title: Refining posttraumatic stress disorder diagnosis: evaluation of symptom criteria with the National Survey of Adolescents.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.affiliation: Department of Psychiatry MC1410, University of Connecticut Health Center, Farmington, CT 06032, USA. ford@psychiatry.uchc.edu
authors.forename: Julian D
authors.initials: JD
authors.lastname: Ford
authors.forename: Jon D
authors.initials: JD
authors.lastname: Elhai
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Ruggiero
authors.forename: B Christopher
authors.initials: BC
authors.lastname: Frueh
mesh_terms: D000293:Adolescent; D002648:Child; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology