Alternative Models of DSM‐5 Posttraumatic Stress Disorder in Portuguese Adolescents Exposed to Trauma and Childhood Adversity

Abstract

The factor structure of DSM-5 posttraumatic stress disorder (PTSD) has been extensively debated, with evidence supporting the recently proposed seven-factor hybrid model. However, few studies examining PTSD symptom structure have assessed the implications of these proposed models on diagnostic criteria and PTSD prevalence. In the present study, we examined seven alternative DSM-5 PTSD models within a confirmatory factor analysis (CFA), using the Child PTSD Symptom Scale-Self-Report for DSM-5 (CPSS-5). Additionally, we generated prevalence rates for each of the seven models by using a symptom-based diagnostic algorithm and assessed whether substance abuse, depression, anxiety symptoms, and daily functioning were differentially associated with PTSD depending on the model used to derive the diagnosis. Participants were 317 adolescents aged 13-17 years (M = 15.93, SD = 1.23) who had experienced a DSM-5 Criterion A trauma and/or childhood adversity. The CFA results showed good fit indices for all models, with the seven-factor hybrid model presenting the best fit. The rates of PTSD diagnosis varied according to each model. The four-factor DSM-5 model presented the highest rate (30.6%), and the seven-factor hybrid model presented the lowest rate (17.4%). Similar to the CFA analysis, the inclusion criteria for the diagnosis based on the hybrid model also presented the strongest associations with daily functional impairment, odds ratio (OR) = 1.48, 95% CI [1.25, 1.75]; and adverse childhood experiences, OR = 1.46, 95% CI [1.16, 1.82]. Research and clinical implications of these results are discussed, and suggestions for future investigation are presented.

Psychometric properties of the Spanish Child PTSD Symptom Scale for DSM‐5–Self‐Report in El Salvador

“…Additionally, mean symptom levels in this sample ( M = 25.46, SD = 17.17) were markedly higher than those reported in previous community‐based studies (e.g., Stewart et al., 2017; Venta & Mercado, 2019) as well as those that specifically selected for participants with a history of PTEs (Correia‐Santos et al., 2019; Meyer et al., 2015; Serrano‐Ibanez et al., 2018). Only Foa et al.’s (2018) validation sample, which included previous exposure to a Criterion A PTE as a selection criterion, reported higher levels of PTSS ( M = 32.67, SD = 18.97) than the present sample.…”

“…The primary analysis in the current sample was a confirmatory factor analysis (CFA) of the 20 PTSS items, using the four‐factor DSM‐5 model implemented in previous studies (Correia‐Santos et al., 2019; Meyer et al., 2015; Serrano‐Ibanez et al., 2017). Given the ordinal, Likert‐type structure of the data, a polychoric correlation matrix (Holgado‐Tello et al., 2010; Li, 2016) and robust weighted least squares with mean and variance adjustment (WLSMV) estimator were used, per established recommendations (Flora & Curran, 2004; Muthén et al., 1997).…”

“…We aimed to fill this research gap by examining the factor structure and psychometric properties of a Spanish version of the CPSS‐5‐SR in a sample of Salvadorian youth. We hypothesized that the factor structure would follow the four‐factor model utilized in previous studies of the English, Spanish, and Portuguese translations of the CPSS (Correia‐Santos et al., 2019; Meyer et al., 2015; Serrano‐Ibanez et al., 2017). Additionally, we posited that the measure would be statistically invariant across boys and girls and that scores would be moderately associated with a broad measure of anxiety and depression.…”

The mediating role of posttraumatic stress symptoms on somatization in adolescents: A two-wave longitudinal study.

“…The Life Events Checklist for DSM-5 (LEC-5; Weathers et al, 2013; Portuguese version, Correia-Santos et al, 2017) is a self-report measure developed to evaluate traumatic events in an individual's life according to the DSM–5 . It evaluates exposure to 14 potentially traumatic events (e.g., natural disasters, accidents, sexual assault) and includes an additional item where respondents could report another traumatic event that was not listed in the 14 previous items.…”

The Impact of Psychopathology Associated With Childhood Trauma on Quality of Life in Portuguese Adolescents: A Two-Wave Longitudinal Study

“…The present study is part of a larger longitudinal research project on the impact of traumatic events on adolescents in the North of Portugal (27)(28)(29). All procedures performed in this study were in accordance with the APA ethical standards.…”