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Sex differences in PTSD symptoms: A differential item functioning approach

Murphy S, Elklit A, Chen YY, Ghazali SR, Shevlin M

Psychol Trauma, 2019 Mar;11(3):319-327.
PMID: 29723027 DOI: 10.1037/tra0000355

OBJECTIVE: Evidence has suggested there are sex differences in posttraumatic stress disorder (PTSD) symptom expression; however, few studies have assessed whether these differences are due to measurement invariance. This study aimed to examine sex differences in PTSD symptoms based on the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) using differential item functioning (DIF).
METHOD: Confirmatory factor analysis was conducted on the DSM-5 model of PTSD, followed by a multiple indicators multiple causes (MIMIC) model to examine possible DIF using the PTSD Checklist for DSM-5. Data were analyzed from a Malaysian adolescent sample (n = 481) of which 61.7% were female, with a mean age of 17.03 years.
RESULTS: The results indicated the presence of DIF for 2 of 20 PTSD criteria. Females scored significantly higher on emotional cue reactivity (B4), and males reported significantly higher rates of reckless or self-destructive behavior (E2) while statistically controlling for the latent variables in the model. However, the magnitude of these item-level differences was small.
CONCLUSION: These findings indicate that despite the presence of DIF for 2 DSM-5 symptoms, this does not provide firm support for nonequivalence across sex. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Matched MeSH terms: Stress Disorders, Post-Traumatic/diagnosis*
Alternative models of DSM-5 PTSD: Examining diagnostic implications

Murphy S, Hansen M, Elklit A, Yong Chen Y, Raudzah Ghazali S, Shevlin M

Psychiatry Res, 2018 04;262:378-383.
PMID: 28917443 DOI: 10.1016/j.psychres.2017.09.011

The factor structure of DSM-5 posttraumatic stress disorder (PTSD) has been extensively debated with evidence supporting the recently proposed seven-factor Hybrid model. However, despite myriad studies examining PTSD symptom structure few have assessed the diagnostic implications of these proposed models. This study aimed to generate PTSD prevalence estimates derived from the 7 alternative factor models and assess whether pre-established risk factors associated with PTSD (e.g., transportation accidents and sexual victimisation) produce consistent risk estimates. Seven alternative models were estimated within a confirmatory factor analytic framework using the PTSD Checklist for DSM-5 (PCL-5). Data were analysed from a Malaysian adolescent community sample (n = 481) of which 61.7% were female, with a mean age of 17.03 years. The results indicated that all models provided satisfactory model fit with statistical superiority for the Externalising Behaviours and seven-factor Hybrid models. The PTSD prevalence estimates varied substantially ranging from 21.8% for the DSM-5 model to 10.0% for the Hybrid model. Estimates of risk associated with PTSD were inconsistent across the alternative models, with substantial variation emerging for sexual victimisation. These findings have important implications for research and practice and highlight that more research attention is needed to examine the diagnostic implications emerging from the alternative models of PTSD.

Matched MeSH terms: Stress Disorders, Post-Traumatic/diagnosis*
PTSD's latent structure in Malaysian tsunami victims: assessing the newly proposed Dysphoric Arousal model

Armour C, Raudzah Ghazali S, Elklit A

Psychiatry Res, 2013 Mar 30;206(1):26-32.
PMID: 23017656 DOI: 10.1016/j.psychres.2012.09.012

The underlying latent structure of Posttraumatic Stress Disorder (PTSD) is widely researched. However, despite a plethora of factor analytic studies, no single model has consistently been shown as superior to alternative models. The two most often supported models are the Emotional Numbing and the Dysphoria models. However, a recently proposed five-factor Dysphoric Arousal model has been gathering support over and above existing models. Data for the current study were gathered from Malaysian Tsunami survivors (N=250). Three competing models (Emotional Numbing/Dysphoria/Dysphoric Arousal) were specified and estimated using Confirmatory Factor Analysis (CFA). The Dysphoria model provided superior fit to the data compared to the Emotional Numbing model. However, using chi-square difference tests, the Dysphoric Arousal model showed a superior fit compared to both the Emotional Numbing and Dysphoria models. In conclusion, the current results suggest that the Dysphoric Arousal model better represents PTSD's latent structure and that items measuring sleeping difficulties, irritability/anger and concentration difficulties form a separate, unique PTSD factor. These results are discussed in relation to the role of Hyperarousal in PTSD's on-going symptom maintenance and in relation to the DSM-5.

Matched MeSH terms: Stress Disorders, Post-Traumatic/diagnosis*
Fulltext Functional impairment as a proxy measure indicating high rates of trauma exposure, post-migration living difficulties, common mental disorders, and poor health amongst Rohingya refugees in Malaysia

Tay AK, Rees S, Miah MAA, Khan S, Badrudduza M, Morgan K, et al.

Transl Psychiatry, 2019 09 02;9(1):213.
PMID: 31477686 DOI: 10.1038/s41398-019-0537-z

A major challenge in the refugee field is to ensure that scarce mental health resources are directed to those in greatest need. Based on data from an epidemiological survey of 959 adult Rohingya refugees in Malaysia (response rate: 83%), we examine whether a brief screening instrument of functional impairment, the WHO Disability Assessment Schedule (WHODAS), prove useful as a proxy measure to identify refugees who typically attend community mental health services. Based on estimates of mental disorder requiring interventions from analyses of epidemiological studies conducted worldwide, we selected a WHODAS cutoff that identified the top one-fifth of refugees according to severity of functional impairment, the remainder being distributed to moderate and lower impairment groupings, respectively. Compared to the lower impairment grouping, the severe impairment category comprised more boat arrivals (AOR: 5.96 [95% CI 1.34-26.43); stateless persons (A20·11 [95% CI 7.14-10); those with high exposure to pre-migration traumas (AOR: 4.76 [95% CI 1.64-13.73), peri-migration stressors (AOR: 1.26 [95% CI 1.14-1.39]) and postmigration living difficulties (AOR: 1.43 [95% CI 1.32-1.55); persons with single (AOR: 7.48 [95% CI 4.25-13.17]) and comorbid (AOR: 13.54 [95% CI 6.22-29.45]) common mental disorders; and those reporting poorer general health (AOR: 2.23 [95% CI 1-5.02]). In addition, half of the severe impairment grouping (50.6%) expressed suicidal ideas compared to one in six (16.2 percent) of the lower impairment grouping (OR: 2.39 [95% CI 1.94-2.93]). Differences between the severe and moderate impairment groups were similar but less extreme. In settings where large-scale epidemiological studies are not feasible, the WHODAS may serve as readily administered and brief public health screening tool that assists in stratifying the population according to urgency of mental health needs.

Matched MeSH terms: Stress Disorders, Post-Traumatic/diagnosis
The report of posttraumatic growth in Malaysian cancer patients: relationships with psychological distress and coping strategies

Schroevers MJ, Teo I

Psychooncology, 2008 Dec;17(12):1239-46.
PMID: 18457342 DOI: 10.1002/pon.1366

The challenge of a cancer diagnosis may eventually lead to the experience of positive psychological changes, also referred to as posttraumatic growth. As most research on posttraumatic growth in cancer patients has been conducted in Western countries, little is known about the experience of such positive psychological changes in non-Western countries. Therefore, the purpose of this cross-sectional study was to investigate the prevalence of posttraumatic growth in a Malaysian sample of cancer patients. Secondly, we examined the association of posttraumatic growth with patients' report of psychological distress and their use of coping strategies.

Matched MeSH terms: Stress Disorders, Post-Traumatic/diagnosis
Quality of life and psychological status in survivors of severe acute respiratory syndrome at 3 months postdischarge

Kwek SK, Chew WM, Ong KC, Ng AW, Lee LS, Kaw G, et al.

J Psychosom Res, 2006 May;60(5):513-9.
PMID: 16650592

BACKGROUND: Little is known about the long-term consequence of severe acute respiratory syndrome (SARS). We carried out an assessment on SARS patients after their recovery from their acute illness.
METHOD: Postal survey comprising Health-Related Quality of Life (HRQoL) questionnaires and anxiety and depression measures was sent to them at 3 months' postdischarge.
RESULTS: There was a significant impairment in both the HRQoL and mental functioning. Forty-one percent had scores indicative of a posttraumatic stress disorder (PTSD); about 30% had likely anxiety and depression.
CONCLUSION: SARS has significant impact on HRQoL and psychological status at 3 months.

Matched MeSH terms: Stress Disorders, Post-Traumatic/diagnosis