The two-factorial symptom structure of post-traumatic stress disorder: depression-avoidance and arousal-anxiety
The two-factorial symptom structure of post-traumatic stress disorder: depression-avoidance and arousal-anxiety
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DOI：
10.1016/s0165-1781(98)00094-8
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发表时间：
1998-11-16
影响因子：
11.3
通讯作者：
Rousseeuw, PJ
中科院分区：
文献类型：
--
作者：
Maes, M;Delmeire, L;Rousseeuw, PJ
本研究第一部分表明，DSM-III-R创伤后应激障碍（PTSD）的症状结构，即B（再体验）、C（回避-麻木）和D（唤醒）标准，并因此不能在火灾和车祸受害者中得到PTSD的诊断。本研究的目的是：(i)确定创伤后应激障碍症状的因素及其结构；（ii）发展一种新的PTSD分类或类型。采用探索性和验证性因素分析和聚类分析：(i)检查PTSD症状学的因素；（ii）找到并验证PTSD的适当诊断标准。在创伤事件发生后的7到9个月间，对185名遭受两种不同创伤事件的受害者（即130名火灾受害者和55名车祸受害者）进行了PTSD模块的综合国际诊断访谈（CIDI）。我们的研究结果支持两个因素的存在，即第一个被标记为“抑郁-避免（DAV）维度”，因为它包含让人联想到抑郁和逃避的项目，第二个被标记为“焦虑-唤醒（AA）维度”，因为它包含让人联想到焦虑和觉醒增加的症状。聚类分析得到两组，即一组有PTSD病例，另一组无PTSD病例。与DSM-III-R对PTSD的诊断相比，我们的算法的限制性显著降低。在聚类分析派生的类之间只有数量上的差异，而没有质量上的差异。总之：PTSD并不是一个明确的临床实体，因为从PTSD非病例到DAV和AA症状较轻和较严重的病例存在一个临床连续体。用PTSD的一般严重程度以及DAV和AA维度的严重程度来表达PTSD更为合适。(C) 1998爱思唯尔科学爱尔兰有限公司版权所有。
The first part of this study showed that the DSM-III-R symptom structure of post-traumatic stress disorder (PTSD), i.e. criteria B (reexperience), C (avoidance-numbing), and D (arousal), and, consequently the diagnosis of PTSD, could not be validated in fire and car-accident victims. The aims of this study were to: (i) determine the factors as well as their structure in the symptoms of PTSD; and (ii) develop a new classification or typology of PTSD. Exploratory and confirmatory factor analyses and cluster analyses were employed to: (i) examine the factors in PTSD symptomatology; and (ii) find and validate adequate diagnostic criteria for PTSD. The Composite International Diagnostic Interview (CIDI), PTSD Module, was used between 7 and 9 months after the traumatic event in a study group of 185 victims of two different traumatic events, i.e. 130 fire and 55 car-accident victims. Our findings support the existence of two factors, i.e. a first labeled 'depression-avoidance (DAV) dimension', as it contains items reminiscent of depression and avoidance, and a second labeled 'the anxiety-arousal (AA) dimension', as it contains symptoms reminiscent of anxiety and increased arousal. Cluster analysis yielded two clusters, i.e, a cluster of subjects with PTSD cases and another with non-cases. Our PTSD algorithm was significantly less restrictive than the DSM-III-R diagnosis of PTSD. There are only quantitative, but no qualitative, differences between the cluster analytically derived classes. In conclusion: PTSD is not a well-delineated clinical entity, as there is a clinical continuum from PTSD non-cases to cases with less and more severe DAV and AA symptoms. It is more appropriate to express PTSD in terms of general severity of PTSD and severity of the DAV and AA dimensions. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.