TY - JOUR
T1 - Posttraumatic Stress Disorder Symptom Structure in Injured Children
T2 - Functional Impairment and Depression Symptoms in a Confirmatory Factor Analysis
AU - Kassam-Adams, Nancy
AU - Marsac, Meghan L.
AU - Cirilli, Carla
N1 - Funding Information:
Financial support for the studies from which these datasets originated was provided by the Maternal and Child Health Bureau ; the Emergency Medical Services for Children Program ; and the Centers for Disease Control and Prevention .
PY - 2010/6
Y1 - 2010/6
N2 - Objective: To examine the factor structure of posttraumatic stress disorder (PTSD) symptoms in children and adolescents who have experienced an acute single-incident trauma, associations between PTSD symptom clusters and functional impairment, and the specificity of PTSD symptoms in relation to depression and general distress. Method: Examined PTSD symptom structure in two samples of children (8 to 17 years of age) assessed an average of 6 months after unintentional injury: (1) a combined dataset of 479 children assessed with a PTSD symptom checklist, and (2) a sample of 204 children assessed via a standardized clinical interview. We evaluated the fit of six alternative models for the factor structure of PTSD symptoms, and the association of PTS symptom clusters with indicators of functional impairment. We then evaluated three models for the structure of PTSD and depression symptoms jointly, to examine specificity of PTSD versus general distress or mood symptoms. Results: In both samples, the DSM-IV 3-factor model fit the data reasonably well. Two alternative four-factor models fit the data very well: one that separates effortful avoidance from emotional numbing, and one that separates PTSD-specific symptoms from general emotional distress. Effortful avoidance and dysphoria symptoms were most consistently associated with impairment. The best-fitting model for PTSD and depression symptom clusters had three factors: PTSD-specific, depression-specific, and general dysphoria symptoms. Conclusions: The DSM-IV model for PTSD symptom categories was a reasonable fit for these child data, but several alternative models fit equally well or better, and suggest potential improvements to the current diagnostic criteria for PTSD in children.
AB - Objective: To examine the factor structure of posttraumatic stress disorder (PTSD) symptoms in children and adolescents who have experienced an acute single-incident trauma, associations between PTSD symptom clusters and functional impairment, and the specificity of PTSD symptoms in relation to depression and general distress. Method: Examined PTSD symptom structure in two samples of children (8 to 17 years of age) assessed an average of 6 months after unintentional injury: (1) a combined dataset of 479 children assessed with a PTSD symptom checklist, and (2) a sample of 204 children assessed via a standardized clinical interview. We evaluated the fit of six alternative models for the factor structure of PTSD symptoms, and the association of PTS symptom clusters with indicators of functional impairment. We then evaluated three models for the structure of PTSD and depression symptoms jointly, to examine specificity of PTSD versus general distress or mood symptoms. Results: In both samples, the DSM-IV 3-factor model fit the data reasonably well. Two alternative four-factor models fit the data very well: one that separates effortful avoidance from emotional numbing, and one that separates PTSD-specific symptoms from general emotional distress. Effortful avoidance and dysphoria symptoms were most consistently associated with impairment. The best-fitting model for PTSD and depression symptom clusters had three factors: PTSD-specific, depression-specific, and general dysphoria symptoms. Conclusions: The DSM-IV model for PTSD symptom categories was a reasonable fit for these child data, but several alternative models fit equally well or better, and suggest potential improvements to the current diagnostic criteria for PTSD in children.
KW - adolescents
KW - children
KW - confirmatory factor analysis
KW - posttraumatic stress disorder
UR - http://www.scopus.com/inward/record.url?scp=77952322915&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77952322915&partnerID=8YFLogxK
U2 - 10.1097/00004583-201006000-00010
DO - 10.1097/00004583-201006000-00010
M3 - Article
C2 - 20494271
AN - SCOPUS:77952322915
SN - 0890-8567
VL - 49
SP - 616-625.e4
JO - Journal of the American Academy of Child and Adolescent Psychiatry
JF - Journal of the American Academy of Child and Adolescent Psychiatry
IS - 6
ER -