brain injury: a population-based study. Brain Impair 2013; 14: 425–35.
24 Flora, DB Curran, PJ. An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. Psychol Methods 2004; 9: 466–491.
25 Wirth, RJ Edwards, MC. Item factor analysis: current approaches and future directions. Psychol Methods 2007; 12: 58–79.
26 Muthén, LK Muthén, BO. Mplus User’s Guide (7th edn). Muthén & Muthén, 2012.
27 Bandalos, D. Is parcelling really necessary? A comparison of results from item parcelling and categorical variable methodology. Struct Equ Modeling 2008; 15: 211–40.
28 Elhai, J Palmieri, P Biehn, T Frueh, BC Magruder, K. Posttraumatic stress disorder’s frequency and intensity ratings are associated with factor structure differences in military veterans. Psychol Assess 2010; 22: 723–8.
29 Cole, D Ciesla, JA Steiger, JH. The insidious effects of failing to include design-driven correlated residuals in latent variable covariance structure analysis. Psychol Methods 2007; 12: 381–98.
30 Hu, LT Bentler, PM. Fit indices in covariance structure modelling: sensitivity to underparameterized model misspecification. Psychol Methods 1998; 3: 424–53.
31 Steiger, JH. EzPATH: Causal Modelling. SYSTAT, 1989.
32 Bentler, PM. Comparative fit indexes in structural models. Psychol Bull 1990; 107: 238–46.
33 Tucker, LR Lewis, C. A reliability coefficient for maximum likelihood factor analysis. Psychometrika 1973; 38: 1–10.
34 Cheung, G Rensvold, R. Evaluating goodness-of-fit indexes for testing measurement invariance. Struct Equ Modeling 2002; 9: 233–55.
35 Raftery, AE. Bayesian model selection in social research. Sociol Methodol 1995; 25: 111–63.
36 O’Donnell, ML Alkemade, N Nickerson, A Creamer, M McFarlane, AC Silove, D et al. . Impact of the diagnostic changes to post-traumatic stress disorder for DSM-5 and the proposed changes to ICD-11. Br J Psychiatry 2014; 205: 230–5.
37 Brewin, CR Gregory, JD Lipton, M Burgess, N. Intrusive images in psychological disorders: characteristics, neural mechanisms, and treatment implications. Psychol Rev 2010; 117: 210–32.
38 Brewin, CR Lanius, RA Novac, A Schnyder, U Galea, S. Reformulating PTSD for DSM-V: life after criterion A. J Trauma Stress 2009; 22: 366–73.
39 Spitzer, RL First, MB Wakefield, JC. Saving PTSD from itself in DSM-V. J Anxiety Disord 2007; 21: 233–41.
40 Andrews, G Charney, DS Sirovatka, PJ Regier, DA. Stress-induced and Fear Circuitry Disorders: Refining the Research Agenda for DSM-V. American Psychiatric Association, 2008.
41 Creamer, M Burgess, P Pattison, P. Reaction to trauma: a cognitive processing model. J Abnorm Psychol 1992; 101: 452–59.
42 Foa, EB Steketee, G Rothbaum, BO. Behavioral/cognitive conceptualizations of post-traumatic stress disorder. Behav Ther 1989; 20: 155–76.
43 Horowitz, MJ. Stress Response Syndromes (2nd edn). Jason Aronson, 1986.
44 Elhai, J Palmieri, P. The factor structure of posttraumatic stress disorder: a literature update, critique of methodology, and agenda for future research. J Anxiety Disord 2011; 25: 849–54.

Latent structure of the proposed ICD-11 post-traumatic stress disorder symptoms: Implications for the diagnostic algorithm

  • David Forbes (a1), Emma Lockwood (a1), Mark Creamer (a1), Richard A. Bryant (a2), Alexander C. McFarlane (a3), Derrick Silove (a4), Angela Nickerson (a2) and Meaghan O'Donnell (a5)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Latent structure of the proposed ICD-11 post-traumatic stress disorder symptoms: Implications for the diagnostic algorithm

  • David Forbes (a1), Emma Lockwood (a1), Mark Creamer (a1), Richard A. Bryant (a2), Alexander C. McFarlane (a3), Derrick Silove (a4), Angela Nickerson (a2) and Meaghan O'Donnell (a5)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *