Several studies have reported the factor structure of posttraumatic stress disorder (PTSD) using confirmatory factor analysis (CFA). The results show models with different number of factors, high correlations between factors, and symptoms that belong to different factors in different models without affecting the fit index. These elements could suppose the existence of considerable item cross-loading, the overlap of different factors or even the presence of a general factor that explains the items common source of variance. The aim is to provide new evidence regarding the factor structure of PTSD using CFA and exploratory structural equation modeling (ESEM). In a sample of 1,372 undergraduate students, we tested six different models using CFA and two models using ESEM and ESEM bifactor analysis. Trauma event and past-month PTSD symptoms were assessed with Life Events Checklist for DSM-5 (LEC–5) and PTSD Checklist for DSM-5 (PCL–5). All six tested CFA models showed good fit indexes (RMSEA = .051–.056, CFI = .969–.977, TLI = .965–.970), with high correlations between factors (M = .77, SD = .09 to M = .80, SD = .09). The ESEM models showed good fit indexes (RMSEA = .027–.036, CFI = .991–.996, TLI = .985–.992). These models confirmed the presence of cross-loadings on several items as well as loads on a general factor that explained 76.3% of the common variance. The results showed that most of the items do not meet the assumption of dimensional exclusivity, showing the need to expand the analysis strategies to study the symptomatic organization of PTSD.

Background Along with other domains of psychopathology, adolescents are at increased risk for psychotic experiences (PE) as well as for suicidal ideation (SI) and suicidal attempts. Literature has found robust associations between PE and SI, with suicidal risk appearing higher in subjects with persistent PE, in general and clinical samples. However, the associations between psychotic experiences and suicidal ideation are not clearly understood, and the role of common risk factors in this link, such as depression (DS), is controversial. Moreover, causality has yet to be properly stablished between PE and SI. A study recently found psychosis may be consequential to suicidal behavior. Under the novel “suicidal drive hypothesis for psychosis” framework, we examined whether depressive symptoms mediate the association between psychotic experiences and suicidal ideation on cross-sectional data from a community sample of adolescents. Additionally, we tested this mediating role when both PE and SI were the outcome variables. Methods 1708 Chilean school adolescents aged 13–19 years (M=15.68 + 1, 67, women= 39%) answered an online mental health screening between May and October 2019. The screening encompassed several questionnaires adapted for Chilean subjects, including the Columbia-suicide Severity Rating scale, the Community assessment for Psychic experiences (CAPE-P15) and the Patient Health Questionnaire (PHQ-9). Informed consent was granted by the parents and caregivers of adolescents. Mediation analyses were executed with the PROCESS statistical package. PROCESS runs regression-based mediations based on the Baron & Kenny procedure. A 5000 bootstrap resampling was used to estimate 95% confidence intervals; these are used to identify an indirect effect that suggests mediation. Results Pearson’s correlations showed significant associations between all the variables in (SI-DS: r= .624, p<.001; PE-SI: r= .539, p<.001; PE-DS: r= .708, p<.001). No demographic variables (i.e age, gender, education) were correlated significantly to the dependent variable (DV), therefore no covariates were controlled for in the mediation analyses. In the mediation analyses, model 1 showed SI as the DV. The link between psychotic experiences and suicide was mediated by depression (b= .3433, 95% BCa CI [.2981, .3885]). When the mediators were not included in the model, PE significantly predicted SI (b = .113, t = 26.45, p < 0.001). Additionally, in model 2, where PE was the DV, the link between suicidal ideation and psychotic experiences was mediated by depression as well (b= .3794, 95% BCa CI [.3431, .4150]). When the mediators were not included in the model, SI significantly predicted PE (b = 2.57, t = 26.45, p < 0.001). Both models exhibit robust and significant partial mediations. Discussion Our results indicate that depressive symptoms partially mediate the association between SI and PE. Moreover, either PE or SI could be outcome variables when depressive symptoms are mediators. This adds new evidence supporting that PE could consequential to SI as stated by the “suicidal drive hypothesis for psychosis”. Our exploratory findings must be carefully interpreted, mainly because of our cross-sectional design, and the fact that there could be unmeasured or non-controlled psychopathological confounder variables in our models.

Early detection of trauma-related psychopathology is fundamental for preventing symptom escalation in adolescents, and this strategy can be carried out by developing accurate measures. The aim of this study is to provide preliminary evidence for the internal structure, construct validity, reliability, sensitivity, and specificity of a brief screening instrument for posttraumatic stress disorder (PTSD) and complex PTSD (C-PTSD) in general population adolescents. 1,501 Chilean adolescents participated by responding to the Brief PTSD scale (BPTSD) along with a battery of additional questionnaires. The internal structure of the eight-item BPTSD was assessed through exploratory and confirmatory factor analyses, while criterion validity was assessed through receiver-operating characteristic (ROC) curves. Confirmatory factor analysis (CFA) demonstrated a two-dimensional internal structure that is in accordance with literature regarding C-PTSD. Our results suggest that BPTSD may measure PTSD with complex features rather than C-PTSD. The scale showed adequate reliability, and criterion validity. The BPTSD is a brief, reliable, and simplyworded measure for PTSD symptoms and C-PTSD features in adolescents. Public Significance StatementPTSD and complex PTSD can be severe in adolescents. Detection of PTSD symptoms is fundamental for early intervention in trauma, but it requires simple yet effective measures. The adjusted BPTSD is a short and reliable measure that assesses PTSD symptoms and complex PTSD features in the general population, adolescents, and young people.

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