DSM-5 posttraumatic stress disorder: Factor structure and rates of diagnosis
DSM-5 posttraumatic stress disorder: Factor structure and rates of diagnosis
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DOI：
10.1016/j.jpsychires.2014.08.014
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发表时间：
2014-12-01
影响因子：
4.8
通讯作者：
Calhoun, Patrick S.
中科院分区：
文献类型：
--
作者：
Gentes, Emily L.;Dennis, Paul A.;Calhoun, Patrick S.
创伤后应激障碍（PTSD）是伊拉克/阿富汗时代退伍军人的一个重要问题。然而，迄今为止，关于DSM-5的最新变化如何影响PTSD的患病率和因素结构的研究非常有限。为了解决这一关键问题，本研究使用了一个修改后的版本的黄金标准的临床访谈，以评估创伤后应激障碍之间的大样本伊拉克/阿富汗时代的退伍军人（N = 414）。37%的样本符合DSM-5的PTSD标准，而使用DSM-IV诊断标准时的比率为38%。DSM-IV和DSM-5之间诊断率的差异主要归因于标准A的变化以及将“回避”和“麻木”症状分为不同的症状群。使用验证性因素分析（CFA）比较先前的3因素DSM-IV模型与DSM-5中规定的4因素模型、4因素“烦躁不安”模型和5因素模型的拟合情况。CFA表明，5因素模型（重新体验，主动回避，情绪麻木，烦躁不安的觉醒，焦虑的觉醒）提供了最好的整体拟合的数据，虽然实质性的支持，也发现了4因素DSM-5模型。DSM-5模型中的两种症状（心因性遗忘和鲁莽/自我毁灭行为）的因子负荷较低，这就提出了关于这些症状与PTSD其他核心特征之间是否匹配的问题。总的来说，研究结果表明，创伤后应激障碍的DSM-5模型是对以前的DSM-IV模型的改进，但仍然可能不代表真正的潜在因素结构的创伤后应激障碍。爱思唯尔有限公司出版
Posttraumatic stress disorder (PTSD) is a significant problem among Iraq/Afghanistan-era veterans. To date, however, there has been only limited research on how the recent changes in DSM-5 influence the prevalence and factor structure of PTSD. To address this key issue, the present research used a modified version of a gold-standard clinical interview to assess PTSD among a large sample of Iraq/Afghanistan-era veterans (N = 414). Thirty-seven percent of the sample met DSM-5 criteria for PTSD compared to a rate of 38% when DSM-IV diagnostic criteria were used. Differences in rates of diagnosis between DSM-IV and DSM-5 were primarily attributable to changes to Criterion A and the separation of the "avoidance" and "numbing" symptoms into separate clusters. Confirmatory factor analysis (CFA) was used to compare the fit of the previous 3-factor DSM-IV model of PTSD to the 4-factor model specified in DSM-5, a 4-factor "dysphoria" model, and a 5-factor model. CFA demonstrated that the 5-factor model (re-experiencing, active avoidance, emotional numbing, dysphoric arousal, anxious arousal) provided the best overall fit to the data, although substantial support was also found for the 4-factor DSM-5 model. Low factor loadings were noted for two of the symptoms in the DSM-5 model (psychogenic amnesia and reckless/self-destructive behavior), raising questions regarding the adequacy of fit between these symptoms and the other core features of PTSD. Overall, findings suggest the DSM-5 model of PTSD is an improvement over the previous DSM-IV model of PTSD, but still may not represent the true underlying factor structure of PTSD. Published by Elsevier Ltd.