The structure of ICD-11 PTSD and complex PTSD in Lithuanian mental health services

Abstract

Background: The updated 11 th edition of International Classification of Diseases (ICD-11) is expected to be released by the WHO in 2018. Disorders specifically associated with stress will be included in a separate chapter in ICD-11, and will include a revision of ICD-10 PTSD as well as a new diagnosis of complex posttraumatic stress disorder (CPTSD). The proposed symptom structures of ICD-11 PTSD and CPTSD have been validated in several studies previously, however few studies have used the International Trauma Questionnaire (ITQ), a specific measure for ICD-11 PTSD and CPTSD. Given that ICD-11 PTSD and CPTSD diagnoses are intended to be applicable across different cultures and nations, it is important that the constructs be evaluated across diverse populations and languages. Objective: Study of the psychological impact of trauma is relatively new in Lithuania, coinciding with its independence from the Soviet Union in the 1990s. Studies thus far reveal a population suffering from the effects of long-term and systematic political oppression and violence. The aim of this study was to assess the validity of the symptoms and structure of PTSD and CPTSD in a Lithuanian treatment-seeking sample as measured by the ITQ. Method: A total of 280 patients from outpatient mental health centres participated in this study. PTSD and CPTSD symptoms were measured with the ITQ. We applied confirmatory factor analysis (CFA) and latent class analysis (LCA) for analysis of data. Results and conclusions: Our study supported the ICD-11 factor structure of CPTSD, and a three-class model was supported in LCA analysis with a PTSD class, a CPTSD class, and a low symptom class. Findings support the factorial and discriminant validity of the ICD-11 proposals for PTSD and CPTSD in a unique clinical population.

A Cross‐Cultural Comparison of ICD‐11 Complex Posttraumatic Stress Disorder Symptom Networks in Austria, the United Kingdom, and Lithuania

“…We found that any two symptoms that were among those with the strongest connections were from the same symptom domain: reexperiencing, difficulties in relationships, avoidance, negative self‐concept, and affect dysregulation (dissociation). This supports the conceptual similarity of these symptoms within their respective domains and the proposed factor structure of ICD‐11 CPTSD (Kazlauskas et al., ; Shevlin et al., ). This result is similar to the findings that have been reported in factor analytical studies, in which symptoms within a factor are strongly related to each other (e.g.…”

“…The studies performed in Scotland and Wales used the English version of the ITQ (Cloitre et al., ), the Austrian study used the German version (Knefel, Lueger‐Schuster, & Maercker, ), and the Lithuanian study used the Lithuanian version of the ITQ (Kazlauskas et al., ). All versions have demonstrated good psychometric properties in previous research (English Version: Karatzias et al., ; German version: Knefel et al., ; Lithuanian version: Kazlauskas et al., ). The Cronbach's alpha values for the total scale were good in all samples (Cronbach's αs = .91–.94); Cronbach's alpha for the total sample was .95.…”

“…The second sample consisted of 280 adult primary mental health care patients in Lithuania (Kazlauskas, Gegieckaite, Hyland, Zelviene, & Cloitre, 2018). Participants were recruited at primary mental health centers, outpatient mental health clinics and hospitals, private clinical psychologists' practice, and addiction rehabilitation centers.…”

Validation of a clinician-administered diagnostic measure of ICD-11 PTSD and Complex PTSD: the International Trauma Interview in a Swedish sample

“…Studies using preliminary versions of the ITQ with samples exposed to various types of traumas and from diverse cultural backgrounds suggest that the instrument is a valid and reliable tool. Factor analyses indicate good fit for the ICD-11 model of CPTSD (i.e., a secondorder hierarchical model separating PTSD and DSO symptomatology), although there is also support for a model that distinguishes between these symptoms at the first-order level (Ben-Ezra et al, 2018;Hyland et al, 2017;Karatzias et al, 2016;Kazlauskas, Gegieckaite, Hyland, Zelviene, & Cloitre, 2018;Nickerson et al, 2016;Vallières et al, 2018). In general, PTSD symptoms have been found to be associated with measures of fear and anxiety whereas DSO symptoms show stronger associations with measures of depression, dysthymia, and general distress.…”

PTSD and Complex PTSD: ICD-11 updates on concept and measurement in the UK, USA, Germany and Lithuania

“…The ICD-11 PTSD and CPTSD structures were validated recently in a clinical treatment-seeking sample ( n  = 280) using a Lithuanian version of the ITQ (Kazlauskas, Gegieckaite, Hyland, Zelviene, & Cloitre, in press). CFA supported the factor structure of ICD-11 PTSD and CPTSD.…”