Dimensionality of DSM-5 Posttraumatic Stress Disorder and Its Association with Suicide Attempts: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III

Overview

Journal Soc Psychiatry Psychiatr Epidemiol

Specialties Psychiatry
Public Health
Social Sciences

Date 2017 Apr 13

PMID 28401275

Citations 4

Authors

Chiung M Chen

Young-Hee Yoon

Thomas C Harford

Bridget F Grant

Affiliations

Soon will be listed here.

Abstract

Background: Emerging confirmatory factor analytic (CFA) studies suggest that posttraumatic stress disorder (PTSD) as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is best characterized by seven factors, including re-experiencing, avoidance, negative affect, anhedonia, externalizing behaviors, and anxious and dysphoric arousal. The seven factors, however, have been found to be highly correlated, suggesting that one general factor may exist to explain the overall correlations among symptoms.

Methods: Using data from the National Epidemiologic Survey on Alcohol and Related Conditions-III, a large, national survey of 36,309 U.S. adults ages 18 and older, this study proposed and tested an exploratory bifactor hybrid model for DSM-5 PTSD symptoms. The model posited one general and seven specific latent factors, whose associations with suicide attempts and mediating psychiatric disorders were used to validate the PTSD dimensionality.

Results: The exploratory bifactor hybrid model fitted the data extremely well, outperforming the 7-factor CFA hybrid model and other competing CFA models. The general factor was found to be the single dominant latent trait that explained most of the common variance (~76%) and showed significant, positive associations with suicide attempts and mediating psychiatric disorders, offering support to the concurrent validity of the PTSD construct.

Conclusions: The identification of the primary latent trait of PTSD confirms PTSD as an independent psychiatric disorder and helps define PTSD severity in clinical practice and for etiologic research. The accurate specification of PTSD factor structure has implications for treatment efforts and the prevention of suicidal behaviors.

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References

Haviland M, Banta J, Sonne J, Przekop P . Posttraumatic Stress Disorder-Related Hospitalizations in the United States (2002-2011): Rates, Co-Occurring Illnesses, Suicidal Ideation/Self-Harm, and Hospital Charges. J Nerv Ment Dis. 2015; 204(2):78-86. DOI: 10.1097/NMD.0000000000000432. View

Kessler R, Berglund P, Demler O, Jin R, Merikangas K, Walters E . Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005; 62(6):593-602. DOI: 10.1001/archpsyc.62.6.593. View

Pompili M, Sher L, Serafini G, Forte A, Innamorati M, Dominici G . Posttraumatic stress disorder and suicide risk among veterans: a literature review. J Nerv Ment Dis. 2013; 201(9):802-12. DOI: 10.1097/NMD.0b013e3182a21458. View

Simms L, Gros D, Watson D, OHara M . Parsing the general and specific components of depression and anxiety with bifactor modeling. Depress Anxiety. 2007; 25(7):E34-46. DOI: 10.1002/da.20432. View

Elhai J, Palmieri P . The factor structure of posttraumatic stress disorder: a literature update, critique of methodology, and agenda for future research. J Anxiety Disord. 2011; 25(6):849-54. DOI: 10.1016/j.janxdis.2011.04.007. View

Bullman T, Kang H . Posttraumatic stress disorder and the risk of traumatic deaths among Vietnam veterans. J Nerv Ment Dis. 1994; 182(11):604-10. DOI: 10.1097/00005053-199411000-00002. View

Toyinbo P, Vanderploeg R, Donnell A, Mutolo S, Cook K, Kisala P . Development and Initial Validation of Military Deployment-Related TBI Quality-of-Life Item Banks. J Head Trauma Rehabil. 2014; 31(1):52-61. DOI: 10.1097/HTR.0000000000000089. View

Patrick C, Hicks B, Nichol P, Krueger R . A bifactor approach to modeling the structure of the psychopathy checklist-revised. J Pers Disord. 2007; 21(2):118-41. PMC: 2242629. DOI: 10.1521/pedi.2007.21.2.118. View

Wisco B, Marx B, Miller M, Wolf E, Mota N, Krystal J . Probable Posttraumatic Stress Disorder in the US Veteran Population According to DSM-5: Results From the National Health and Resilience in Veterans Study. J Clin Psychiatry. 2016; 77(11):1503-1510. DOI: 10.4088/JCP.15m10188. View

10.

Panagioti M, Gooding P, Dunn G, Tarrier N . Pathways to suicidal behavior in posttraumatic stress disorder. J Trauma Stress. 2011; 24(2):137-45. DOI: 10.1002/jts.20627. View

11.

Kessler R, Chiu W, Demler O, Merikangas K, Walters E . Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005; 62(6):617-27. PMC: 2847357. DOI: 10.1001/archpsyc.62.6.617. View

12.

Armour C, Mullerova J, Elhai J . A systematic literature review of PTSD's latent structure in the Diagnostic and Statistical Manual of Mental Disorders: DSM-IV to DSM-5. Clin Psychol Rev. 2016; 44:60-74. DOI: 10.1016/j.cpr.2015.12.003. View

13.

Yang Y, Sun Y, Zhang Y, Jiang Y, Tang J, Zhu X . Bifactor item response theory model of acute stress response. PLoS One. 2013; 8(6):e65291. PMC: 3676469. DOI: 10.1371/journal.pone.0065291. View

14.

LeBouthillier D, McMillan K, Thibodeau M, Asmundson G . Types and Number of Traumas Associated With Suicidal Ideation and Suicide Attempts in PTSD: Findings From a U.S. Nationally Representative Sample. J Trauma Stress. 2015; 28(3):183-90. DOI: 10.1002/jts.22010. View

15.

Pietrzak R, Tsai J, Armour C, Mota N, Harpaz-Rotem I, Southwick S . Functional significance of a novel 7-factor model of DSM-5 PTSD symptoms: results from the National Health and Resilience in Veterans study. J Affect Disord. 2015; 174:522-6. DOI: 10.1016/j.jad.2014.12.007. View

16.

Liu L, Wang L, Cao C, Qing Y, Armour C . Testing the dimensional structure of DSM-5 posttraumatic stress disorder symptoms in a nonclinical trauma-exposed adolescent sample. J Child Psychol Psychiatry. 2015; 57(2):204-12. DOI: 10.1111/jcpp.12462. View

17.

van Minnen A, Zoellner L, Harned M, Mills K . Changes in comorbid conditions after prolonged exposure for PTSD: a literature review. Curr Psychiatry Rep. 2015; 17(3):549. PMC: 4348535. DOI: 10.1007/s11920-015-0549-1. View

18.

Pietrzak R, Goldstein R, Southwick S, Grant B . Prevalence and Axis I comorbidity of full and partial posttraumatic stress disorder in the United States: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. J Anxiety Disord. 2010; 25(3):456-65. PMC: 3051041. DOI: 10.1016/j.janxdis.2010.11.010. View

19.

Alegria M, Fortuna L, Lin J, Norris F, Gao S, Takeuchi D . Prevalence, risk, and correlates of posttraumatic stress disorder across ethnic and racial minority groups in the United States. Med Care. 2013; 51(12):1114-23. PMC: 3922129. DOI: 10.1097/MLR.0000000000000007. View

20.

Legarreta M, Graham J, North L, Bueler C, McGlade E, Yurgelun-Todd D . DSM-5 posttraumatic stress disorder symptoms associated with suicide behaviors in veterans. Psychol Trauma. 2015; 7(3):277-85. DOI: 10.1037/tra0000026. View