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Similarity in symptom patterns of posttraumatic stress among disaster-survivors: a three-step latent profile analysis
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.ORCID iD: 0000-0001-7062-1011
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.ORCID iD: 0000-0003-2506-6527
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.ORCID iD: 0000-0002-1317-2093
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.

Place, publisher, year, edition, pages
2018. Vol. 9, no 1, article id 1546083
Keywords [en]
PTSD, posttraumatic stress, trauma, latent profile analysis, natural disaster, longitudinal study
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-369456DOI: 10.1080/20008198.2018.1546083ISI: 000450666500001PubMedID: 30479702OAI: oai:DiVA.org:uu-369456DiVA, id: diva2:1270481
Funder
Swedish National Board of Health and WelfareAvailable from: 2018-12-13 Created: 2018-12-13 Last updated: 2020-01-23Bibliographically approved
In thesis
1. Post-traumatic Stress Disorder – Assessment of current diagnostic definitions
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

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Bondjers, KristinaWillebrand, MimmieArnberg, Filip

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