Dimensionality of DSM-5 posttraumatic stress disorder and its association with suicide attempts: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III

• Published in: Social Psychiatry and Psychiatric Epidemiology 2017-06, Vol.52 (6), p.715-725
• Main Authors: Chen, Chiung M., Yoon, Young-Hee, Harford, Thomas C., Grant, Bridget F.
• Format: Article
• Language: English
• Subjects: Adult; Adults; Age; Alcohol; Arousal; Avoidance; Behavior disorders; Construction; Correlation; Diagnostic and Statistical Manual of Mental Disorders; Diagnostic systems; Epidemiology; Etiology; Extreme values; Factor Analysis, Statistical; Female; Humans; Male; Mathematical analysis; Mathematical models; Medicine; Medicine & Public Health; Mental disorders; Middle Aged; Original Paper; Post-traumatic stress disorder; Psychiatry; Stress Disorders, Post-Traumatic - diagnosis; Stress Disorders, Post-Traumatic - psychology; Stresses; Suicidal behavior; Suicidal Ideation; Suicide, Attempted - psychology; Suicides & suicide attempts; Surveys; Surveys and Questionnaires; United States; Variance
• ISSN: 0933-7954; 1433-9285
• DOI: 10.1007/s00127-017-1374-0

Background Emerging confirmatory factor analytic (CFA) studies suggest that posttraumatic stress disorder (PTSD) as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is best characterized by seven factors, including re-experiencing, avoidance, negative affect, anhedonia, externalizing behaviors, and anxious and dysphoric arousal. The seven factors, however, have been found to be highly correlated, suggesting that one general factor may exist to explain the overall correlations among symptoms. Methods Using data from the National Epidemiologic Survey on Alcohol and Related Conditions-III, a large, national survey of 36,309 U.S. adults ages 18 and older, this study proposed and tested an exploratory bifactor hybrid model for DSM-5 PTSD symptoms. The model posited one general and seven specific latent factors, whose associations with suicide attempts and mediating psychiatric disorders were used to validate the PTSD dimensionality. Results The exploratory bifactor hybrid model fitted the data extremely well, outperforming the 7-factor CFA hybrid model and other competing CFA models. The general factor was found to be the single dominant latent trait that explained most of the common variance (~76%) and showed significant, positive associations with suicide attempts and mediating psychiatric disorders, offering support to the concurrent validity of the PTSD construct. Conclusions The identification of the primary latent trait of PTSD confirms PTSD as an independent psychiatric disorder and helps define PTSD severity in clinical practice and for etiologic research. The accurate specification of PTSD factor structure has implications for treatment efforts and the prevention of suicidal behaviors.