Complex posttraumatic stress disorder (CPTSD) following captivity: a 24-year longitudinal study

Gadi Zerach, Mark Shevlin, Marylene Cloitre, Zahava Solomon

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Abstract

Background : The World Health Organization (WHO) International Classification of Diseases, 11th version (ICD-11), has proposed a new trauma-related diagnosis of complex posttraumatic stress disorder (CPTSD), separate and distinct from posttraumatic stress disorder (PTSD). However, to date, no study has examined CPTSD over time.

Objectives : This prospective study aimed to examine predictors and outcomes of latent classes of PTSD and CPTSD following war captivity.

Method : A sample of 183 Israeli former prisoners of the 1973 Yom Kippur War (ex-POWs) participated in a 24-year longitudinal study with three waves of measurements (T1: 1991, T2: 2008, and T3: 2015). Participants completed validated self-report measures, and their cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA).

Results : A Latent Class Analysis (LCA) identified three main classes at T2: (1) a small class with low probability to meet PTSD and CPTSD clusters criteria (15.26%); (2) a class high only in PTSD symptoms (42.37%) and (3) a class high only in CPTSD symptoms (42.37%). Importantly, higher levels of psychological suffering in captivity at T1 were associated with higher odds of being in the CPTSD class at T2. In addition, CPTSD at T2 was more strongly associated with low self-rated health, functional impairment, and cognitive performance at T3, compared to the PTSD only class.

Conclusions : Adulthood prolonged trauma of severe interpersonal intensity such as war captivity is related to CPTSD, years after the end of the war. Exposure to psychological suffering in captivity is a risk factor for future endorsement of CPTSD symptoms. CPTSD among ex-POWs is a marker for future dire mental health and functional consequences.

• We examined predictors and outcomes of latent classes of PTSD and CPTSD among ex-POWs. • A Latent Class Analysis (LCA) identified three main classes. • Psychological suffering in captivity was associated with higher odds of being in the CPTSD. • CPTSD was more strongly associated with low self-rated health, functional and cognitive impairment.

Background : The World Health Organization (WHO) International Classification of Diseases, 11th version (ICD-11), has proposed a new trauma-related diagnosis of complex post-traumatic stress disorder (PTSD), separate and distinct from the disorder post-traumatic stress disorder (PTSD). However, to date, no studies have looked at PTSD over time.

Objectives : This prospective study aimed to examine the predictive factors and outcomes of the latent classes of PTSD and PTSD after war captivity.

Method : A sample of 183 Israeli prisoners from the 1973 Yom Kippur War (ex-prisoners of war) participated in a 24-year longitudinal study with three measurement moments (T1: 1991, T2: 2008, and T3: 2015) . Participants completed validated self-report measures and their cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA).

Results : A Latent Class Analysis (LCA) identified three main classes at T2: (1) a small group with a low probability of meeting the symptomatic criteria for PTSD and PTSD (15.26%); (2) a high group only in PTSD symptoms (42.37%), and (3) a high group only in PTSD symptoms (42.37%). Importantly, higher levels of psychological distress in captivity at T1 were associated with higher odds of being in the PTSD group at T2. In addition, PTSD at T2 was more strongly associated with low self-rated health, functional decline, and cognitive performance at T3, compared to the PTSD group alone.

Conclusions : Prolonged trauma in adulthood of severe interpersonal intensity, such as war captivity, is related to PTSD, years after the end of the war. Exposure to psychological distress in captivity is a risk factor for future confirmation of PTSD symptoms. PTSD among former prisoners of war is a marker for mental health and future functional consequences.
Original languageEnglish
Article number1616488
Pages (from-to)1-12
Number of pages12
JournalEuropean Journal of Psychotraumatology
Volume10
Issue number1
Early online date28 May 2019
DOIs
Publication statusPublished - 31 Dec 2019

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