The occurrence and co-occurrences of ACEs and their relationship to mental health in the United States and Ireland

BACKGROUND: Adverse childhood experiences (ACEs) have various deleterious effects on mental health but few studies have been conducted in Ireland. The primary objective was to determine if there were significant differences in occurrences of ACEs in U.S. and Irish adults. We also sought to determine if there were unique associations between individual and multiple ACE events and mental health. PARTICIPANTS AND SETTING: Preexisting nationally representative adult samples from the U.S. (n = 1893) and Ireland (n = 1020) were utilized for analysis. METHOD: To determine if there were significant differences in the occurrence of specific ACE events and the mean number of ACEs experienced by U.S. and Irish adults, chi-square difference tests and an independent samples t-test were used, respectively. Binary logistic regression was used to examine the unique associations between ACE events and major depressive disorder (MDD), generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), and Complex PTSD (CPTSD). Nationality, sex, age, and educational level were included as covariates and adjusted odds ratios are reported. RESULTS: Irish respondents had a higher rate of ACEs, were more likely to experience specific ACEs, and to meet diagnostic requirements for MDD, GAD, and CPTSD than U.S. RESPONDENTS: Emotional neglect was more strongly related to mental health than all other ACEs, and there was an exceptionally strong dose-response association between ACEs and CPTSD. CONCLUSIONS: ACEs seem to be more common in Ireland than the U.S., and efforts to minimize exposure to ACEs through public policies may lead to beneficial mental health effects

Examining the Discriminant Validity of Complex Posttraumatic Stress Disorder and Borderline Personality Disorder Symptoms: Results From a United Kingdom Population Sample

Complex Posttraumatic Stress Disorder (CPTSD) was added to the diagnostic nomenclature in the 11th version of the International Classification of Diseases (ICD-11). Although considerable evidence exists supporting the construct validity of CPTSD, the distinguishability of CPTSD symptoms from those of Borderline Personality Disorder (BPD) has been questioned. This study examined the discriminant validity of CPTSD and BPD symptoms among a trauma-exposed population sample from the United Kingdom (N = 546). Participants completed self-report measures of CPTSD and BPD symptoms, and their latent structure was assessed using exploratory structural equation modelling (ESEM). A three-factor model with latent variables reflecting ‘PTSD, ‘Disturbance in Self-Organization’ (DSO), and ‘BPD’ symptoms provided the best fit of the data (χ2 (399) = 1650, p < .001; CFI = .944; TLI = .930; RMSEA = .077 [90% CI = .073 - .081]). Multiple symptoms were identified distinguishing each construct (e.g., disturbed relationships and suicidality), as well as symptoms shared across the constructs (e.g., affective dysregulation). The PTSD (β = .24), DSO (β = .23), and BPD (β = .27) latent variables were positively and significantly associated with childhood interpersonal trauma. The current findings support the discriminant validity of CPTSD and BPD symptoms, highlight some of the phenomenological signatures of each construct, but also show how these constructs share important similarities in symptom composition and exogenous correlates

A multi-site single-blind clinical study to compare the effects of STAIR Narrative Therapy to treatment as usual among women with PTSD in public sector mental health settings: study protocol for a randomized controlled trial

Background: This article provides a description of the rationale, design, and methods of a multisite clinical trial which evaluates the potential benefits of an evidence-based psychosocial treatment, STAIR Narrative Therapy, among women with posttraumatic stress disorder (PTSD) related to interpersonal violence who are seeking services in public sector community mental health clinics. This is the first large multisite trial of an evidence-based treatment for PTSD provided in the context of community settings that are dedicated to the treatment of poverty-level patient populations. Methods: The study is enrolling 352 participants in a minimum of 4 community clinics. Participants are randomized into either STAIR Narrative Therapy or Treatment As Usual (TAU). Primary outcomes are PTSD, emotion management and interpersonal problems. The study will allow a flexible application of the protocol determined by patient need and preferences. Secondary analyses will assess the relationship of outcomes to different patterns of treatment implementation for different levels of baseline symptom severity. Discussion The article discusses the rationale and study issues related to the use of a flexible delivery of a protocol treatment and of the selection of treatment as it is actually practiced in the community as the comparator. Trial registration Clinicaltrials.gov identifier: NCT01488539

The replicability of ICD-11 complex post-traumatic stress disorder symptom networks in adults

Background: The 11th revision of the World Health Organization's International Classification of Diseases (ICD-11) includes a new disorder, Complex Posttraumatic Stress Disorder (CPTSD). A network approach to CPTSD will enable investigation of the structure of the disorder at symptom level, which may inform the development of treatments that target specific symptoms to accelerate clinical outcomes.Aims: To test whether similar networks of ICD-11 CPTSD replicate across culturally different samples and to investigate possible differences, using a network analysis.Method: We investigated the network models of four nationally representative, community-based cross-sectional samples drawn from Germany, Israel, the UK, and the US (total N=6417). CPTSD symptoms were assessed with the International Trauma Questionnaire in all samples. Only those participants who reported significant functional impairment by CPTSD symptoms were included (N=1591 included in analysis; age: M=43.55 years, SD=15.10, range=[14;99]; 67.7% women). Regularized partial correlation networks were estimated for each sample and the resulting networks were compared.Results: Despite differences in traumatic experiences, symptom severity, and symptom profiles, the networks were very similar across the four countries. The symptoms within dimensions were strongly associated with each other in all networks, except for the two symptom indicators assessing aspects of affective dysregulation. The most central symptoms were ‘feelings of worthlessness’ and ‘exaggerated startle response’Conclusion: The structure of CPTSD symptoms appears very similar across countries. Addressing symptoms with the strongest associations in the network, such as negative self-worth and startle reactivity, will likely result in rapid treatment response

Childhood trauma, attachment orientation and Complex PTSD (CPTSD) symptoms in a clinical sample: Implications for treatment

Although there has been significant work on the association between Posttraumatic Stress Disorder (PTSD) and attachment orientation, this is less the case for Complex PTSD (CPTSD). The primary aim of this paper was to assess the strength of the association between the four adult attachment styles (i.e. secure, dismissing, preoccupied, and fearful) and severity of CPTSD symptoms (i.e. symptoms of PTSD and Disturbances in Self Organisation (DSO)). We hypothesised that attachment orientation would be more strongly associated with DSO symptoms compared to PTSD symptoms. A trauma exposed clinical sample (N = 331) completed self-report measures of traumatic life events, CPTSD symptoms, and attachment orientation. It was found that secure attachment and fearful attachment were significantly associated with DSO symptoms but not with PTSD symptoms. Dismissing attachment style was significantly associated with PTSD and DSO symptoms. Preoccupied attachment was not significantly associated with CPTSD symptoms. Treatment implications for CPTSD using an attachment framework are discussed

PTSD and complex PTSD in adolescence: discriminating factors in a population-based cross-sectional study

Background: Chronic and repeated trauma are well-established risk factors for complex posttraumatic stress disorder (CPTSD) in adult samples. Less is known about how trauma history and other factors contribute to the development of CPTSD in adolescence. Objective: The aim of this study was to assess the potential contribution of trauma history and social factors to CPTSD in adolescents. Method: In a cross-sectional community study of 1299 adolescents aged 12-16 years, PTSD (n = 97) and CPTSD (n = 108) was assessed with the Child and Adolescent version of the International Trauma Questionnaire (ITQ-CA). Trauma exposure, family functioning, school problems, and social support as potential discriminating factors between the PTSD and CPTSD groups were investigated. Results: Cumulative trauma exposure did not discriminate between PTSD and CPTSD in this sample. CPTSD was associated with family problems (such as financial difficulties and conflicts in the home), school problems (bullying and learning difficulties), and social support. Conclusions: Our study indicates that factors other than cumulative trauma are important for the development of CPTSD in adolescence. Interventions targeting adolescent’s social environment both at home and at school may be beneficial

Translation and Validation of the Chinese ICD-11 International Trauma Questionnaire (ITQ) for the Assessment of Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD)

Background: Two stress-related disorders have been proposed for inclusion in the revised ICD-11: Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). The International Trauma Questionnaire (ITQ) is a bespoke measure of PTSD and CPTSD and has been widely used in English-speaking countries. Objective: The primary aim of this study was to develop a Chinese version of the ITQ and assess its content, construct, and concurrent validity. Methods: Six mental health practitioners and experts rated the Chinese translated and back-translated items to assess content validity. A sample of 423 Chinese young adults completed the ITQ, the WHO Adverse Childhood Experiences International Questionnaire, and the Hospital Anxiety and Depression Scale. Among them, 31 participants also completed the English and Chinese versions of the ITQ administered in random order at retest. Four alternative confirmatory factor analysis models were tested using data from participants who reported at least one adverse childhood experience (ACE; N = 314). Results: The Chinese ITQ received excellent ratings on relevance and appropriateness. Test–retest reliability and semantic equivalence across English and Chinese versions were acceptable. The correlated first-order six-factor model and a second-order two-factor (PTSD and DSO) both provided an acceptable model fit. The six ITQ symptoms clusters were all significantly correlated with anxiety, depression, and the number of ACEs. Conclusions: The Chinese ITQ generates scores with acceptable psychometric properties and provides evidence for including PTSD and CPTSD as separate diagnoses in ICD-11

Initial Validation of the International Trauma Questionnaire (ITQ) in a sample of Chilean Adults

ABSTRACTBackground: ICD-11 Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD) are stress-related disorders. The International Trauma Questionnaire (ITQ) is a widely used instrument to assess PTSD and CPTSD. To date, there is no evidence of the psychometric characteristics of the ITQ in Latin American countries.Objective: The aim of this study was to assess the construct and concurrent validity of the Latin American Spanish adaptation of the ITQ in a sample of Chilean adults.Methods: A sample of 275 Chilean young adults completed the ITQ, a traumatic life events checklist, the Adverse Childhood Experiences Questionnaire, the Depression Anxiety Stress Scales-21, and the Columbia-Suicide Severity Rating Scale short version. Four alternative confirmatory factor analysis models were tested. Correlation analyses were performed to determine concurrent validity with associated measures (number of reported traumatic events, number of adverse childhood experiences, anxiety, depression, and suicidal risk).Results: The second-order two-factor (PTSD and DSO) and the correlated first-order six-factor model provided acceptable fit; however, the first model showed a better fit based on the BIC difference. The PTSD and DSO dimensions, as well as the six ITQ clusters showed positive correlations with reported number of traumatic life-events, reported number of adverse childhood experiences, levels of anxiety, depression, and suicidal risk.Conclusions: The ITQ Latin American Spanish adaptation provides acceptable psychometric evidence to assess PTSD and CPTSD in accordance with the ICD-11

A Systematic Literature Review of Factor Analytic and Mixture Models of ICD-11 PTSD and CPTSD using the International Trauma Questionnaire

The 11th version of the International Classification of Diseases (ICD-11; WHO, 2018) describes two distinct trauma related disorders, Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). This review aims to summarise and synthesize evidence from factor analytic and mixture modelling studies that have investigated the latent structure of the International Trauma Questionnaire. A systematic search of PsycInfo, Web of Science, Scopus and Pubmed databases was conducted to identify relevant articles. Thirty-two studies met the inclusion criteria for this systematic review. The latent structure of the ITQ was best represented by two models; a correlated six-factor model (Re-experiencing, Avoidance, Threat, Affect Dysregulation, Negative Self Concept, and Disturbed Relationships) and a two-factor second-order model (PTSD and Disturbances in Self-Organization). Mixture model studies consistently identified distinct classes representing those displaying PTSD and CPTSD symptoms. Numerous studies demonstrated support for the factorial and discriminant validity of PTSD and CPTSD when analysed in conjunction with other variables. Overall, support was found for the conceptual coherence of PTSD and CPTSD as empirically distinguishable disorders, as measured by the ITQ. The available evidence demonstrates that the ITQ is a valid measure of ICD-11 PTSD and CPTSD. Recommendations for future research are included