Online Program

Posttraumatic stress disorder (PTSD) factor structure among survivors of the 2010 Haitian Earthquake: Adjudicating heterogeneous post-disaster PTSD dimensionality

Monday, November 2, 2015

Sabrina Hermosilla, PhD, MIA, MPH, MS, MPHIL, Department of Epidemiology at Mailman School of Public Health, Psychiatric Institute of New York, Columbia University, New York, NY
Bruce Link, PhD, Department of Epidemiology, Columbia University, New York, NY
Moise Desvarieux, MD, DMM, PhD, Department of Epidemiology, Columbia University, New York, NY
Alastair Ager, PhD, MSc, Columbia University, New York, NY
Magdalena Cerda, PhD, Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, NY
Sandro Galea, MD, DrPH, School of Public Health, Boston University School of Public Health, Boston, MA
Background: There is inconsistent empirical evidence supporting a universal underlying factor structure of posttraumatic stress disorder (PTSD).

Method: We assessed model fit of six theoretical factor structures of PTSD: 1-factor Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV; 3-factor DSM-IV (arousal, avoidance, and intrusion); 3-main factor (arousal, avoidance, and intrusion) and 1-hierarchical factor DSM-IV; 4-factor King 1998 (avoidance, hypervigilance, emotional numbing, re-experiencing); 4-factor Simms 2002 (avoidance, dysphoria, hyperarousal, intrusion); and 4-factor DSM-5 (arousal, avoidance, intrusion, negative mood and cognition) models. Confirmatory factor analyses were conducted on PTSD symptoms identified through the Posttraumatic Checklist – Civilian Version in a population-based sample of 1,302 survivors of the 2010 Haitian Earthquake.

Results: All models adequately fit the data, indexes ranged from: root mean square error of approximation (RMSEA) 0.056–0.069; comparative fit index (CFI) 0.885-0.927; Tucker Lewis Index (TLI) 0.865-0.915; weighted root mean square residual (WRMR) 1.768-2.148; Akaike information criterion (AIC) 24,768.459-29,346.352; and Bayesian information criterion (BIC) 24,952.178-29,584.705. The King 1998 and Simms 2002 models fit slightly better than the DSM-IV 1-factor and DSM-5 models. However, the 3-factor DSM-IV (arousal, avoidance, and intrusion) model fits the sample best (x2=593.257, 116 degrees of freedom; RMSEA=0.056; CFI=0.927; TLI=0.915, WRMR=1.769; AIC=24,760.459; and BIC=24,952.178).

Implications: The tight range in model fit statistics, consistent with published heterogeneous factor structures, suggests that empirical-based model selection is insufficient to universally characterize PTSD in this context. Adjudication of PTSD model selection should be theoretically driven.

Learning Areas:

Diversity and culture
Public health or related research
Social and behavioral sciences

Learning Objectives:
Evaluate the posttraumatic stress disorder factor structure in a post-natural disaster population based sample.

Keyword(s): Disasters

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have over 13 years experience working in global health research and am completing my doctoral degree in epidemiology.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.