Is there empirical evidence for a universal posttraumatic stress disorder factor structure? A systematic review

Background: Complexity in posttraumatic stress disorder (PTSD) symptom presentation, limits our ability to develop appropriate responses. Identifying a universal, empirically supported, multifactorial model would strengthen cross-study and population comparisons, guiding intervention and policy development.

Methods: We systematically reviewed the empiric literature from PubMed and PsychINFO on PTSD symptom structure to identify a universal PTSD factor structure.

Findings: 40 (3%) out of 1,249 citations published between 1980-2014 provided empirical PTSD factor structure estimates. Studies were largely from United States’ samples (70%), of unspecified potentially traumatic event(s) (17%), with sample sizes from 111-12,443, and response rates from 22%-96%. The Posttraumatic Checklist – Civilian Version (38%) was the most common instrument and confirmatory factor analysis (73%) was the most common analytic method. 152 PTSD latent factor models were specified in the 40 papers reviewed. There is a clear consensus in the factor components of PTSD (98% of models had arousal and avoidance factors, 95% intrusion or re-experiencing factor, and 93% emotional numbing factor). Significant heterogeneity in underlying factor structures of PTSD remains, with the 4-factor King 1998 (30%, avoidance, hypervigilance, emotional numbing, re-experiencing) and Simms 2002 (20%, avoidance, dysphoria, hyperarousal, intrusion) models consistently fitting study data better than other tested models (remaining studies identified 11 different factor structures).

Implications: A universal understanding of the specific operationalization of the multifactorial structure of PTSD, supported by the empirical literature, is absent. However, overall consistency of main factors across models could guide general program development.