Dimensional Structure of DSM-5 Posttraumatic Stress Disorder Symptoms

Jack Tsai, Ilan Harpaz-Rotem, Cherie Armour, Steven M. Southwick, John H. Krystal, Robert H. Pietrzak

Research output: Contribution to journalArticle

79 Citations (Scopus)

Abstract

OBJECTIVE:To evaluate the prevalence of DSM-5 posttraumatic stress disorder (PTSD) and factor structure of PTSD symptomatology in a nationally representative sample of US veterans and examine how PTSD symptom clusters are related to depression, anxiety, suicidal ideation, hostility, physical and mental health-related functioning, and quality of life.METHOD:Data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative survey of 1,484 US veterans conducted from September through October 2013. Confirmatory factor analyses were conducted to evaluate the factor structure of PTSD symptoms, and structural equation models were constructed to examine the association between PTSD symptom clusters and external correlates.RESULTS:12.0% of veterans screened positive for lifetime PTSD and 5.2% for past-month PTSD. A 5-factor dysphoric arousal model and a newly proposed 6-factor model both fit the data significantly better than the 4-factor model of DSM-5. The 6-factor model fit the data best in the full sample, as well as in subsamples of female veterans and veterans with lifetime PTSD. The emotional numbing symptom cluster was more strongly related to depression (P <.001) and worse mental health-related functioning (P <.001) than other symptom clusters, while the externalizing behavior symptom cluster was more strongly related to hostility (P <.001).CONCLUSIONS:A total of 5.2% of US veterans screened positive for past-month DSM-5 PTSD. A 6-factor model of DSM-5 PTSD symptoms, which builds on extant models and includes a sixth externalizing behavior factor, provides the best dimensional representation of DSM-5 PTSD symptom clusters and demonstrates validity in assessing health outcomes of interest in this population.
LanguageEnglish
Pages546-553
JournalJournal of Clinical Psychiatry
Volume76
Issue number5
DOIs
Publication statusPublished - 2014

Fingerprint

Post-Traumatic Stress Disorders
Veterans
Hostility
Mental Health
Depression
Suicidal Ideation
Structural Models
Health
Arousal
Statistical Factor Analysis
Anxiety
Quality of Life

Keywords

  • PTSD
  • CFA
  • DSM5

Cite this

Tsai, J., Harpaz-Rotem, I., Armour, C., Southwick, S. M., Krystal, J. H., & Pietrzak, R. H. (2014). Dimensional Structure of DSM-5 Posttraumatic Stress Disorder Symptoms. Journal of Clinical Psychiatry, 76(5), 546-553. https://doi.org/10.4088/JCP.14m09091
Tsai, Jack ; Harpaz-Rotem, Ilan ; Armour, Cherie ; Southwick, Steven M. ; Krystal, John H. ; Pietrzak, Robert H. / Dimensional Structure of DSM-5 Posttraumatic Stress Disorder Symptoms. In: Journal of Clinical Psychiatry. 2014 ; Vol. 76, No. 5. pp. 546-553.
@article{db5badf52cd44e7f8b3eb093206abab9,
title = "Dimensional Structure of DSM-5 Posttraumatic Stress Disorder Symptoms",
abstract = "OBJECTIVE:To evaluate the prevalence of DSM-5 posttraumatic stress disorder (PTSD) and factor structure of PTSD symptomatology in a nationally representative sample of US veterans and examine how PTSD symptom clusters are related to depression, anxiety, suicidal ideation, hostility, physical and mental health-related functioning, and quality of life.METHOD:Data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative survey of 1,484 US veterans conducted from September through October 2013. Confirmatory factor analyses were conducted to evaluate the factor structure of PTSD symptoms, and structural equation models were constructed to examine the association between PTSD symptom clusters and external correlates.RESULTS:12.0{\%} of veterans screened positive for lifetime PTSD and 5.2{\%} for past-month PTSD. A 5-factor dysphoric arousal model and a newly proposed 6-factor model both fit the data significantly better than the 4-factor model of DSM-5. The 6-factor model fit the data best in the full sample, as well as in subsamples of female veterans and veterans with lifetime PTSD. The emotional numbing symptom cluster was more strongly related to depression (P <.001) and worse mental health-related functioning (P <.001) than other symptom clusters, while the externalizing behavior symptom cluster was more strongly related to hostility (P <.001).CONCLUSIONS:A total of 5.2{\%} of US veterans screened positive for past-month DSM-5 PTSD. A 6-factor model of DSM-5 PTSD symptoms, which builds on extant models and includes a sixth externalizing behavior factor, provides the best dimensional representation of DSM-5 PTSD symptom clusters and demonstrates validity in assessing health outcomes of interest in this population.",
keywords = "PTSD, CFA, DSM5",
author = "Jack Tsai and Ilan Harpaz-Rotem and Cherie Armour and Southwick, {Steven M.} and Krystal, {John H.} and Pietrzak, {Robert H.}",
year = "2014",
doi = "10.4088/JCP.14m09091",
language = "English",
volume = "76",
pages = "546--553",
journal = "Journal of Clinical Psychiatry",
issn = "0160-6689",
publisher = "Physicians Postgraduate Press",
number = "5",

}

Tsai, J, Harpaz-Rotem, I, Armour, C, Southwick, SM, Krystal, JH & Pietrzak, RH 2014, 'Dimensional Structure of DSM-5 Posttraumatic Stress Disorder Symptoms', Journal of Clinical Psychiatry, vol. 76, no. 5, pp. 546-553. https://doi.org/10.4088/JCP.14m09091

Dimensional Structure of DSM-5 Posttraumatic Stress Disorder Symptoms. / Tsai, Jack; Harpaz-Rotem, Ilan; Armour, Cherie; Southwick, Steven M.; Krystal, John H.; Pietrzak, Robert H.

In: Journal of Clinical Psychiatry, Vol. 76, No. 5, 2014, p. 546-553.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Dimensional Structure of DSM-5 Posttraumatic Stress Disorder Symptoms

AU - Tsai, Jack

AU - Harpaz-Rotem, Ilan

AU - Armour, Cherie

AU - Southwick, Steven M.

AU - Krystal, John H.

AU - Pietrzak, Robert H.

PY - 2014

Y1 - 2014

N2 - OBJECTIVE:To evaluate the prevalence of DSM-5 posttraumatic stress disorder (PTSD) and factor structure of PTSD symptomatology in a nationally representative sample of US veterans and examine how PTSD symptom clusters are related to depression, anxiety, suicidal ideation, hostility, physical and mental health-related functioning, and quality of life.METHOD:Data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative survey of 1,484 US veterans conducted from September through October 2013. Confirmatory factor analyses were conducted to evaluate the factor structure of PTSD symptoms, and structural equation models were constructed to examine the association between PTSD symptom clusters and external correlates.RESULTS:12.0% of veterans screened positive for lifetime PTSD and 5.2% for past-month PTSD. A 5-factor dysphoric arousal model and a newly proposed 6-factor model both fit the data significantly better than the 4-factor model of DSM-5. The 6-factor model fit the data best in the full sample, as well as in subsamples of female veterans and veterans with lifetime PTSD. The emotional numbing symptom cluster was more strongly related to depression (P <.001) and worse mental health-related functioning (P <.001) than other symptom clusters, while the externalizing behavior symptom cluster was more strongly related to hostility (P <.001).CONCLUSIONS:A total of 5.2% of US veterans screened positive for past-month DSM-5 PTSD. A 6-factor model of DSM-5 PTSD symptoms, which builds on extant models and includes a sixth externalizing behavior factor, provides the best dimensional representation of DSM-5 PTSD symptom clusters and demonstrates validity in assessing health outcomes of interest in this population.

AB - OBJECTIVE:To evaluate the prevalence of DSM-5 posttraumatic stress disorder (PTSD) and factor structure of PTSD symptomatology in a nationally representative sample of US veterans and examine how PTSD symptom clusters are related to depression, anxiety, suicidal ideation, hostility, physical and mental health-related functioning, and quality of life.METHOD:Data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative survey of 1,484 US veterans conducted from September through October 2013. Confirmatory factor analyses were conducted to evaluate the factor structure of PTSD symptoms, and structural equation models were constructed to examine the association between PTSD symptom clusters and external correlates.RESULTS:12.0% of veterans screened positive for lifetime PTSD and 5.2% for past-month PTSD. A 5-factor dysphoric arousal model and a newly proposed 6-factor model both fit the data significantly better than the 4-factor model of DSM-5. The 6-factor model fit the data best in the full sample, as well as in subsamples of female veterans and veterans with lifetime PTSD. The emotional numbing symptom cluster was more strongly related to depression (P <.001) and worse mental health-related functioning (P <.001) than other symptom clusters, while the externalizing behavior symptom cluster was more strongly related to hostility (P <.001).CONCLUSIONS:A total of 5.2% of US veterans screened positive for past-month DSM-5 PTSD. A 6-factor model of DSM-5 PTSD symptoms, which builds on extant models and includes a sixth externalizing behavior factor, provides the best dimensional representation of DSM-5 PTSD symptom clusters and demonstrates validity in assessing health outcomes of interest in this population.

KW - PTSD

KW - CFA

KW - DSM5

U2 - 10.4088/JCP.14m09091

DO - 10.4088/JCP.14m09091

M3 - Article

VL - 76

SP - 546

EP - 553

JO - Journal of Clinical Psychiatry

T2 - Journal of Clinical Psychiatry

JF - Journal of Clinical Psychiatry

SN - 0160-6689

IS - 5

ER -

Tsai J, Harpaz-Rotem I, Armour C, Southwick SM, Krystal JH, Pietrzak RH. Dimensional Structure of DSM-5 Posttraumatic Stress Disorder Symptoms. Journal of Clinical Psychiatry. 2014;76(5):546-553. https://doi.org/10.4088/JCP.14m09091