The Relationship of Complex Post-traumatic Stress Disorder and Post-traumatic Stress Disorder in a Culturally Distinct, Conflict-Affected Population: A Study among West Papuan Refugees Displaced to Papua New Guinea

Abstract

Background: Controversy continues about the validity of the construct of complex post-traumatic stress disorder (C-PTSD). In particular, questions remain whether C-PTSD can be differentiated from post-traumatic stress disorder (PTSD) and, secondarily, other common mental disorders. The examination of these issues needs to be expanded to populations of diverse cultural backgrounds exposed to prolonged persecution. We undertake such an inquiry among a community sample of West Papuan refugees exposed to extensive persecution and trauma. Methods:We interviewed over 300 West Papuan refugees using the Refugee-Mental Health Assessment Package to record symptoms of PTSD, C-PTSD, major depressive disorder (MDD), and complex grief (CG). We used first-and second-order confirmatory factor analysis (CFA) to test aspects of the convergent and discriminant validity of C-PTSD.results: The CFA analysis supported both a one-factor and two-factor model of PTSD and C-PTSD. Nested model comparison tests provide support for the parsimonious one-factor model solution. A second-order CFA model of PTSD and C-PTSD produced a poor fit. The modified three-factor multi-disorder solution combining a traumatic stress (TS) factor (amalgamating PTSD and C-PTSD), MDD, and CG yielded a good fit only after removing three CG domains (estrangement, yearning, and behavioral change), a model that produced large standardized residuals (>0.20).conclusion: The most parsimonious model yielded a single TS factor combining symptom domains of C-PTSD and PTSD in this culturally distinct community exposed to extensive persecution and conflict-related trauma. There may be grounds for expanding the scope of psychological treatments for refugees to encompass this wider TS response. Our findings are consistent with theoretical frameworks focusing on the wider TS reaction of refugees exposed to human rights-related traumas of mass conflict, persecution, and displacement.

Testing competing factor models of the latent structure of post-traumatic stress disorder and complex post-traumatic stress disorder according to ICD-11

“…This finding is considerably higher than reported by Silove et al (2017) and Ben-Ezra et al (2018), with CPTSD prevalence estimates of 3% and 2.6%, respectively, but lower than a multicultural refugee sample of whom 32.8% met the CPTSD criteria (Nickerson et al, 2016). However, given the context of the traumatic exposure that these individuals faced during their childhood, this finding is not surprising.…”

“…The model that included two second-order latent variables, PTSD and DSO (Model 7), to explain the covariation among the seven first-order factors also fitted the data; however, the chi-squared difference test indicated that Model 3 provided a significantly better fit to the data. Previous studies have found mixed support for the alternative factor models, with some evidence indicating model superiority for a second-order two-factor model with six correlated first-order factors (Hyland et al, 2017; Karatzias et al, 2016; Nickerson et al, 2016) and others finding support for a higher-order one-factor model representing CPTSD and six second-order factors (Silove et al, 2017). However, an important difference between these studies and the current study is that the AD factor was estimated as a unidimensional construct and the study conducted by Silove and colleagues did not estimate a correlated first-order model.…”

“…The factorial validity of PTSD and CPTSD has been tested, with emerging evidence supporting three possible models: a factor structure in which all six symptom clusters are correlated with each other in a non-hierarchical fashion (Tay et al, 2015), a single higher-order factor supported by six second-order factors (Silove, Tay, Kareth, & Rees, 2017), and a second-order two-factor model represented by PTSD and DSO and six correlated first-order factors (Hyland et al, 2017; Karatzias et al, 2016; Shevlin et al, 2017). Collectively, the evidence indicates the superiority of the two-factor higher-order model comprised of the PTSD and DSO domains, which supports the theoretical model of CPTSD as being comprised of two distinct but related components.…”

ICD‐11 PTSD and complex PTSD amongst Syrian refugees in Lebanon: the factor structure and the clinical utility of the International Trauma Questionnaire

“…The current study was undertaken in order to provide (i) the first assessment of the factorial validity of the ITQ amongst an Arabic‐speaking sample of refugees from the Middle East and (ii) the first assessment of the clinical utility of the ITQ within a low‐resourced, humanitarian setting. Building on previous studies which estimated the prevalence rates of PTSD and CPTSD amongst refugees and internally displaced persons , the current study represents the first assessment of the prevalence rates of ICD‐11 PTSD and CPTSD using a disorder‐specific measure ITQ. Prevalence rates of PTSD (25.2%) and CPTSD (36.1%) in this group of treatment‐seeking Syrian refugees were similar to those observed within another treatment‐seeking refugee sample resettled in Switzerland (PTSD = 19.7%, CPTSD = 32.8%) .…”

“…To date, only four studies have investigated the nature of ICD‐11 PTSD/CPTSD amongst refugee and internally displaced samples. The factorial validity of ICD‐11 PTSD and CPTSD has been supported in two studies with West Papuan refugees resettled in Papa New Guinea ( N = 230, and N = 250). Nickerson et al also found evidence to support the factor structure of CPTSD amongst a nationally diverse, treatment‐seeking sample of refugees ( N = 134) resettled in Switzerland.…”