Post-Traumatic Stress Disorder Symptoms in United Nations Peacekeepers: An Examination of Factor Structure in Peacekeepers with and without Chronic Pain

Abstract

Recent factor analytic investigations of post-traumatic stress disorder in military veterans suggest that symptoms are best described by either a hierarchical 2-factor model or a 4-factor inter-correlated model. Other recent evidence suggests that post-traumatic stress disorder and chronic pain are intricately related; however, the nature of this relationship is not well understood. Factor analysis provides one method for clarifying this relationship. In study 1, we compared competing models of post-traumatic stress disorder symptom structure in a sample of 400 male United Nations peacekeepers using confirmatory factor analysis. Results indicated that both the hierarchical 2-factor and the 4-factor inter-correlated models provided good fit to the data. In study 2, the reliability of these models was assessed in 427 male United Nations peacekeepers with chronic back pain and 341 without. Group comparisons of the confirmatory factor analysis results revealed that the structure of the hierarchical 2-factor and 4-factor inter-correlated models both provided good fit to the data in both the chronic back pain and the group without. However, the structure of the models for the group with chronic back pain group differed in significant ways from that of the group without chronic back pain. Post-traumatic stress disorder symptoms in military veterans can be adequately conceptualized using either a hierarchical 2-factor or 4-factor inter-correlated model. Chronic pain has a minimal influence on overall factor structure. The hierarchical 2-factor model, while parsimonious, does not provide the degree of symptom detail provided by the 4-factor inter-correlated model. Implications for conceptualization of post-traumatic stress disorder symptoms for patients with chronic back pain and significant post-traumatic stress disorder symptomatology are discussed.

Psychometric properties of the Turkish version of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5)

“…Only on the mean scale scores of C symptom cluster (including avoidance symptoms), PTSD patients did not significantly differ from depressive patients. Some of the prior studies suggested that avoidance and numbing symptoms should be conceived as distinct rather than as similar [42,43]. However, contrarily, the four-factor numbing model of PTSD suggested by King et al [16] centres on avoidance and numbing symptoms in their conceptualization.…”

The structure of post-traumatic stress disorder symptoms in three female trauma samples: A comparison of interview and self-report measures

“…A four-factor, intercorrelated solution, with factors described as re-experiencing, effortful avoidance, emotional numbing, and hyperarousal, provided the best fit. This model has subsequently been supported in several other trauma groups (Asmundson et al, 2003;DuHamel et al, 2004;Marshall, 2004;Palmieri & Fitzgerald, 2005; Palmieri, Marshall, et al, 2007; Palmieri, Weathers, et al, 2007;Stewart et al, 2004). Simms et al (2002) examined the fit of six symptom models in a large group of military personnel (N = 3695).…”

“…To date, exploratory factor analyses of DSM-III-R/DSM-IV PTSD symptoms have been conducted with numerous populations, including survivors of fires, motor vehicle accidents and assaults, United Nations peacekeepers, refugees, and military veterans (Fawzi et al, 1997;Foa, Riggs, & Gershuny, 1995;Keane, 1993;Maes et al, 1998aMaes et al, , 1998bSack, Seeley, & Clarke, 1997;Shelby, Golden-Kreutz, & Andersen, 2005;Smith, Redd, DuHamel, Vickberg, & Ricketts, 1999;Smith, Perrin, Dyregrov, & Yule, 2003;Stewart et al, 1999;Taylor, Kuch, Koch, Crockett, & Passey, 1998). Two-, three-, four-, and five-factor solutions have been reported, with no solution clearly paralleling the symptom clusters suggested by the most recent versions of the DSM.Along with these exploratory factor analyses, numerous confirmatory factor analyses (CFAs) of DSM-III-R/DSM-IV PTSD symptoms have been conducted (Andrews, Joseph, Shevlin, & Troop, 2006;Anthony, Lonigan, & Hecht, 1999;Anthony et al, 2005;Asmundson et al, 2000;Asmundson, Wright, McCreary, & Pedlar, 2003;Baschnagel, O'Connor, Colder, & Hawk, 2005;Buckley, Blanchard, & Hickling, 1998;Cordova, Studts, Hann, Jacobsen, & Andrykowski, 2000;DuHamel et al, 2004;King, Leskin, King, & Weathers, 1998;Maes et al, 1998aMaes et al, , 1998bMarshall, 2004;McWilliams, Cox, & Asmundson, 2005;Palmieri & Fitzgerald, 2005; Palmieri, Marshall, & Schell, 2007; Palmieri, Weathers, Difede, & King, 2007;Sack et al, 1997;Simms, Watson, & Doebbeling, 2002;Stewart et al, 2004). CFAs have several advantages over exploratory factor analyses in elucidating the structure of PTSD symptoms.…”

“…Along with these exploratory factor analyses, numerous confirmatory factor analyses (CFAs) of DSM-III-R/DSM-IV PTSD symptoms have been conducted (Andrews, Joseph, Shevlin, & Troop, 2006;Anthony, Lonigan, & Hecht, 1999;Anthony et al, 2005;Asmundson et al, 2000;Asmundson, Wright, McCreary, & Pedlar, 2003;Baschnagel, O'Connor, Colder, & Hawk, 2005;Buckley, Blanchard, & Hickling, 1998;Cordova, Studts, Hann, Jacobsen, & Andrykowski, 2000;DuHamel et al, 2004;King, Leskin, King, & Weathers, 1998;Maes et al, 1998aMaes et al, , 1998bMarshall, 2004;McWilliams, Cox, & Asmundson, 2005;Palmieri & Fitzgerald, 2005;Palmieri, Marshall, & Schell, 2007;Palmieri, Weathers, Difede, & King, 2007;Sack et al, 1997;Simms, Watson, & Doebbeling, 2002;Stewart et al, 2004). CFAs have several advantages over exploratory factor analyses in elucidating the structure of PTSD symptoms.…”

“…The DSM-IV-based model demonstrated superior fit. Buckley et al (1998) and Asmundson et al (2003) examined the fit of a hierarchical model with two lower-order factors, intrusion/ avoidance and hyperarousal/numbing, loading onto a higher-order factor. This model was derived from an earlier exploratory factor analysis with motor vehicle accident survivors and United Nations peacekeepers (Taylor et al, 1998).…”