Tracey L. Biehn

Posttraumatic stress disorder in DSM-5: estimates of prevalence and symptom structure in a nonclinical sample of college students.

We empirically investigated recent proposed changes to the posttraumatic stress disorder (PTSD) diagnosis for DSM-5 using a non-clinical sample. A web survey was administered to 585 college students using the Stressful Life Events Screening Questionnaire to assess for trauma exposure but with additions for the proposed traumatic stressor changes in DSM-5 PTSD. For the 216 subjects endorsing previous trauma exposure and nominating a worst traumatic event, we administered the original PTSD Symptom Scale based on DSM-IV PTSD symptom criteria and an adapted version for DSM-5 symptoms, and the Center for Epidemiological Studies-Depression Scale. While 67% of participants endorsed at least one traumatic event based on DSM-IV PTSDs trauma classification, 59% of participants would meet DSM-5 PTSDs proposed trauma classification. Estimates of current PTSD prevalence were .4-1.8% points higher for the DSM-5 (vs. the DSM-IV) diagnostic algorithm. The DSM-5 symptom set fit the data very well based on confirmatory factor analysis, and neither symptom sets factors were more correlated with depression.

Dimensional structure of DSM-5 posttraumatic stress symptoms: support for a hybrid Anhedonia and Externalizing Behaviors model.

Several revisions to the symptom clusters of posttraumatic stress disorder (PTSD) have been made in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Central to the focus of this study was the revision of PTSDs tripartite structure in DSM-IV into four symptom clusters in DSM-5. Emerging confirmatory factor analytic (CFA) studies have suggested that DSM-5 PTSD symptoms may be best represented by one of two 6-factor models: (1) an Externalizing Behaviors model characterized by a factor which combines the irritability/anger and self-destructive/reckless behavior items; and (2) an Anhedonia model characterized by items of loss of interest, detachment, and restricted affect. The current study conducted CFAs of DSM-5 PTSD symptoms assessed using the PTSD Checklist for DSM-5 (PCL-5) in two independent and diverse trauma-exposed samples of a nationally representative sample of 1484 U.S. veterans and a sample of 497 Midwestern U.S. university undergraduate students. Relative fits of the DSM-5 model, the DSM-5 Dysphoria model, the DSM-5 Dysphoric Arousal model, the two 6-factor models, and a newly proposed 7-factor Hybrid model, which consolidates the two 6-factor models, were evaluated. Results revealed that, in both samples, both 6-factor models provided significantly better fit than the 4-factor DSM-5 model, the DSM-5 Dysphoria model and the DSM-5 Dysphoric Arousal model. Further, the 7-factor Hybrid model, which incorporates key features of both 6-factor models and is comprised of re-experiencing, avoidance, negative affect, anhedonia, externalizing behaviors, and anxious and dysphoric arousal symptom clusters, provided superior fit to the data in both samples. Results are discussed in light of theoretical and empirical support for the latent structure of DSM-5 PTSD symptoms.

Relations between the underlying dimensions of PTSD and major depression using an epidemiological survey of deployed Ohio National Guard soldiers.

BACKGROUND In the present study, the authors investigated the relationship between the underlying symptom dimensions of posttraumatic stress disorder (PTSD) and dimensions of major depressive disorder (MDD). METHOD A sample of 1266 Ohio National Guard soldiers with a history of overseas deployment participated and were administered the PTSD Checklist (assessing PTSD) and Patient Health Questionnaire-9 (assessing depression). RESULTS Using confirmatory factor analysis, results demonstrated that both PTSDs dysphoria and hyperarousal factors were more related to depressions somatic than non-somatic factor. Furthermore, depressions somatic factor was more related to PTSDs dysphoria than hyperarousal factor. LIMITATIONS Limitations of this study include the use of self-report measures and a predominately male military sample. CONCLUSIONS Results indicate that PTSDs dysphoria factor is related to depression specifically by way of depressions somatic construct. Given PTSDs substantial dysphoria/distress component, these results have implications for understanding the nature of PTSDs high comorbidity with depression.

Changes in the Beck Depression Inventory-II's underlying symptom structure over 1 month of inpatient treatment.

Abstract Research has not investigated changes in the symptom structure of depression over the course of mental health treatment. In the present study, 1025 psychiatric inpatients were recruited and assessed for depression symptom severity using the Beck Depression Inventory-II (BDI-II) at admission and after 1 month of treatment. A three-factor BDI-II model was tested using confirmatory factor analysis and fit reasonably well at both time points. Measurement invariance testing results demonstrated that factor loadings increased, indicating that the meaning of the three underlying depression dimensions changed through treatment. However, observed variable intercepts and residual error variances decreased significantly after 1 month of treatment, reflecting decreases in symptom severity as well as measurement error. Thus, depressive symptom severity decreased over the course of treatment, and the underlying factor structure of depression improved in fit after treatment. Implications for changes to the structure of depression symptoms and in the clinical practice of tracking depression over time are discussed.

Posttraumatic Stress Disorder Instrument Wording Content Is Associated With Differences in Factor Structure

The authors examined posttraumatic stress disorder (PTSD) item wording differences on the factor structure of PTSD. Nonclinical, trauma-exposed participants were randomly assigned to complete a PTSD measure using item wording content from the PTSD Checklist (n = 182) or PTSD Symptom Scale (n = 203). Compared to the 4-factor emotional numbing PTSD model, the 4-factor dysphoria PTSD model fit best across groups based on smaller Bayesian information criterion (BIC) values. For PTSD Checklist participants, the numbing models BIC was 6238.54 compared to the dysphoria models BIC of 6156.03. For the PTSD Symptom Scale, the numbing models BIC was 6161.38 compared to the dysphoria models BIC of 6102.87. Groups differed on variable intercepts and residual variances. Instrument and construct implications are discussed.

Preliminary Study on the Relationship Between Visitation in the Emergency Department and Posttraumatic Mental Health

This study documented family/friend support to patients in the Emergency Department (ED), including bedside visits and transportation of patients from the ED after discharge, and measured depression, anxiety, and stress symptoms within 2 weeks, 1 month, and 3 months after motor vehicle accidents. Stress and depression symptoms significantly decreased during the initial three months. Family/friend visitation in the ED was negatively associated with anxiety and depression symptoms within 2 weeks and with stress symptoms months after trauma. This pilot study suggests family/friend visitation in the ED is associated with fewer mental health issues in the months following an accident.