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Underlying Dimensions of DSM-5 Posttraumatic Stress Disorder and Major Depressive Disorder Symptoms

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Abstract

This study examined the relationship between the underlying latent factors of major depression symptoms and DSM-5 posttraumatic stress disorder (PTSD) symptoms (American Psychiatric Association, 2013). A nonclinical sample of 266 participants with a trauma history participated in the study. Confirmatory factor analyses were conducted to evaluate the fit of the DSM-5 PTSD model and dysphoria model, as well as a depression model comprised of somatic and nonsomatic factors. The DSM-5 PTSD model demonstrated somewhat better fit over the dysphoria model. Wald tests indicated that PTSD’s negative alterations in cognitions and mood factor was more strongly related to depression’s nonsomatic factor than its somatic factor. This study furthers a nascent line of research examining the relationship between PTSD and depression factors in order to better understand the nature of the high comorbidity rates between the two disorders. Moreover, this study provides an initial analysis of the new DSM-5 diagnostic criteria for PTSD.

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References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (4-text revisionth ed.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • Armour, C., Elhai, J. D., Richardson, D., Ractliffe, K., Wang, L., & Elklit, A. (2012). Assessing a five factor model of PTSD: is dysphoric arousal a unique PTSD construct showing differential relationships with anxiety and depression? Journal of Anxiety Disorders, 26, 368–376. doi:10.1016/j.janxdis.2011.12.002

    Article  PubMed  Google Scholar 

  • Asmundson, G. J. G., Stapleton, J. A., & Taylor, S. (2004). Are avoidance and numbing distinct PTSD symptom clusters? Journal of Traumatic Stress, 17, 467–475. doi:10.1007/sl0960-004-5795-7

    Article  PubMed  Google Scholar 

  • Baas, K. D., Cramer, A. O. J., Koeter, M. W. J., Van de Lisdonk, E. H., Van Weert, H. C., & Schene, A. H. (2011). Measurement invariance with respect to ethnicity of the Patient Health Questionnaire-9 (PHQ-9). Journal of Affective Disorders. doi:10.1016/j.jad.2010.08.026

    Google Scholar 

  • Biehn, T. L., Contractor, A., Elhai, J. D., Tamburrino, M., Fine, T. H., Prescott, M. R., & Galea, S. (2013). Relations between the underlying dimensions of PTSD and major depression using an epidemiological survey of deployed Ohio National Guard soldiers. Journal of Affective Disorders, 144, 106–111.

    Article  PubMed  Google Scholar 

  • Cameron, I. M., Crawford, J. R., Lawton, K., & Reid, I. C. (2008). Psychometric comparison of PHQ-9 and HADS for measuring depression severity in primary care. British Journal of General Practice, 58, 32–36. doi:10.3399/bjgp08X263794

    Article  PubMed  Google Scholar 

  • Dum, M., Pickren, J., Sobell, L. C., & Sobell, M. B. (2008). Comparing the BDI-II and the PHQ-9 with outpatient substance abusers. Addictive Behaviors, 33, 381–387. doi:10.1016/j.addbeh.2007.09.017

    Article  PubMed  Google Scholar 

  • Elhai, J. D., Biehn, T. L., Armour, C., Klopper, J. J., Frueh, B. C., & Palmieri, P. A. (2011a). Evidence for a unique PTSD construct represented by PTSD’s D1-D3 symptoms. Journal of Anxiety Disorders, 25, 340–345. doi:10.1016/j.janxdis.2010.10.007

    Article  PubMed  Google Scholar 

  • Elhai, J. D., Contractor, A. A., Palmieri, P. A., Forbes, D., & Richardson, J. D. (2011b). Exploring the relationship between underlying dimensions of posttraumatic stress disorder and depression in a national, trauma-exposed military sample. Journal of Affective Disorders, 133, 477–480. doi:10.1016/j.jad.2011.04.035

    Article  PubMed  Google Scholar 

  • Elhai, J. D., Contractor, A., Tamburrino, M., Fine, T. H., Prescott, M. R., Shirley, E., & Calabrese, J. R. (2012a). The factor structure of major depression symptoms: a test of four competing models using the Patient Health Questionnaire-9. Psychiatry Research, 199, 169–173. doi:10.1016/j.psychres.2012.05.018

    Article  PubMed  Google Scholar 

  • Elhai, J. D., Franklin, C. L., & Gray, M. J. (2008a). The SCID PTSD module’s trauma screen: validity with two samples in detecting trauma history. Depression and Anxiety, 25, 737–741.

    Article  PubMed  Google Scholar 

  • Elhai, J. D., Gray, M. J., Kashdan, T. B., & Franklin, C. L. (2005). Which instruments are most commonly used to assess traumatic event exposure and posttraumatic effects? A survey of traumatic stress professionals. Journal of Traumatic Stress, 18, 541–545.

    Article  PubMed  Google Scholar 

  • Elhai, J. D., Grubaugh, A. L., Kashdan, T. B., & Frueh, B. C. (2008b). Empirical examination of a proposed refinement to DSM-IV posttraumatic stress disorder symptom criteria using the National Comorbidity Survey Replication data. Journal of Clinical Psychiatry, 69, 597–602. doi:10.4088/JCP.v69n0411

    Article  PubMed  Google Scholar 

  • Elhai, J. D., Miller, M. E., Ford, J. D., Biehn, T. L., Palmieri, P. A., & Frueh, B. C. (2012b). Posttraumatic stress disorder in DSM-5: estimates of prevalence and symptom structure in a nonclinical sample of college students. Journal of Anxiety Disorders, 26, 58–64. doi:10.1016/j.janxdis.2011.08.013

    Article  PubMed  Google Scholar 

  • Elhai, J. D., & Palmieri, P. A. (2011). The factor structure of posttraumatic stress disorder: a literature update, critique of methodology, and agenda for future research. Journal of Anxiety Disorders, 25, 849–854. doi:10.1016/j.janxdis.2011.04.007

    Article  PubMed  Google Scholar 

  • First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. (1996). Structured clinical interview for DSM-IV axis I disorders, clinician version (SCID-CV). Washington, DC: American Psychiatric Press.

    Google Scholar 

  • Flora, D. B., & Curran, P. J. (2004). An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. Psychological Methods, 9, 466–491. doi:10.1037/1082-989x.9.4.466

    Article  PubMed  Google Scholar 

  • Foa, E. B., Riggs, D. S., & Gershuny, B. S. (1995). Arousal, numbing, and intrusion: symptom structure of PTSD following assault. American Journal of Psychiatry, 152, 116–120.

    PubMed  Google Scholar 

  • Friedman, M. J., Resick, P. A., Bryant, R. A., Strain, J., Horowitz, M., & Spiegel, D. (2011). Classification of trauma and stressor-related disorders in DSM-5. Depression and Anxiety, 28, 737–749. doi:10.1002/da.20845

    Article  PubMed  Google Scholar 

  • Frueh, B. C., Grubaugh, A. L., Elhai, J. D., & Buckley, T. C. (2007). US Department of Veterans Affairs disability policies for posttraumatic stress disorder: administrative trends and implications for treatment, rehabilitation, and research. American Journal of Public Health, 97, 2143–2145.

    Article  PubMed  Google Scholar 

  • Goodman, L., Corcoran, C., Turner, K., Yuan, N., & Green, B. L. (1998). Assessing traumatic event exposure: general issues and preliminary findings for the Stressful Life Events Screening Questionnaire. Journal of Traumatic Stress, 11, 521–542.

    Article  PubMed  Google Scholar 

  • Graham, J. W. (2009). Missing data analysis: making it work in the real world. Annual Review of Psychology, 60, 549–576. doi:10.1146/annurev.psych.58.110405.085530

    Article  PubMed  Google Scholar 

  • Hu, L., & Bentler, P. M. (1998). Fit indices in covariance structural modeling: sensitivity to underparameterized model misspecification. Psychological Methods, 3, 424–453.

    Article  Google Scholar 

  • Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.

    Article  Google Scholar 

  • Huang, F. Y., Chung, H., Kroenke, K., Delucchi, K. L., & Spitzer, R. L. (2006). Using the patient health Questionnaire-9 to measure depression among racially and ethnically diverse primary care patients. Journal of General Internal Medicine, 21, 547–552. doi:10.1111/j.1525-1497.2006.00409.x

    Article  PubMed  Google Scholar 

  • Kalpakjian, C. Z., Toussaint, L. L., Albright, K. J., Bombardier, C. H., Krause, J. K., & Tate, D. G. (2009). Patient Health Questionnaire-9 in spinal cord injury: an examination of factor structure as related to gender. The Journal of Spinal Cord Medicine, 32, 147–156.

    PubMed  Google Scholar 

  • Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the national comorbidity survey. Archives of General Psychiatry, 52, 1048–1060. doi:10.1001/archpsyc.1995.03950240066012

    Article  PubMed  Google Scholar 

  • King, D. W., Leskin, G. A., King, L. A., & Weathers, F. W. (1998). Confirmatory factor analysis of the clinician-administered PTSD scale. Psychological Assessment, 10, 90–96. doi:10.1037/1040-3590.10.2.90

    Article  Google Scholar 

  • Krause, J. S., Bombardier, C., & Carter, R. E. (2008). Assessment of depressive symptoms during inpatient rehabilitation for spinal cord injury: is there an underlying somatic factor when using the PHQ? Rehabilitation Psychology, 53, 513–520. doi:10.1037/a0013354

    Article  Google Scholar 

  • Krause, J. S., Reed, K. S., & McArdle, J. J. (2010). Factor structure and predictive validity of somatic and nonsomatic symptoms from the Patient Health Questionnaire-9: a longitudinal study after spinal cord injury. Archives of Physical Medicine and Rehabilitation, 91, 1218–1224. doi:10.1016/j.apmr.2010.04.015

    Article  PubMed  Google Scholar 

  • Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613. doi:10.1046/j.1525-1497.2001.016009606.x

    Article  PubMed  Google Scholar 

  • MacCallum, R. C., Browne, M. W., & Sugawara, H. M. (1996). Power analysis and determination of sample size for covariance structure modeling. Psychological Methods, 1, 130–149. doi:10.1037//1082-989x.1.2.130

    Article  Google Scholar 

  • McDonald, S. D., & Calhoun, P. S. (2010). The diagnostic accuracy of the PTSD checklist: a critical review. Clinical Psychology Review, 30, 976–987. doi:10.1016/j.cpr.2010.06.012

    Article  PubMed  Google Scholar 

  • Miller, M. W., Wolf, E. J., Kilpatrick, D. G., Resnick, H. S., Marx, B. P., Holowka, D. W., Rosen, R. (2013). The prevalence and latent structure of proposed DSM-5 posttraumatic stress disorder symptoms in U.S. national and veteran samples. Psychological Trauma: Theory, Research, Practice, and Policy. DOI: 10.1037/a0029730

  • Preacher, K. J., & Merkle, E. C. (2012). The problem of model selection uncertainty in structural equation modeling. Psychological Methods, 17, 1–14. doi:10.1037/a0026804

    Article  PubMed  Google Scholar 

  • Raftery, A. E. (1995). Bayesian model selection in social research. Sociological Methodology, 25, 111–163.

    Article  Google Scholar 

  • Regier, D. A., Narrow, W. E., Clarke, D. E., Kraemer, H. C., Kuramoto, S. J., Kuhl, E. A., & Kupfer, D. J. (2013). DSM-5 field trials in the United States and Canada, part II: test–retest reliability of selected categorical diagnoses. American Journal of Psychiatry, 170, 59–70. doi:10.1176/appi.ajp.2012.12070999

    Article  PubMed  Google Scholar 

  • Rhemtulla, M., Brosseau-Liard, P. E., & Savalei, V. (2012). When can categorical variables be treated as continuous? A comparison of robust continuous and categorical SEM estimation methods under suboptimal conditions. Psychological Methods, 17, 354–373. doi:10.1037/a0029315

    Article  PubMed  Google Scholar 

  • Richardson, E. J., & Richards, J. S. (2008). Factor structure of the PHQ-9 screen for depression across time since injury among persons with spinal cord injury. Rehabilitation Psychology, 53, 243–249. doi:10.1037/0090-5550.53.2.243

    Article  Google Scholar 

  • Ruggiero, K. J., Del Ben, K., Scotti, J. R., & Rabalais, A. E. (2003). Psychometric properties of the PTSD checklist—civilian version. Journal of Traumatic Stress, 16, 495–502.

    Article  PubMed  Google Scholar 

  • Simms, L. J., Watson, D., & Doebbeling, B. N. (2002). Confirmatory factor analyses of posttraumatic stress symptoms in deployed and nondeployed veterans of the Gulf War. Journal of Abnormal Psychology, 111, 637–647. doi:10.1037//0021-843x.111.4.637

    Article  PubMed  Google Scholar 

  • Spitzer, R. L., First, M. B., & Wakefield, J. C. (2007). Saving PTSD from itself in DSM-V. Journal of Anxiety Disorders. doi:10.1016/j.janxdis.2006.09.006

    PubMed  Google Scholar 

  • Spitzer, R. L., Williams, J. B. W., Kroenke, K., Linzer, M., deGruy, F. V., Hahn, S. R., & Johnson, J. G. (1994). Utility of a new procedure for diagnosing mental disorders in primary care. Journal of the American Medical Association. doi:10.1001/jama.1994.03520220043029

    Google Scholar 

  • Wang, L., Long, D., Li, Z., & Armour, C. (2011a). Posttraumatic stress disorder symptom structure in Chinese adolescents exposed to a deadly earthquake. Journal of Abnormal Child Psychology, 39, 749–758. doi:10.1007/s10802-011-9508-4

    Article  PubMed  Google Scholar 

  • Wang, L., Zhang, J., Shi, Z., Zhou, M., Li, Z., Zhang, K., Elhai, J. D. (2011). Comparing alternative factor models of PTSD symptoms across earthquake victims and violent riot witnesses in China: evidence for a five-factor model proposed by Elhai et al. (2011). Journal of Anxiety Disorders, 25, 771-776. doi: 10.1016/j.janxdis.2011.03.011

  • Watson, D. (2005). Rethinking the mood and anxiety disorders: a quantitative hierarchical model for DSM-V. Journal of Abnormal Psychology, 114, 522–536.

    Article  PubMed  Google Scholar 

  • Watson, D. (2009). Differentiating the mood and anxiety disorders: a quadripartite model. Annual Review of Clinical Psychology, 5, 221–247.

    Article  PubMed  Google Scholar 

  • Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD checklist: reliability, validity, & diagnostic utility. Paper presented at the annual meeting of the International Society for Traumatic Stress Studies, San Antonio, TX.

  • Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The PTSD checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD. www.ptsd.va.gov

  • Wilkins, K. C., Lang, A. J., & Norman, S. B. (2011). Synthesis of the psychometric properties of the PTSD checklist (PCL) military, civilian, and specific versions. Depression and Anxiety, 28, 596–606. doi:10.1002/da.20837

    Article  PubMed  Google Scholar 

  • Wirth, R. J., & Edwards, M. C. (2007). Item factor analysis. Psychological Methods, 12, 58–79. doi:10.1037/1082-989x.12.1.58

    Article  PubMed  Google Scholar 

  • Yufik, T., & Simms, L. J. (2010). A meta-analytic investigation of the structure of posttraumatic stress disorder symptoms. Journal of Abnormal Psychology, 119, 764–776. doi:10.1037/a0020981

    Article  PubMed  Google Scholar 

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This paper was based on the first author’s doctoral dissertation, supervised by the second author.

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Biehn, T.L., Elhai, J.D., Seligman, L.D. et al. Underlying Dimensions of DSM-5 Posttraumatic Stress Disorder and Major Depressive Disorder Symptoms. Psychol. Inj. and Law 6, 290–298 (2013). https://doi.org/10.1007/s12207-013-9177-4

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