Posttraumatic Stress Disorder Symptom Structure in Injured Children: Functional Impairment and Depression Symptoms in a Confirmatory Factor Analysis

Center for Injury Research and Prevention, Children's Hospital of Philadelphia, 3535 Market Street, Suite 1150, Philadelphia, PA 19104, USA.
Journal of the American Academy of Child and Adolescent Psychiatry (Impact Factor: 7.26). 06/2010; 49(6):616-25, 625.e1-4. DOI: 10.1016/j.jaac.2010.02.011
Source: PubMed


To examine the factor structure of posttraumatic stress disorder (PTSD) symptoms in children and adolescents who have experienced an acute single-incident trauma, associations between PTSD symptom clusters and functional impairment, and the specificity of PTSD symptoms in relation to depression and general distress.
Examined PTSD symptom structure in two samples of children (8 to 17 years of age) assessed an average of 6 months after unintentional injury: (1) a combined dataset of 479 children assessed with a PTSD symptom checklist, and (2) a sample of 204 children assessed via a standardized clinical interview. We evaluated the fit of six alternative models for the factor structure of PTSD symptoms, and the association of PTS symptom clusters with indicators of functional impairment. We then evaluated three models for the structure of PTSD and depression symptoms jointly, to examine specificity of PTSD versus general distress or mood symptoms.
In both samples, the DSM-IV 3-factor model fit the data reasonably well. Two alternative four-factor models fit the data very well: one that separates effortful avoidance from emotional numbing, and one that separates PTSD-specific symptoms from general emotional distress. Effortful avoidance and dysphoria symptoms were most consistently associated with impairment. The best-fitting model for PTSD and depression symptom clusters had three factors: PTSD-specific, depression-specific, and general dysphoria symptoms.
The DSM-IV model for PTSD symptom categories was a reasonable fit for these child data, but several alternative models fit equally well or better, and suggest potential improvements to the current diagnostic criteria for PTSD in children.

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Available from: Nancy Kassam-Adams
    • "La evaluación de este aspecto en niños y niñas es particularmente difícil, dado que se exige al niño o niña una meta-cognición respecto de sus procesos de recuerdo. lo que es claro, en convergencia con otros estudios, es que el ítem 8, en su forma actual, debe ser excluido de la CPSS (Kassam-Adams et al., 2010). Dificultades con los ítems de medición de la amnesia psicógena se han encontrado también en adultos (Foa, Riggs y Gershuny, 1995). "

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    • "Anthony and colleagues proposed an alternative hierarchical model with three first-order factors (intrusion/active avoidance, numbing/passive avoidance, and arousal) and a second-order general PTSD factor, and validated the model in samples of adolescents exposed to hurricane (Anthony et al. 1999; Anthony et al. 2005). However, subsequent studies indicated that the hierarchical model fit data worse than the four-factor numbing model (Kassam-Adams et al. 2010; Saul et al. 2008). From the available literature, a clear majority of youth CFA studies have tended to replicate findings in adults, and found support for either the four-factor numbing model or the four-factor dysphoria model (e.g., Armour et al. 2011; Ayer et al. 2011; Elhai et al. 2009b; Ford et al. 2009; Kassam-Adams et al. 2010; Saul et al. 2008; Stewart et al. 2004; Wang et al. 2009). "
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    ABSTRACT: This present study examined the structure of posttraumatic stress disorder (PTSD) symptoms in a large sample of Chinese adolescents exposed to a deadly earthquake. A total of 2,800 middle school students aged 12 to 18 years participated in the study 6 months after the "Wenchuan Earthquake". Results of confirmatory factor analysis indicated that a five-factor intercorrelated model composed of intrusion, avoidance, numbing, dysphoric arousal, and anxious arousal, fit data significantly better than both the four-factor numbing model King et al. (Psychological Assessment 10:90-96, 1998) and the four-factor dysphoria model Simms et al. (Journal of Abnormal Psychology 111:637-647, 2002). Further examination of the external convergent and discriminant validity revealed that except for the dysphoric arousal factor, the remaining four PTSD factors yielded significantly different correlations with external measures of anxiety vs. depression. The findings add to the limited literature on the factor structure of PTSD in youths and on the five-factor PTSD model. In addition, they provide more detail into the latent psychopathological processes of PTSD, and inform the forthcoming DSM-5.
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