Reappraising the dimensional structure of the PTSD Checklist: lessons from the DSM-IV-based PCL-C

Reichenheim, Michael Eduardo; Oliveira, Aline Gaudard e Silva de; Moraes, Cláudia Leite; Coutinho, Evandro Silva Freire; Figueira, Ivan; Lobato, Gustavo

doi:10.1590/1516-4446-2017-2239

Cited by 22 publications

(28 citation statements)

References 42 publications

(66 reference statements)

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“…Analysis of the construct of postpartum PTSD found it was best explained by two factors of birth-related symptoms and general symptoms. This is consistent with previous studies of the factor structure of postpartum PTSD which found the same two symptom clusters ( 6 , 26 , 27 ). The symptom subscales of intrusions and avoidance loaded onto the birth-related factor, and the hyperarousal subscale loaded onto the general symptom factor.…”

Section: Discussionsupporting

confidence: 93%

Development of a Measure of Postpartum PTSD: The City Birth Trauma Scale

2018

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Post-traumatic stress disorder (PTSD) affects 4% of women after birth yet there are very few questionnaire measures of postpartum PTSD that have been validated in this population. In addition, none of the available questionnaires assess postpartum PTSD in accordance with criteria specified in the latest edition of the Diagnostic and Statistical Manual [DSM-5, (1)]. The City Birth Trauma Scale is a 29-item questionnaire developed to measure birth-related PTSD according to DSM-5 criteria of: stressor criteria (A), symptoms of re-experiencing (B), avoidance (C), negative cognitions and mood (D), and hyperarousal (E), as well as duration of symptoms (F), significant distress or impairment (E), and exclusion criteria or other causes (H). Two additional items from DSM-IV were also included on the basis of evidence suggesting they might be important in this population. The first was criterion A2 that women responded to events during birth with intense fear, helplessness or horror. The second was symptoms of emotional numbing. Items were first reviewed by researchers (n = 9) and postpartum women (n = 8) and revised accordingly. The questionnaire was then completed by 950 women recruited online. Results showed the City Birth Trauma Scale had excellent reliability (Cronbach's α = 0.92) and is easy to understand (Flesch reading score 64.17). Exploratory factor analysis found two factors which together accounted for 56% of the variance: (i) Birth-related symptoms (40.8% variance) and (ii) General symptoms (15.5% variance). PTSD symptoms were highly associated with distress, impaired functioning, and women reporting they wanted treatment (r = 0.50–0.61). Removing DSM-IV A2 criteria only increased births classified as traumatic by 2%. Adding the item on emotional numbing did not change the psychometric properties of the scale. These items were therefore removed. The City Birth Trauma Scale has good psychometric properties and the two symptom clusters identified are consistent with previous research on symptoms of postpartum PTSD. This scale therefore provides a promising measure of PTSD following childbirth that can be used in research and clinical practice. Future research should examine the scale's predictive validity using clinical interviews.

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Section: Discussionsupporting

confidence: 93%

Development of a Measure of Postpartum PTSD: The City Birth Trauma Scale

2018

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“…SRH is an ordinal variable measured on 5-point scale, with 1 = excellent, 2 = very good, 3 = good, 4 = fair, and 5 = poor. Because few respondents reported “fair” and “poor” categories (0.24% reported “poor” and 2.69% reported “fair”), we combined those two groups into one as “poor/fair.” We measured mental health based on responses to screening items of the widely used and validated civilian version of the posttraumatic stress disorder checklist [ 23 ], asking respondents whether, during the past month, they had felt 1) Anhedonia: loss of interest in activities you liked in the past, 2) Sleep problems: difficulty falling asleep, or staying asleep, or waking up frequently or early, 3) Anger: being easily irritable or angry, 4) Difficulty in concentrating, or 5) Repeated disturbing dreams related to COVID-19. Respondents indicate the frequency of each feeling on a 5-point scale of 1 = not at all, 2 = a little, 3 = some, 4 = a lot, and 5 = extremely.…”

Section: Methodsmentioning

confidence: 99%

Income-related health inequality among Chinese adults during the COVID-19 pandemic: evidence based on an online survey

Ding

Chen

Liu

et al. 2021

Int J Equity Health

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BackgroundPartial- or full-lockdowns, among other interventions during the COVID-19 pandemic, may disproportionally affect people (their behaviors and health outcomes) with lower socioeconomic status (SES). This study examines income-related health inequalities and their main contributors in China during the pandemic.MethodsThe 2020 China COVID-19 Survey is an anonymous 74-item survey administered via social media in China. A national sample of 10,545 adults in all 31 provinces, municipalities, and autonomous regions in mainland China provided comprehensive data on sociodemographic characteristics, awareness and attitudes towards COVID-19, lifestyle factors, and health outcomes during the lockdown. Of them, 8448 subjects provided data for this analysis. Concentration Index (CI) and Corrected CI (CCI) were used to measure income-related inequalities in mental health and self-reported health (SRH), respectively. Wagstaff-type decomposition analysis was used to identify contributors to health inequalities.ResultsMost participants reported their health status as “very good” (39.0%) or “excellent” (42.3%). CCI of SRH and mental health were − 0.09 (p < 0.01) and 0.04 (p < 0.01), respectively, indicating pro-poor inequality in ill SRH and pro-rich inequality in ill mental health. Income was the leading contributor to inequalities in SRH and mental health, accounting for 62.7% (p < 0.01) and 39.0% (p < 0.05) of income-related inequalities, respectively. The COVID-19 related variables, including self-reported family-member COVID-19 infection, job loss, experiences of food and medication shortage, engagement in physical activity, and five different-level pandemic regions of residence, explained substantial inequalities in ill SRH and ill mental health, accounting for 29.7% (p < 0.01) and 20.6% (p < 0.01), respectively. Self-reported family member COVID-19 infection, experiencing food and medication shortage, and engagement in physical activity explain 9.4% (p < 0.01), 2.6% (the summed contributions of experiencing food shortage (0.9%) and medication shortage (1.7%),p < 0.01), and 17.6% (p < 0.01) inequality in SRH, respectively (8.9% (p < 0.01), 24.1% (p < 0.01), and 15.1% (p < 0.01) for mental health).ConclusionsPer capita household income last year, experiences of food and medication shortage, self-reported family member COVID-19 infection, and physical activity are important contributors to health inequalities, especially mental health in China during the COVID-19 pandemic. Intervention programs should be implemented to support vulnerable groups.

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“…Research examining the factor structure of postpartum PTSD using other measures also finds two factors that are broadly consistent with the City BiTS. For example, Ayers et al (2009) , Stramrood et al (2010) , and Reichenheim et al (2018) identified two clusters of re-experiencing and avoidance and numbing and (hyper)arousal. However, not all studies of postpartum PTSD find this two-factor structure, Olde et al (2006) identified a three-factor structure of intrusion, avoidance and hyperarousal, and a systematic review of PTSD symptoms’ latent structure in other populations even suggests six [e.g., Anhedonia model ( Liu et al, 2014 ) 1 or seven-factor (Hybrid model, Armour et al, 2015 ) 2 models ( Armour et al, 2016 )].…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Measure of Birth-Related PTSD for Fathers and Birth Partners: The City Birth Trauma Scale (Partner Version)

et al. 2021

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Research suggests that some fathers and birth partners can experience post-traumatic stress disorder (PTSD) after witnessing a traumatic birth. Birth-related PTSD may impact on many aspects of fathers’ and birth partners’ life, including relationship breakdown, self-blame and reducing plans for future children. Despite the potential impact on birth partners’ lives there is currently no measure of birth-related PTSD validated for use with birth partners. The current study therefore adapted the City Birth Trauma Scale for use with birth partners. The City Birth Trauma Scale (Partner version) is a 29-item questionnaire developed to measure birth-related PTSD according to DSM-5 criteria: stressor criteria (A), symptoms of re-experiencing (B), avoidance (C), negative cognitions and mood (D), and hyperarousal (E), as well as duration of symptoms (F), significant distress or impairment (G), and exclusion criteria or other causes (H). A sample of 301 fathers/birth partners was recruited online and completed measures of birth-related PTSD, bonding, and demographic details. Results showed the City Birth Trauma Scale (Partner version) had good reliability (α = 0.94) and psychometric and construct validity. The fathers/birth partners version has the same two-factor structure as the original scale: (1) general symptoms and (2) birth-related symptoms, which accounted for 51% of the variance. PTSD symptoms were associated with preterm birth and maternal and infant complications. Overall, the City Birth Trauma Scale (Partner version) provides a promising measure of PTSD following childbirth that can be used in research and clinical practice.

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Reappraising the dimensional structure of the PTSD Checklist: lessons from the DSM-IV-based PCL-C

Cited by 22 publications

References 42 publications

Development of a Measure of Postpartum PTSD: The City Birth Trauma Scale

Development of a Measure of Postpartum PTSD: The City Birth Trauma Scale

Income-related health inequality among Chinese adults during the COVID-19 pandemic: evidence based on an online survey

Development and Validation of a Measure of Birth-Related PTSD for Fathers and Birth Partners: The City Birth Trauma Scale (Partner Version)

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