Using Exploratory Structural Equation Modeling (ESEM) to Examine the Internal Structure of Posttraumatic Stress Disorder Symptoms

Abstract

Several studies have reported the factor structure of posttraumatic stress disorder (PTSD) using confirmatory factor analysis (CFA). The results show models with different number of factors, high correlations between factors, and symptoms that belong to different factors in different models without affecting the fit index. These elements could suppose the existence of considerable item cross-loading, the overlap of different factors or even the presence of a general factor that explains the items common source of variance. The aim is to provide new evidence regarding the factor structure of PTSD using CFA and exploratory structural equation modeling (ESEM). In a sample of 1,372 undergraduate students, we tested six different models using CFA and two models using ESEM and ESEM bifactor analysis. Trauma event and past-month PTSD symptoms were assessed with Life Events Checklist for DSM-5 (LEC–5) and PTSD Checklist for DSM-5 (PCL–5). All six tested CFA models showed good fit indexes (RMSEA = .051–.056, CFI = .969–.977, TLI = .965–.970), with high correlations between factors (M = .77, SD = .09 to M = .80, SD = .09). The ESEM models showed good fit indexes (RMSEA = .027–.036, CFI = .991–.996, TLI = .985–.992). These models confirmed the presence of cross-loadings on several items as well as loads on a general factor that explained 76.3% of the common variance. The results showed that most of the items do not meet the assumption of dimensional exclusivity, showing the need to expand the analysis strategies to study the symptomatic organization of PTSD.

Post-traumatic Stress Disorder and Associated Factors 1 Year After the Beginning of the COVID-19 Pandemic Among Chinese Residents

“…China was the first country to be affected by the COVID-19 outbreak and was ultimately severely affected, resulting in a high risk of infection among the residents. According to the Life Events Checklist for DSM-5 (LEC-5), which is part of the PCL-5, this type of experience constitutes a traumatic event ( 21 ). Thus, in the present study, residents of different regions of China were selected and instructed to rate how much they were affected by the outbreak of COVID-19 in the last month by completing the PCL-5.…”

Preliminary evidence for internal structure, sensitivity, and specificity of a brief PTSD and complex PTSD measure in adolescents.

“…However, our results also showed that the best fit of the two-factor model occurred when items with cross-loadings were eliminated. As frequently observed in studies on PTSD measures, we found cross-loading issues (Fresno et al, 2020), and our final model comprised five items. Although it is a considerable item reduction, our decision was based on two reasons.…”

Bifactor exploratory structural equation modeling: A meta-analytic review of model fit

“…The fourth dimension of depression and wellbeing includes the constructs of depression (Borges et al, 2017 ; Volmer et al, 2019 ; Bianchi, 2020 ; Bianchi and Schonfeld, 2020 ; Cano-García et al, 2020 ; Gomez et al, 2020a ; Nixon et al, 2020 ; Vaughan et al, 2020 ; Høstmælingen et al, 2021 ; Jovanovic et al, 2021 ), burnout (Isoard-Gautheur et al, 2018 ; Bianchi, 2020 ; Sakakibara et al, 2020 ; Trógolo et al, 2020 ; Doherty et al, 2021 ; Tóth-Király et al, 2021 ), positive thoughts (Appiah et al, 2020 ), wellbeing (Myers et al, 2016 ; Fadda et al, 2017 , 2020a ; Morin et al, 2017 ; Schutte and Wissing, 2017 ; Espinoza et al, 2018 ; Kyriazos et al, 2018a ; Lamborn et al, 2018 ; Perera et al, 2018a ; Rogoza et al, 2018 ; Silverman et al, 2018 ; Ferentinos et al, 2019 ; Cromhout, 2020 ; Longo et al, 2020 ; Reinhardt et al, 2020a , b ), workaholism (Huyghebaert-Zouaghi et al, 2022 ), stress (Morin et al, 2016c ; Portoghese et al, 2020 ), stress disorder (Fresno et al, 2020 ), anxiety disorder (Deller et al, 2020 ; Styck et al, 2021 ), problem behavior (Lahey et al, 2018 ; Hukkelberg, 2019 ; Hukkelberg and Ogden, 2020 ; Gomez et al, 2021 ), and attention deficit hyperactivity disorder (Arias et al, 2016 ; Rodenacker et al, 2017 ; Frutos, 2019 , 2021 ; Gomez and Stavropoulos, 2021 ; Yi et al, 2021 ).…”