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

War exposure, PTSD, and Complex PTSD among parents living in Ukraine during the Russian war

Background: High rates of posttraumatic stress disorder (PTSD) have been documented in war-affected populations. The prevalence of Complex PTSD (CPTSD) has never been assessed in an active war zone. Here, we provide initial data on war-related experiences, and prevalence rates of ICD-11 PTSD and CPTSD in a large sample of adults in Ukraine during the Russian war. We also examined how war-related stressors, PTSD, and CPTSD were associated with age, sex, and living location in Ukraine. Method: Self-report data were gathered from a nationwide sample of 2,004 adult parents of children under 18 from the general population of Ukraine approximately six months after Russia’s invasion. Results: All participants were exposed to at least one war-related stressor, and the mean number of exposures was 9.07 (range = 1-26). Additionally, 25.9% (95% CI = 23.9%, 27.8%) met diagnostic requirements for PTSD and 14.6% (95% CI = 12.9%, 16.0%) met requirements for CPTSD. There was evidence of a strong dose-response relationship between war-related stressors and meeting criteria for PTSD and CPTSD. Participants who had the highest exposure to war-related stressors were significantly more likely to meet the requirements for PTSD (OR = 4.20; 95% CI = 2.96 -5.95) and CPTSD (OR = 8.12; 95% CI = 5.11 - 12.91) compared to the least exposed.Conclusions: Humanitarian responses to the mental health needs of the Ukrainian population will need to take account of posttraumatic stress reactions. Education in diagnosing and treating PTSD/CPTSD, especially in the situation of a significant lack of human resources and continuing displacement of the population, is necessary.<br/

On top or underneath: where does the general factor of psychopathology fit within a dimensional model of psychopathology?

Background: Dimensional models of psychopathology are increasingly common, and there is evidence for the existence of a general dimension of psychopathology (‘p’). The existing literature presented two ways to model p: as a bifactor or as a higher-order dimension. Bifactor models typically fit sample data better than higher-order models, and are often selected as better fitting alternatives but there are reasons to be cautious of such an approach to model selection. In this study, the bifactor and higher-order models of p were compared in relation to associations with established risk variables for mental illness. Methods: A trauma-exposed community sample from the United Kingdom (N = 1,051) completed self-report measures of 49 symptoms of psychopathology. Results: A higher-order model with four first-order dimensions (Fear, Distress, Externalizing, and Thought Disorder) and a higher-order p dimension provided satisfactory model fit, and a bifactor representation provided superior model fit. Bifactor p and higher-order p were highly correlated (r = .97) indicating that both parametrizations produce near equivalent general dimensions of psychopathology. Latent variable models including predictor variables showed that the risk variables explained more variance in higher-order p than bifactor p. The higher order model produced more interpretable associations for the first-order/specific dimensions compared to the bifactor model. Conclusions: The higher-order representation of p, as described in the Hierarchical Taxonomy of Psychopathology, appears to be a more appropriate way to conceptualise the general dimension of psychopathology than the bifactor approach. The research and clinical implications of these discrepant ways of modelling p are discussed

Borderline Personality Disorder (BPD) and Complex Post Traumatic Stress Disorder (CPTSD): A network analysis in a highly traumatised clinical sample

Whether Complex Posttraumatic Stress Disorder (CPTSD) and Borderline Personality Disorder (BPD) diagnoses differ substantially enough to warrant separate diagnostic classifications, has been a subject of controversy for years. To contribute to the nomological network of cumulative evidence, the main goal of the present study was to explore, using network analysis, how the symptoms of ICD-11 PTSD and DSO are interconnected with BPD in a clinical sample of polytraumatised individuals (n=330). Participants completed measures of life events, CPTSD and BPD. Overall, our study suggests that BPD and CPTSD are largely separated. The bridges between BPD and CPTSD symptom clusters were scarce with “Affective Dysregulation” items being the only items related to BPD. The present study contributes to the growing literature on discriminant validity of CPTSD and supports its distinctiveness to BPD. Implications for treatment are discussed

Complex PTSD symptoms mediate the association between childhood trauma and physical health problems

The ICD-11 reconceptualized Posttraumatic Stress Disorder (PTSD) as a narrowly defined fear-based disorder, and introduced Complex PTSD (CPTSD) as a new diagnosis comprised of PTSD symptoms and symptoms of ‘Disturbances in Self-Organization’ (DSO) that are more reflective of general dysphoria. Previous research suggests that PTSD symptoms mediate the association between childhood trauma and physical health problems, including cardiovascular disease. No study has yet assessed how posttraumatic stress symptoms, as outlined in the ICD-11, influence the association between childhood trauma and somatic problems in adulthood.ObjectiveThis cross-sectional descriptive study examined whether PTSD and DSO symptoms mediated the associations between childhood physical and sexual abuse and childhood emotional abuse and neglect and somatic problems and cardiovascular diseases (CVD) load in adulthood.MethodsGeneral adult population samples from Ireland (N = 1020) and the United Kingdom (N = 1051) completed self-report questionnaires online.ResultsStructural equation modelling results indicated that PTSD and DSO symptoms fully mediated the association between both forms of childhood trauma and somatic problems, and that PTSD symptoms but not DSO symptoms fully mediated the association between childhood trauma and CVD load.ConclusionPsychological interventions that effectively treat CPTSD symptoms may have the added benefit of reducing risk of physical health problems

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Relationships between types of UK national newspapers, illness classification, and stigmatising coverage of mental disorders

BACKGROUND: Media coverage on mental health problems has been found to vary by newspaper type, and stigma disproportionately affects people with mental illness by diagnosis. OBJECTIVE: This study investigated the relationships between types of UK national newspaper (tabloid vs. broadsheet), illness classification (SMI–severe mental illnesses vs. CMD–common mental disorders), and stigmatising coverage of mental disorders, and whether these relationships changed over the course of the Time to Change anti-stigma programmes in England and Wales. METHODS: Secondary analysis of data from a study of UK newspaper coverage of mental illness was performed. Relevant articles from nine UK national newspapers in 2008–11, 2013, 2016 and 2019 were retrieved. A structured coding framework was used for content analysis. The odds an article was stigmatising in a tabloid compared to a broadsheet, and about SMI compared to CMD, were calculated. Coverage of CMD and SMI by newspaper type was compared using the content elements categorised as stigmatising or anti-stigmatising. RESULTS: 2719 articles were included for analysis. Articles in tabloids had 1.32 times higher odds of being stigmatising than articles in broadsheet newspapers (OR 1.32, 95% CI 1.12–1.55). Odds of stigmatising coverage was 1.72 times higher for articles on SMI than CMD (OR  1.72, 95% CI 1.39–2.13). Different patterns in reporting were observed when results were stratified by years for all analyses. A few significant associations were observed for the portrays of stigmatising elements between tabloid and broadsheet newspapers regarding SMI or CMD. CONCLUSIONS: Tailored interventions are needed for editors and journalists of different newspaper types, to include specific strategies for different diagnoses

Physical, mental, and behavioral health after adverse and benevolent childhood experiences: a comparison of two adversity conceptualizations

Objective: Adverse and benevolent childhood experiences (ACEs, BCEs) impact health across the lifespan. No known study has investigated these associations across different health domains using a representative adult sample. This study examined the associations between adult physical, mental, and behavioral health with ACEs and BCEs based on two ACEs conceptualizations. Methods: A cross-sectional population-based survey was conducted in Hong Kong. Thirteen ACEs were measured and conceptualized as cumulative ACE scores and ACE patterns. Selfreports of BCEs; ten physical health problems; current mental health; posttraumatic stress; history of diagnosed mental illness; suicidal thought and suicide attempt; and engagement in three health-risk behaviors (smoking, illicit substance misuse, binge drinking) were also included. A series of regression analyses were conducted to examine the association between childhood experiences and health. Results: In a random sample of 1,070 Hong Kong adults (mean age, 41.78 years; 53.93% female; mean ACEs=1.64), 649 (60.65%) reported at least one ACE. Four ACE patterns were identified (Low ACEs, Household Instability, Household Violence, and High ACEs). Higher ACE scores associated with poorer health in a dose-response fashion. Two ACE patterns shared similar average ACE scores but differentially linked with outcomes across health domains. High BCEs negatively associated with mental and behavioral health problems