Factor structure of the international trauma questionnaire in trauma exposed LGBTQ+ adults: Role of cumulative traumatic events and minority stress heterosexist experiences.

Abstract

Exposure to prolonged and/or multiple types of psychological trauma and stressors has been shown to be more strongly associated with ICD-11 complex posttraumatic stress disorder (CPTSD) than posttraumatic stress disorder (PTSD). Lesbian, gay, bisexual, trans-and queer adults (LGBTQ+) are at a heightened risk of exposure to traumatic events, and minority stressors including harassment, discrimination, rejection by family, and isolation. Objective: To examine the factor structure of the international trauma questionnaire (ITQ), a self-report measure of PTSD and CPTSD, and the associations of cumulative lifetime trauma exposure assessed via the life events checklist and minority stress assessed via the daily heterosexist experiences scale, with CPTSD (three PTSD symptom clusters, three clusters reflecting disturbances in self-organization [DSO]) among LGBTQ+ adults. Method: Participants comprised 225 LGBTQ+ adults (including 74 transgender and gender diverse individuals; age range: 18-60 years; M/SD = 31.35/9.48) residing in Spain. Results: Confirmatory factor analyses indicated that both a first-order six-factor model and a hierarchical two-factor model, comprising PTSD and DSO as second-order factors, fit the data best. Cumulative traumatic events score was associated with PTSD, and cumulative minority stress was associated with PTSD and DSO. Among the minority stress subscales, harassment based on gender expression was positively associated with all symptom clusters of PTSD and DSO. Conclusion: This is the first study to examine the role of minority stressors alongside exposure to psychological traumas in ICD-11 PTSD and CPTSD and emphasizes the inclusion of minority stressors in trauma-related assessments. Clinical Impact StatementThe present study findings validated the structure of CPTSD comprising PTSD and DSO, using the ITQ in LGBTQ+ adults from Spain. Findings further suggested that exposure to cumulative minority stressors (i.e., heterosexism/cissexism) was positively associated with the PTSD and DSO clusters of complex PTSD emphasizing the importance of inclusion of minority stressors in clinical assessments and traumafocused treatments. Ruby Charakhttps://orcid.org/0000-0002-5806-6884 Ruby Charak served as lead for conceptualization, investigation, methodology, project administration, resources, software, validation and writingoriginal draft and contributed equally to formal analysis. Ines Cano-Gonzalez served as lead for formal analysis and served in a supporting role for data curation, methodology, project administration and writing-review and editing. Roman Ronzón-Tirado served in a supporting role for writing-review and editing. Julian D. Ford served in a supporting role for writing-review and editing. Brianna M. Byllesby served in a supporting role for writing-review and editing. Mark Shevlin served in a supporting role for writing-review and editing. Thanos Karatzias served in a supporting role for writing-review and editing. Philip Hyland served in a supporting role for conceptualization, investig...

The role of complex posttraumatic stress disorder in the associations between minority stressors and self-reported suicide likelihood in LGBTQ+ adults.

“…The Spanish version of ITQ was translated and backtranslated, verified, and explored for appropriate linguistic and cultural context by a group of experts (Fernández-Fillol et al, 2020). The factor validity for PTSD and CPTSD showed good model fit on the present LGBTQ+ sample from Spain (Charak, Cano-Gonzalez, Ronzón-Tirado, Ford, et al, 2023). Results indicate that the first-order six-factor model and a hierarchical two-factor model, comprising PTSD and DSO as second-order factors, fit the data best (Charak, Cano-Gonzalez, Ronzón-Tirado, Ford, et al, 2023).…”

“…The factor validity for PTSD and CPTSD showed good model fit on the present LGBTQ+ sample from Spain (Charak, Cano-Gonzalez, Ronzón-Tirado, Ford, et al, 2023). Results indicate that the first-order six-factor model and a hierarchical two-factor model, comprising PTSD and DSO as second-order factors, fit the data best (Charak, Cano-Gonzalez, Ronzón-Tirado, Ford, et al, 2023). The internal reliability scores of the PTSD (α = .86, 95% CI = [0.83–0.89]) and DSO (α = .87, 95% CI = [0.84–0.90]) were good.…”

“…Descriptive analysis of the cisheterosexism subscales, conventional trauma, and ICD-11 PTSD and DSO are reported in Charak, Cano-Gonzalez, Ronzón-Tirado, Ford, et al (2023). All participants indicated exposure to at least one traumatic event ( M = 2.70, SD = 1.70, range = 1–10).…”

“…Most participants indicated at least one experience of vicarious trauma (99.7%, M = 5.70, SD = 0.85), and vigilance (92.6%, M = 3.47, SD = 1.91), in a lesser extend participants reported gender expression related harassment (86.0%, M = 2.54, SD = 1.81), discrimination (87.7%, M = 2.97, SD = 1.98), isolation (83.4%, M = 2.19, SD = 1.43), and rejection by the family of origin (73.1%, M = 1.97, SD = 1.81). All participants identified at least one traumatic experience, 18.4% met the criteria for CPTSD and 6.6% met the criteria for PTSD (6.6%; Charak, Cano-Gonzalez, Ronzón-Tirado, Ford, et al, 2023). More than half of the participants (54.6%, n = 125) met the cutoff criteria of at-risk of suicide behavior.…”

“…Findings are congruent with prior studies indicating that daily cisheterosexism experiences are common among LGBTQ+ individuals (Balsam et al, 2013). Regarding mental health prevalence, as discussed in Charak, Cano-Gonzalez, Ronzón-Tirado, Ford, et al (2023), findings indicated that CPTSD is more prevalent than PTSD among LGBTQ+ adults. More frequent CPTSD diagnoses is befitting, being that the disorder is related to prolonged exposure to stressors (Brewin et al, 2017) and that LGBTQ+ individuals are at an elevated risk experiencing a number of accumulating stressors since childhood (Craig et al, 2020; Mustanski et al, 2016).…”