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Bondjers, K. (2020). Post-traumatic Stress Disorder – Assessment of current diagnostic definitions. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Open this publication in new window or tab >>Post-traumatic Stress Disorder – Assessment of current diagnostic definitions
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Post-traumatic stress disorder (PTSD) is a debilitating condition that may arise after exposure to shocking, frightening, or dangerous events. Hallmark symptoms are re-experiencing, avoidance, and hyperarousal. Other common symptoms are more ancillary and overlap with other psychiatric disorders (e.g., anhedonia, interpersonal problems, and affective dysregulation). The variety of symptoms associated with PTSD allows for large differences in symptom presentation between individuals. Studies of the latent structure of PTSD (e.g., latent class analysis, confirmatory factor analysis) have been highly influential in the conceptualisation of the disorder. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the eleventh edition of the International Classification of Diseases (ICD-11) have taken vastly different approaches to handling the symptom variety, with DSM-5 encompassing a broad definition, and the ICD-11 instead proposing a narrow PTSD construct and introducing the new diagnosis complex PTSD (CPTSD), comprising PTSD in conjunction with ancillary symptoms.

The principal aims of the present thesis were to examine how different symptom presentations of PTSD were associated with well-known predictors of PTSD and prospective outcome, to evaluate the dimensional structure of PTSD as it is proposed in current diagnostic nomenclature, to provide methods for assessing PTSD in the Swedish language, and to evaluate the diagnostic agreement between DSM-5 and ICD-11.

Using latent class analysis, subgroups with differences in PTSD symptom presentation were examined and assessed regarding their predictive validity. In a sample of natural disaster survivors, subgroups differed mainly in symptom severity. In a mixed trauma sample, subgroups differed in their likelihood of fulfilling hallmark versus ancillary symptoms, and in self-reported concurrent and prospective psychological distress.

As for the dimensional structure of DSM-5 symptomology, support was not found for the four-factor DSM-5 model, but rather for a six-factor and a seven-factor model. For ICD-11 symptomatology, the ICD-11 model was supported, both with and without a higher-order separation of PTSD and CPTSD. Two instruments for assessing PTSD were evaluated: the PTSD checklist for DSM-5 (PCL-5) and the International Trauma Interview for ICD-11 (ITI). Results indicated support for both instruments as valid and reliable tools. The diagnostic agreement between DSM-5 and ICD-11 was moderate.

Summarised, the studies suggest that variables such as secondary stressors and event-specific exposure influence symptom expression, and that the combination of hallmark and ancillary symptoms of PTSD is associated with the long-term maintenance of psychological distress. Results support the use of the PCL-5 and the ITI as assessment tools for DSM-5 and ICD-11 PTSD. The insufficient agreement between DSM-5 and ICD-11 PTSD and CPTSD poses a challenge for future researchers and clinicians.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2020. p. 54
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1634
Keywords
PTSD, Complex PTSD, Post-traumatic Stress, Psychological assessment, DSM-5, ICD-11, Confirmatory factor analysis, Latent class analysis, Structural equation modelling, psychometric, psychiatric diagnoses
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-403118 (URN)978-91-513-0861-6 (ISBN)
Public defence
2020-03-13, Rudbecksalen, Dag Hammarskjölds Väg 20, Uppsala, 13:00 (English)
Opponent
Supervisors
Available from: 2020-02-19 Created: 2020-01-23 Last updated: 2020-02-19
Bondjers, K., Willebrand, M. & Arnberg, F. (2020). Psychometric Properties of the Swedish Version of the PTSD Checklist for DSM-5 (PCL-5): Sensitivity, Specificity, Diagnostic Accuracy and Structural Validity in a Mixed Trauma Sample.
Open this publication in new window or tab >>Psychometric Properties of the Swedish Version of the PTSD Checklist for DSM-5 (PCL-5): Sensitivity, Specificity, Diagnostic Accuracy and Structural Validity in a Mixed Trauma Sample
2020 (English)In: Article in journal (Refereed) Submitted
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-403113 (URN)
Available from: 2020-01-23 Created: 2020-01-23 Last updated: 2020-01-31Bibliographically approved
Bondjers, K., Roberts, N., Bisson, J., Hyland, P., Willebrand, M. & Arnberg, F. (2019). Reliability and validity of the Swedish international trauma interview for posttraumatic stress disorders in the ICD-11. In: European Journal of Psychotraumatology: Trauma in Transition: Building Bridges. Paper presented at The 16th ESTSS Conference, 14-16 June 2019, Rotterdam, Netherlands. , 10, Article ID 1613836.
Open this publication in new window or tab >>Reliability and validity of the Swedish international trauma interview for posttraumatic stress disorders in the ICD-11
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2019 (English)In: European Journal of Psychotraumatology: Trauma in Transition: Building Bridges, 2019, Vol. 10, article id 1613836Conference paper, Oral presentation with published abstract (Refereed)
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-391173 (URN)10.1080/20008198.2019.1613836 (DOI)
Conference
The 16th ESTSS Conference, 14-16 June 2019, Rotterdam, Netherlands
Available from: 2019-08-20 Created: 2019-08-20 Last updated: 2019-08-20
Bondjers, K., Hyland, P., Roberts, N. P., Bisson, J. I., Willebrand, M. & Arnberg, F. (2019). Validation of a clinician-administered diagnostic measure of ICD-11 PTSD and Complex PTSD: the International Trauma Interview in a Swedish sample. European Journal of Psychotraumatology, 10(1), Article ID 1665617.
Open this publication in new window or tab >>Validation of a clinician-administered diagnostic measure of ICD-11 PTSD and Complex PTSD: the International Trauma Interview in a Swedish sample
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2019 (English)In: European Journal of Psychotraumatology, ISSN 2000-8066, E-ISSN 2000-8066, Vol. 10, no 1, article id 1665617Article in journal (Refereed) Published
Abstract [en]

Background: The recently published ICD-11 includes substantial changes to the diagnosis of posttraumatic stress disorder (PTSD) and introduces the diagnosis of Complex PTSD (CPTSD). The International Trauma Interview (ITI) has been developed for clinicians to assess these new diagnoses but has not yet been evaluated.

Objectives: To evaluate the psychometric properties of the Swedish translation of the ITI by examining the interrater agreement, latent structure, internal consistency, and convergent and discriminant validity.

Methods: In a prospective study, 186 adults who had experienced a potentially traumatic event were assessed with the ITI and answered questionnaires for symptoms of posttraumatic stress, other psychiatric disorders, functional disability, and quality of life (QoL).

Results: The diagnostic rate was 16% for PTSD and 6% for CPTSD. Interrater agreement was satisfactory (α = .76), and confirmatory factor analysis indicated that a two-factor second-20 order model consistent with the ICD-11 model of CPTSD provided acceptable fit to the data. Composite reliability analysis demonstrated that the ITI possessed acceptable internal reliability, and associations with measures of other psychiatric disorders, insomnia, functional disability, and QoL supported the concurrent validity of the ITI.

Conclusion: Swedish ITI shows promise as a clinician-administered instrument to assess and diagnose ICD-11 PTSD and CPTSD.

National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-395492 (URN)10.1080/20008198.2019.1665617 (DOI)000488883400001 ()31632616 (PubMedID)
Funder
Swedish National Board of Health and Welfare
Available from: 2019-10-20 Created: 2019-10-20 Last updated: 2020-01-23Bibliographically approved
Bondjers, K., Willebrand, M. & Arnberg, F. (2018). A Prospective Study of ICD-11 and DSM-5 PTSD, Functional Disability and Quality of Life. In: : . Paper presented at The International Society for Traumatic Stress Studies 34th Annual Meeting, Promoting Societal Change: Integrating Traumatic Stress Research, Practice and Policy for Vulnerable Populations, Washington D.C., USA, November 8-10.
Open this publication in new window or tab >>A Prospective Study of ICD-11 and DSM-5 PTSD, Functional Disability and Quality of Life
2018 (English)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Introduction: It is unclear if there are differences between the ICD-11 and DSM-5 diagnoses for PTSD related to type of potential traumatic event (PTE) and patient-reported outcomes.Method: In an ongoing prospective study, 250 participants were assessed with structured clinical interviews for ICD-11 and DSM-5 PTSD, functional disability (FD) and quality of life (QoL) at the first assessment point (T1). Participants were followed up after six months (T2) with self-rated symptom levels, functional disability (FD), and quality of life (QoL).

Results: Interim results (N=184) from T1 indicate that 68% did not fulfil criteria for any PTSD diagnosis. Of those with PTSD, 58% fulfilled criteria for both systems, 13% for ICD-11 only and 31% for DSM-5 only. Fulfilling criteria for both disorders was associated with higher FD and lower QoL at T1. Loss was more common among those fulfilling criteria for DSM-5 only.Conclusions: The concordance between the systems were low, and there were differences regarding event type and outcome. This presentation will discuss these results and present outcomes assessed at T2.Relevance: Knowledge about the differences between the ICD-11 and DSM-5 PTSD specifications are necessary to better understand how these differences influence prevalence rates, diagnostic status, as well as to understand the advantages and disadvantages of each system.

National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-382954 (URN)
Conference
The International Society for Traumatic Stress Studies 34th Annual Meeting, Promoting Societal Change: Integrating Traumatic Stress Research, Practice and Policy for Vulnerable Populations, Washington D.C., USA, November 8-10
Available from: 2019-05-07 Created: 2019-05-07 Last updated: 2019-10-24
Bondjers, K., Willebrand, M. & Arnberg, F. (2018). Similarity in symptom patterns of posttraumatic stress among disaster-survivors: a three-step latent profile analysis. European Journal of Psychotraumatology, 9(1), Article ID 1546083.
Open this publication in new window or tab >>Similarity in symptom patterns of posttraumatic stress among disaster-survivors: a three-step latent profile analysis
2018 (English)In: European Journal of Psychotraumatology, ISSN 2000-8066, E-ISSN 2000-8066, Vol. 9, no 1, article id 1546083Article in journal (Refereed) Published
Abstract [en]

Background: Individuals express symptoms of posttraumatic stress in various ways, noted for example in the many symptom combinations in the diagnostic manuals. Studies aiming to examine differences of symptom presentations by extracting latent classes or profiles indicate both the presence of subtypes with differing symptomatology and subtypes distinguished by severity levels. Few studies have examined subtype associations with long-term outcomes. Objective: The current study aimed to apply latent profile analysis on posttraumatic stress (PTS) in a highly homogenous sample of Swedish tourists exposed to the 2004 Southeast Asia tsunami and to examine if classes differed in their long-term outcome. Methods: An latent profile analysis was conducted using self-report data collected one year after the disaster from 1638 highly exposed survivors that endorsed 1 symptom of PTS. Associations were examined between the classes and predictors of PTS (loss of a relative or friend, subjective life threat) and levels of PTS at a three-year follow up. Results: The latent profile analysis indicated four classes: minimal, low, moderate, and severe symptoms. The classes were distinguished mainly by their levels of PTS. Loss of a relative or friend and subjective life threat were associated with a higher likelihood of belonging to any other class than the minimal class. The severity level of the classes at one year were predictive of PTS severity at the three-year follow-up. Conclusions: Homogeneous profiles of posttraumatic stress differing mainly in symptom severity were found in this sample of disaster survivors. Profile diversity may be related to sample variation and unmeasured confounders rather than reflect qualitatively different disorders.

Keywords
PTSD, posttraumatic stress, trauma, latent profile analysis, natural disaster, longitudinal study
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-369456 (URN)10.1080/20008198.2018.1546083 (DOI)000450666500001 ()30479702 (PubMedID)
Funder
Swedish National Board of Health and Welfare
Available from: 2018-12-13 Created: 2018-12-13 Last updated: 2020-01-23Bibliographically approved
Hensler, I., Bondjers, K., Hursti, T. & Arnberg, F. (2018). The Relation between Disgust and PTSD Symptom Severity. In: : . Paper presented at The International Society for Traumatic Stress Studies 34th Annual meeting, Washington D.C., USA, November 8-10.
Open this publication in new window or tab >>The Relation between Disgust and PTSD Symptom Severity
2018 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Psychology
Identifiers
urn:nbn:se:uu:diva-382959 (URN)
Conference
The International Society for Traumatic Stress Studies 34th Annual meeting, Washington D.C., USA, November 8-10
Available from: 2019-05-07 Created: 2019-05-07 Last updated: 2019-08-22
Bondjers, K., Arnberg, F. & Willebrand, M. (2017). DSM-5 and ICD-11 symptom profiles in a diverse sample of trauma victims. In: : . Paper presented at The 15th European Society for Traumatic Stress Studies Conference, Odense, Denmark, June 2-4.
Open this publication in new window or tab >>DSM-5 and ICD-11 symptom profiles in a diverse sample of trauma victims
2017 (English)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Introduction: Research suggest different trajectories of posttraumatic stress symptoms over time (e.g., resilient, recovering, and chronic) among survivors from natural disasters. It is not known, however, if disaster survivors present with distinct symptom profiles and, if so, whether these profiles are related to severity, recovery and exposure characteristics.Methods and Results: This study aims to investigate symptom profiles among Swedish survivors of the 2004 Indian Ocean tsunami using latent profile analysis. Participants include adult survivors who were pulled into the waves and responded to postal surveys 1 and 3 years after the disaster (n=2009). Posttraumatic stress symptoms were assessed with the Impact of Event Scale-Revised (IES-R). The symptom profiles generated from the first year survey will be compared with regard to established predictors of posttraumatic stress, such as disaster exposure, bereavement, perceived social support as well as posttraumatic stress and general distress at three years.Discussion: The presentation will shed light on whether there are distinct symptom profiles among disaster survivors. We will discuss the implications for psychosocial care after natural disasters. The results are relevant for victims of natural disasters in general, and increases knowledge about the characteristics of posttraumatic stress and may improve psychosocial services after traumatic events.

National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-382947 (URN)
Conference
The 15th European Society for Traumatic Stress Studies Conference, Odense, Denmark, June 2-4
Available from: 2019-05-07 Created: 2019-05-07 Last updated: 2019-10-24
Bondjers, K., Arnberg, F. & Willebrand, M. (2017). Screening for chronic PTSD after disasters: The gap between self-reported posttraumatic stress and PTSD cases in psychiatric services. In: : . Paper presented at The 15th European Society for Traumatic Stress Studies Conference, Child Maltreatment - What do we know? Where do we go from here?, Odense, Denmark, June 2-4.
Open this publication in new window or tab >>Screening for chronic PTSD after disasters: The gap between self-reported posttraumatic stress and PTSD cases in psychiatric services
2017 (English)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Introduction: Screening disaster survivors for mental health problems after initial recovery may detect unrecognized cases of chronic PTSD. This presentation compares published findings of PTSD prevalence after the 2004 tsunami among exposed Swedish adult survivors.

Method: Register data were collected for psychiatric diagnoses made in specialized healthcare for 8762 Swedish adults with various levels of disaster exposure. Posttraumatic stress (PTS) was assessed and exposure established for 2268 individuals who filled out the Impact of Event Scale–Revised (IES-R) in surveys at 1, 3, and 6 years post-disaster. A subset of directly exposed participants (n=142) were assessed for current and post-disaster PTSD with SCID interviews.

Results: In the survey sample, 5% of participants reported very high and 11% reported high levels of PTS across all surveys. The post-disaster prevalence of PTSD was 11.3% in the interview sample. In healthcare services, the 5-year incidence was 0.5% for PTSD and 2.1% for any stress-related disorder. Findings suggested that the IES-R possessed good screening properties, e.g., sensitivity ≥ 0.92.

Discussion: These studies indicate large differences between the PTS load among survivors and the number of PTSD cases in healthcare services, making a case for individual symptom screening. Yet, screening for chronic PTSD with current methods will yield a substantial numbers of incorrectly classified survivors (640 false positives in this sample), providing challenges to psychosocial follow-up services.

Part of symposium: Screening for mental health after trauma in children and adults: importance, instruments, & innovations

National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-382948 (URN)
Conference
The 15th European Society for Traumatic Stress Studies Conference, Child Maltreatment - What do we know? Where do we go from here?, Odense, Denmark, June 2-4
Available from: 2019-05-07 Created: 2019-05-07 Last updated: 2019-10-24
Bondjers, K., Arnberg, F. & Willebrand, M. (2017). Symptom profiles of posttraumatic stress among Swedish survivors of a natural disaster and their prospective value to long-term distress. In: : . Paper presented at The 15th European Society for Traumatic Stress Studies Conference, Odense, Denmark, June 2-4.
Open this publication in new window or tab >>Symptom profiles of posttraumatic stress among Swedish survivors of a natural disaster and their prospective value to long-term distress
2017 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Introduction: Research suggest different trajectories of posttraumatic stress symptoms over time (e.g., resilient, recovering, and chronic) among survivors from natural disasters. It is not known, however, if disaster survivors present with distinct symptom profiles and, if so, whether these profiles are related to severity, recovery and exposure characteristics.Methods and Results: This study aims to investigate symptom profiles among Swedish survivors of the 2004 Indian Ocean tsunami using latent profile analysis. Participants include adult survivors who were pulled into the waves and responded to postal surveys 1 and 3 years after the disaster (n=2009). Posttraumatic stress symptoms were assessed with the Impact of Event Scale-Revised (IES-R). The symptom profiles generated from the first year survey will be compared with regard to established predictors of posttraumatic stress, such as disaster exposure, bereavement, perceived social support as well as posttraumatic stress and general distress at three years.Discussion: The presentation will shed light on whether there are distinct symptom profiles among disaster survivors. We will discuss the implications for psychosocial care after natural disasters. The results are relevant for victims of natural disasters in general, and increases knowledge about the characteristics of posttraumatic stress and may improve psychosocial services after traumatic events.

National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-382945 (URN)
Conference
The 15th European Society for Traumatic Stress Studies Conference, Odense, Denmark, June 2-4
Available from: 2019-05-07 Created: 2019-05-07 Last updated: 2019-10-24
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-7062-1011

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