Development and validation of the Continuous Traumatic Stress Response scale (CTSR) among adults exposed to ongoing security threats

Abstract

Background Current diagnostic criteria for posttraumatic stress disorder (PTSD) do not include symptoms resulting from exposure to continuous or ongoing traumatic stress. Thus existing assessment tools do not fully capture stress symptoms associated with exposure to threats that extend over months or years. To address this void, we enumerated the symptoms associate with ongoing exposure to stress including those that are distinct from existing PTSD diagnostic criteria. Objectives To develop the Continuous Traumatic Stress Response Scale (CTSR) and assess its psychometric properties. Method We sampled 313 adults exposed and unexposed to ongoing security threat between December 2016 and February 2017. Respondents lived in communities bordering the Gaza Strip in southern Israel where they are exposed to frequent rocket attacks, requiring they locate and find shelter in 30 seconds or less. We assessed the concurrent validity of CTSR relative to the Posttraumatic Diagnostic Scale (PDS). Results On the basis of exploratory factor analysis (EFA), we retained 11 of 25 items measuring three distinct factors: exhaustion/detachment, rage/betrayal, and fear/helplessness. We found moderate concurrence between the scales; that is, the CTSR appears to measure a construct related to, but distinct from PTSD. This conclusion is supported by confirmatory factor analysis (CFA) indicating that each factor significantly contributes to measurement of a higher-order, continuous traumatic stress latent construct. Conclusions These results support the psychometric properties of CTSR. Future research is required to confirm these findings in other countries and cultures and among individuals exposed to other forms of continuous traumatic stress.

The Effectiveness and Feasibility of Psychological Interventions for Populations Under Ongoing Threat: A Systematic Review

“…Future studies should detail the extent of past and ongoing (re)exposure throughout the study period, to facilitate a richer understanding of the unique nature of ongoing threat in relation to people’s psychological responses in these contexts. Goral et al (2021) devised a measure of “ongoing traumatic response” which could be used in future studies. They found that, unlike PTSD symptoms, CTS symptom severity was not significantly associated with level of exposure to trauma.…”

Patient Experiences of Victimization during Mandatory Psychiatric Treatment: A Qualitative Study

“…This is troublesome, as it is at odds with the assumption that medical treatment, including psychiatric hospitalization, should cause no harm. There is increasing attention on continuous traumatic stress and responses to ongoing traumatic stressors (Eagle & Kaminer, 2013;Goral et al, 2021) in addition to the literature on impact of past traumatic events. The experiences of the interviewed patients can be viewed in this light, also in terms of the consequences.…”

War-related continuous traumatic stress as a potential mediator of associations between moral distress and professional quality of life in nurses: a cross-sectional study in Ukraine

“…The Continuous Traumatic Stress Response Scale (CTSR) is designed to measure people's well-being over the past month [24]. The scale consists of 11 items, each of which are rated on a 4-point scale ranging from 0 = not at all to 3 = extremely, and summed for a continuous traumatic stress score.…”