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Soc Psychiatry Psychiatr Epidemiol. 2017 Jun;52(6):715-725. doi: 10.1007/s00127-017-1374-0. Epub 2017 Apr 11.

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.

Author information

1
CSR, Incorporated, 4250 N. Fairfax Dr., Suite 500, Arlington, VA, 22203, USA. cchen@csrincorporated.com.
2
CSR, Incorporated, 4250 N. Fairfax Dr., Suite 500, Arlington, VA, 22203, USA.
3
National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Bethesda, MD, 20892, USA.

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.

KEYWORDS:

DSM-5 PTSD diagnostic criteria; NESARC-III; PTSD; PTSD symptoms; Posttraumatic stress disorder; Suicide attempts

PMID:
28401275
DOI:
10.1007/s00127-017-1374-0
[Indexed for MEDLINE]

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