Gender differences in the factor structure of posttraumatic stress disorder symptoms in war-exposed adolescents

National Centre of Psychotraumatology, University of Southern Denmark, Odense, Denmark.
Journal of anxiety disorders (Impact Factor: 2.68). 03/2011; 25(4):604-11. DOI: 10.1016/j.janxdis.2011.01.010
Source: PubMed


DSM-IV's three-factor model of posttraumatic stress disorder (PTSD) is rarely empirically supported, whereas other four-factor models (King et al., 1998; Simms, Watson, & Doebbeling, 2002) have proven to be better representations of PTSD's latent structure. To date, a clear consensus as to which model provides the best representation of PTSD's underlying dimensions has yet to be reached. The current study investigated whether gender is associated with factor structure differences using the King et al. (1998) model of reexperiencing, avoidance, numbing, and hyperarousal PTSD symptoms. Participants were war-exposed Bosnian secondary/high school boys and girls (N=1572) assessed nearly two years after the 1992-1995 Bosnian conflict. Confirmatory factor analytic tests of measurement invariance across PTSD model parameters revealed many significant sex-linked differences. Implications regarding the potential role of gender as a moderator of the King et al. (1998) model's factor structure are discussed.

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Available from: Jon Elhai, Feb 16, 2014
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    • "Finally, the observed gender difference may be due to differences in the construct validity of PTSD. Armour et al. (2011), who found a greater degree of PTSD measurement error among women than men, raised the point that early research on the latent structure of PTSD was conducted with all-male samples such that gender differences may not be taken into Table 2 Diagnostic characteristics of the in-lab PCL-S by cut-point. "
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    ABSTRACT: We evaluated the specific version of the PTSD Checklist (PCL-S) as a screening tool for the recruitment of community-residing men and women with diverse trauma experiences. We administered the PCL-S via telephone in the context of participant recruitment, as well as in a laboratory setting preceding administration of the Clinician Administered PTSD Scale (CAPS), the gold standard PTSD assessment tool. In the laboratory, the PCL-S performed reasonably well for men and women, yielding overall diagnostic efficiency (ODE) values (representing percentage of cases accurately identified) of 0.78 and 0.73, respectively, for our recommended cut-points of 42 for men and 49 for women. In contrast, as a recruitment tool, the PCL-S yielded an acceptable ODE of 0.79 for men at the recommended cut-point of 47, but only an ODE of 0.56 (representing diagnostic efficiency no greater than chance) for women at the recommended cut-point of 50. A recruitment cut-point of 57 for women yields a similarly modest ODE of 0.61, but with substantial cost to sensitivity. These findings suggest that use of the PCL-S to screen for PTSD among potential study participants may lead to gender biased study results, even when separate diagnostic cut-points for men and women are used.
    Full-text · Article · Jan 2015 · Psychiatry Research
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    • "The female sex has repeatedly been found associated with increased risk of PTSD and higher levels of both ASD and dissociation compared to males (c.f. Armour et al., 2011; Bryant and Harvey, 2003). Additionally, somatization has also been found to be positively associated with both PTSD and dissociation (Spindler and Elklit, 2003; Elklit and Christiansen, 2009). "
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    ABSTRACT: Acute Stress Disorder (ASD) was first included in the DSM-IV in 1994. It was proposed to account for traumatic responding in the early post trauma phase and to act as an identifier for later Posttraumatic Stress Disorder (PTSD). Unlike PTSD it included a number of dissociative indicators. The revised DSM-5 PTSD criterion included a dissociative-PTSD subtype. The current study assessed if a dissociative-ASD subtype may be present for DSM-5 ASD. Moreover, we assessed if a number of risk factors resulted in an increased probability of membership in symptomatic compared to a baseline ASD profile. We used data from 450 bank robbery victims. Latent profile analysis (LPA) was used to uncover latent profiles of ASD. Multinomial logistic regression was used to determine if female gender, age, social support, peritraumatic panic, somatization, and number of trauma exposures increased or decreased the probability of profile membership. Four latent profiles were uncovered and included an intrusion rather than dissociative subtype. Increased age and social support decreased the probability of individuals being grouped into the intrusion subtype whereas increased peritraumatic panic and somatization increased the probability of individuals being grouped into the intrusion subtype. Findings are discussed in regard to the ICD-11 and the DSM-5.
    Full-text · Article · Dec 2014 · Psychiatry Research
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    • "Recent studies have also examined the relation between the five factors of the Dysphoric Arousal model of PTSD, and external measures of psychopathology (e.g., depression, anxiety, health-related quality of life; Tsai, Whealin, Scott, Harpaz- Rotem, & Pietrzak, 2012; Wang, Li, et al., 2011; Wang, Long, Li, & Armour, 2011). For example, a study on 323,903 US veterans assessing the factor structure of PTSD indicated that the Numbing factor of the Dysphoric Arousal model was most strongly associated with a diagnosis of depression and substance use disorder, and the Dysphoric Arousal factor was most strongly related to a diagnosis of anxiety disorder (Harpaz-Rotem, Tsai, Pietrzak, & Hoff, 2014). "
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    ABSTRACT: Background The factor structure of posttraumatic stress disorder (PTSD) has been extensively studied in Western countries. Some studies have assessed its factor structure in Asia (China, Sri Lanka, and Malaysia), but few have directly assessed the factor structure of PTSD in an Indian adult sample. Furthermore, in a largely patriarchal society in India with strong gender roles, it becomes imperative to assess the association between the factors of PTSD and gender. Objective The purpose of the present study was to assess the factor structure of PTSD in an Indian sample of trauma survivors based on prevailing models of PTSD defined in the DSM-IV-TR (APA, 2000), and to assess the relation between PTSD factors and gender. Method The sample comprised of 313 participants (55.9% female) from Jammu and Kashmir, India, who had experienced a natural disaster (N=200) or displacement due to cross-border firing (N=113). Results Three existing PTSD models—two four-factor models (Emotional Numbing and Dysphoria), and a five-factor model (Dysphoric Arousal)—were tested using Confirmatory Factor Analysis with addition of gender as a covariate. The three competing models had similar fit indices although the Dysphoric Arousal model fit significantly better than Emotional Numbing and Dysphoria models. Gender differences were found across the factors of Re-experiencing and Anxious arousal. Conclusions Findings indicate that the Dysphoric Arousal model of PTSD was the best model; albeit the fit indices of all models were fairly similar. Compared to males, females scored higher on factors of Re-experiencing and Anxious arousal. Gender differences found across two factors of PTSD are discussed in light of the social milieu in India.
    Full-text · Article · Nov 2014
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