title: Elucidating dimensions of posttraumatic stress symptoms and their functional correlates in disaster-exposed adolescents.
abstract: The aim of this study was to elucidate the dimensional structure of posttraumatic stress disorder (PTSD) and potential moderators and functional correlates of this structure in disaster-affected adolescents. A population-based sample of 2000 adolescents aged 12-17 years (M = 14.5 years; 51% female) completed interviews on post-tornado PTSD symptoms, substance use, and parent-adolescent conflict between 4 and 13 months (M = 8.8, SD = 2.6) after tornado exposure. Confirmatory factor analyses revealed that all models fit well but a 5-factor dysphoric arousal model provided a statistically significantly better representation of adolescent PTSD symptoms compared to 4-factor dysphoria and emotional numbing models. There was evidence of measurement invariance of the dysphoric arousal model across gender and age, although girls and older adolescents aged 15-17 years had higher mean scores than boys and younger adolescents aged 12-14 years, respectively, on some PTSD dimensions. Differential magnitudes of association between PTSD symptom dimensions and functional correlates were observed, with emotional numbing symptoms most strongly positively associated with problematic substance use since the tornado, and dysphoric arousal symptoms most strongly positively associated with parent-adolescent conflict; both correlations were significantly larger than the corresponding correlations with anxious arousal. Taken together, these results suggest that the dimensional structure of tornado-related PTSD symptomatology in adolescents is optimally characterized by five separate clusters of re-experiencing, avoidance, numbing, dysphoric arousal, and anxious arousal symptoms, which showed unique associations with functional correlates. Findings emphasize that PTSD in disaster-exposed adolescents is not best conceptualized as a homogenous construct and highlight potential differential targets for post-disaster assessment and intervention.
authors.affiliation: Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W. 168th St, New York, NY 10032, USA. Electronic address: js4456@columbia.edu.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Sumner
authors.affiliation: Clinical Neurosciences Division, National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA; Department of Psychiatry, Yale University School of Medicine, 300 George St, Suite 901, New Haven, CT 06511, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Pietrzak
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, MSC 861, 2nd Fl. IOP South Building, Charleston, SC 29425, USA.
authors.forename: Carla Kmett
authors.initials: CK
authors.lastname: Danielson
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, MSC 861, 2nd Fl. IOP South Building, Charleston, SC 29425, USA.
authors.forename: Zachary W
authors.initials: ZW
authors.lastname: Adams
authors.affiliation: College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St, MSC 160, Charleston, SC 29425, USA; Ralph H. Johnson VA Medical Center, 109 Bee St, Charleston, SC 29401, USA.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Ruggiero
mesh_terms: D000293:Adolescent; D002648:Child; D004190:Disasters; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D010287:Parent-Child Relations; D012189:Retrospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D019966:Substance-Related Disorders / Q000523:psychology; D055869:Tornadoes; D014481:United States / Q000453:epidemiology
keywords: Adolescents; Confirmatory factor analysis; Disasters; Dysphoric arousal model; Posttraumatic stress disorder