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Latent structure of the proposed ICD-11 post-traumatic stress disorder symptoms: implications for the diagnostic
David Forbes1, Emma Lockwood1, Mark Creamer1
1David Forbes, PhD, Emma Lockwood, PGDipPsych, Mark Creamer, PhD, Australian Centre For Posttraumatic Mental Health and Department of Psychiatry, University of Melbourne, Victoria; Richard A. Bryant, PhD, School of Psychology, University of New South Wales, New South Wales; Alexander C. McFarlane, MD, Centre for Traumatic Stress Studies, University of Adelaide, South Australia; Derrick Silove, MD, School of Psychiatry, University of New South Wales, New South Wales; Angela Nickerson, PhD, School of Psychology, University of New South Wales, New South Wales; Meaghan O'Donnell, PhD, Australian Centre for Posttraumatic Mental Health and Department of Psychiatry, University of Melbourne, Victoria, Australia.
Background:
The latent structure of the proposed ICD-11 post-traumatic stress disorder (PTSD) symptoms has not been explored.
Aims:
To investigate the latent structure of the proposed ICD-11 PTSD symptoms.
Method:
Confirmatory factor analyses using data from structured clinical interviews administered to injury patients (n = 613) 6 years post-trauma. Measures of disability and psychological quality of life (QoL) were also administered.
Results:
Although the three-factor model implied by the ICD-11 diagnostic criteria fit the data well, a two-factor model provided equivalent, if not superior, fit. Whereas diagnostic criteria based on this two-factor model resulted in an increase in PTSD point prevalence (5.1% v. 3.4%; z = 2.32, P<0.05), they identified individuals with similar levels of disability (P = 0.933) and QoL (P = 0.591) to those identified by the ICD-11 criteria.
Conclusions:
Consistent with theorised reciprocal relationships between re-experiencing and avoidance in PTSD, these findings support an alternative diagnostic algorithm requiring at least two of any of the four re-experiencing/avoidance symptoms and at least one of the two hyperarousal symptoms.
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