Examining the latent structure mechanisms for comorbid posttraumatic stress disorder and major depressive disorder
Examining the latent structure mechanisms for comorbid posttraumatic stress disorder and major depressive disorder
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DOI：
10.1016/j.jad.2017.12.076
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发表时间：
2018-03-15
影响因子：
6.6
通讯作者：
Franklin, C. Laurel
中科院分区：
文献类型：
--
作者：
Hurlocker, Margo C.;Vidaurri, Desirae N.;Franklin, C. Laurel
背景：创伤后应激障碍(PTSD)是一种复杂的精神疾病，很难诊断，部分原因是它与严重抑郁障碍(MDD)共病。鉴于研究人员在考虑了重叠症状后，PTSD和MDD的患病率没有发现差异，PTSD和MDD的潜在结构可能解释了高共患率。特别是，创伤后应激障碍的认知和情绪负性改变(NACM)和过度唤醒因素被认为是创伤后应激障碍的非特异性因素。因此，我们比较了《精神疾病诊断与统计手册》(DSM-5)第五版PTSD和MDD的因素结构，并检验了PTSD NACM和过度觉醒因素在MDD和PTSD症状严重程度之间的中介作用。方法：598名创伤暴露退伍军人(男性=48.39岁，89%男性)完成了DSM-5 PTSD和MDD的症状自评量表。与其他PTSD因子相比，PTSD NACM因子与MDD情感因子的相关性最强，PTSD NACM和高唤醒因子与MDD躯体因子的相关性最强。此外，创伤后应激障碍NACM因素解释了MDD因素与创伤后应激障碍症状严重程度的关系。更多的情感和躯体抑郁与更多的NACM症状相关，这反过来又与PTSD的严重程度相关。限制：限制包括依赖自我报告测量和使用寻求治疗、创伤暴露的退伍军人样本，这可能不适用于其他人群。结论：讨论了共同的躯体主诉和心理困扰在PTSD和MDD共病中的影响。
Background: Posttraumatic stress disorder (PTSD) is a complex psychiatric illness that can be difficult to diagnose, due in part to its comorbidity with major depressive disorder (MDD). Given that researchers have found no difference in prevalence rates of PTSD and MDD after accounting for overlapping symptoms, the latent structures of PTSD and MDD may account for the high comorbidity. In particular, the PTSD Negative Alterations in Cognition and Mood (NACM) and Hyperarousal factors have been characterized as non-specific to PTSD. Therefore, we compared the factor structures of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) PTSD and MDD and examined the mediating role of the PTSD NACM and Hyperarousal factors on the relationship between MDD and PTSD symptom severity.Methods: Participants included 598 trauma-exposed veterans (M-age = 48.39, 89% male) who completed symptom self-report measures of DSM-5 PTSD and MDD.Results: Confirmatory factor analyses indicated an adequate-fitting four-factor DSM-5 PTSD model and two-factor MDD model. Compared to other PTSD factors, the PTSD NACM factor had the strongest relationship with the MDD Affective factor, and the PTSD NACM and Hyperarousal factors had the strongest association with the MDD Somatic factor. Further, the PTSD NACM factor explained the relationship between MDD factors and PTSD symptom severity. More Affective and Somatic depression was related to more NACM symptoms, which in turn were related to increased severity of PTSD.Limitations: Limitations include the reliance on self-report measures and the use of a treatment-seeking, trauma-exposed veteran sample which may not generalize to other populations.Conclusions: Implications concerning the shared somatic complaints and psychological distress in the comorbidity of PTSD and MDD are discussed.