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Refining posttraumatic stress disorder diagnosis: evaluation of symptom criteria with the National Survey of Adolescents.
J Clin Psychiatry. 2009 May; 70(5):748-55.JC

Abstract

OBJECTIVE

To compare the prevalence estimates, comorbidity rates, and structural validity of a revised symptom criteria set for the diagnosis of posttraumatic stress disorder (PTSD) with those of the DSM-IV criteria in a representative community sample of adolescents.

METHOD

Cross-sectional data from the National Survey of Adolescents, a 1995 household probability sample of 4,023 adolescents aged 12-17 years, were examined. DSM-IV PTSD symptoms were assessed with a modification of the National Women's Study PTSD module. Three- and 4-factor DSM-IV models were compared to a 2-factor PTSD model that deleted symptoms potentially overlapping with depression or other anxiety disorders. Comorbidity was assessed using DSM-IV criteria for major depressive episodes and substance use disorders.

RESULTS

PTSD prevalence varied across models (ie, 5.2%-8.8%, lifetime; 3.2%-5.7%, past 6 months). When the 2-factor model was used with a proportionate symptom threshold, lifetime PTSD prevalence was comparable to that with the 3-factor DSM-IV model, and major depressive episode comorbidity was reduced by 9%-14%. Comorbidity with substance use disorders was comparable across models. Structural validity, tested with confirmatory factor analyses, showed that the 2-factor model and a 4-factor DSM-IV model were superior to the DSM-IV 3-factor model.

CONCLUSION

Compared to the DSM-IV 3-factor PTSD model, a 2-factor model that removed depression and anxiety symptoms and used a proportionate symptom threshold may produce comparable lifetime PTSD prevalence estimates, reduced PTSD-depression comorbidity, and superior structural validity (comparable to a 4-factor PTSD model) when applied to community samples of adolescents. Further research on PTSD structure and diagnosis with adolescents is warranted.

Authors+Show Affiliations

Department of Psychiatry MC1410, University of Connecticut Health Center, Farmington, CT 06032, USA. ford@psychiatry.uchc.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

19389336

Citation

Ford, Julian D., et al. "Refining Posttraumatic Stress Disorder Diagnosis: Evaluation of Symptom Criteria With the National Survey of Adolescents." The Journal of Clinical Psychiatry, vol. 70, no. 5, 2009, pp. 748-55.
Ford JD, Elhai JD, Ruggiero KJ, et al. Refining posttraumatic stress disorder diagnosis: evaluation of symptom criteria with the National Survey of Adolescents. J Clin Psychiatry. 2009;70(5):748-55.
Ford, J. D., Elhai, J. D., Ruggiero, K. J., & Frueh, B. C. (2009). Refining posttraumatic stress disorder diagnosis: evaluation of symptom criteria with the National Survey of Adolescents. The Journal of Clinical Psychiatry, 70(5), 748-55. https://doi.org/10.4088/JCP.08m04692
Ford JD, et al. Refining Posttraumatic Stress Disorder Diagnosis: Evaluation of Symptom Criteria With the National Survey of Adolescents. J Clin Psychiatry. 2009;70(5):748-55. PubMed PMID: 19389336.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Refining posttraumatic stress disorder diagnosis: evaluation of symptom criteria with the National Survey of Adolescents. AU - Ford,Julian D, AU - Elhai,Jon D, AU - Ruggiero,Kenneth J, AU - Frueh,B Christopher, PY - 2008/09/09/received PY - 2008/12/18/accepted PY - 2009/4/25/entrez PY - 2009/4/25/pubmed PY - 2009/7/23/medline SP - 748 EP - 55 JF - The Journal of clinical psychiatry JO - J Clin Psychiatry VL - 70 IS - 5 N2 - OBJECTIVE: To compare the prevalence estimates, comorbidity rates, and structural validity of a revised symptom criteria set for the diagnosis of posttraumatic stress disorder (PTSD) with those of the DSM-IV criteria in a representative community sample of adolescents. METHOD: Cross-sectional data from the National Survey of Adolescents, a 1995 household probability sample of 4,023 adolescents aged 12-17 years, were examined. DSM-IV PTSD symptoms were assessed with a modification of the National Women's Study PTSD module. Three- and 4-factor DSM-IV models were compared to a 2-factor PTSD model that deleted symptoms potentially overlapping with depression or other anxiety disorders. Comorbidity was assessed using DSM-IV criteria for major depressive episodes and substance use disorders. RESULTS: PTSD prevalence varied across models (ie, 5.2%-8.8%, lifetime; 3.2%-5.7%, past 6 months). When the 2-factor model was used with a proportionate symptom threshold, lifetime PTSD prevalence was comparable to that with the 3-factor DSM-IV model, and major depressive episode comorbidity was reduced by 9%-14%. Comorbidity with substance use disorders was comparable across models. Structural validity, tested with confirmatory factor analyses, showed that the 2-factor model and a 4-factor DSM-IV model were superior to the DSM-IV 3-factor model. CONCLUSION: Compared to the DSM-IV 3-factor PTSD model, a 2-factor model that removed depression and anxiety symptoms and used a proportionate symptom threshold may produce comparable lifetime PTSD prevalence estimates, reduced PTSD-depression comorbidity, and superior structural validity (comparable to a 4-factor PTSD model) when applied to community samples of adolescents. Further research on PTSD structure and diagnosis with adolescents is warranted. SN - 1555-2101 UR - https://www.unboundmedicine.com/medline/citation/19389336/Refining_posttraumatic_stress_disorder_diagnosis:_evaluation_of_symptom_criteria_with_the_National_Survey_of_Adolescents_ L2 - http://www.psychiatrist.com/jcp/article/pages/2009/v70n05/v70n0516.aspx DB - PRIME DP - Unbound Medicine ER -