title: The structure of post-traumatic stress disorder and complex post-traumatic stress disorder amongst West Papuan refugees.
abstract: BACKGROUND
  The validity of applying the construct of post-traumatic stress disorder (PTSD) across cultures has been the subject of contention. Although PTSD symptoms have been identified across multiple cultures, questions remain whether the constellation represents a coherent construct with an interpretable factor structure across diverse populations, especially those naïve to western notions of mental disorder. An important additional question is whether a constellation of Complex-PTSD (C-PTSD) can be identified and if so, whether there are distinctions between that disorder and core PTSD in patterns of antecedent traumatic events. Our study amongst West Papuan refugees in Papua New Guinea (PNG) aimed to examine the factorial structure of PTSD based on the DSM-IV, DSM-5, ICD-10 and ICD-11 definitions, and C-PTSD according to proposed ICD-11 criteria. We also investigated domains of traumatic events (TEs) and broader psychosocial effects of conflict (sense of safety and injustice) associated with the factorial structures identified.
  
  
  METHODS
  Culturally adapted measures were applied to assess exposure to conflict-related traumatic events (TEs), refugees' sense of safety and justice, and symptoms of PTSD and C-PTSD amongst 230 West Papuan refugees residing in Port Morseby, PNG.
  
  
  RESULTS
  Confirmatory factor analysis (CFA) supported a unitary construct of both ICD-10 and ICD-11 PTSD, comprising the conventional symptom subdomains of intrusion, avoidance, and hyperarousal. In contrast, CFA did not identify a unitary construct underlying C-PTSD. The interaction of witnessing murders and sense of injustice was associated with both the intrusion and avoidance domains of PTSD, but not with the unique symptom clusters characterizing C-PTSD.
  
  
  CONCLUSIONS
  Our findings support the ICD PTSD construct and its three-factor structure in this transcultural refugee population. Traumatic experiences of witnessing murder associated with a sense of injustice were specifically related to the intrusion and avoidance domains of PTSD. The unitary nature of C-PTSD across cultures remains in question.
authors.affiliation: Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, Australia. alvin.tay@unsw.edu.au.|South Western Sydney Clinical School, Liverpool Hospital, Faculty of Medicine, University of New South Wales, Sydney, Australia. alvin.tay@unsw.edu.au.
authors.forename: Alvin Kuowei
authors.initials: AK
authors.lastname: Tay
authors.affiliation: Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, Australia. s.j.rees@unsw.edu.au.|The Ingham Institute, Liverpool Hospital, Faculty of Medicine, University of New South Wales, Sydney, Australia. s.j.rees@unsw.edu.au.
authors.forename: Susan
authors.initials: S
authors.lastname: Rees
authors.affiliation: The Ingham Institute, Liverpool Hospital, Faculty of Medicine, University of New South Wales, Sydney, Australia. jackchen@unsw.edu.au.|Simpson Centre for Health Services Research, Faculty of Medicine, University of New South Wales, Sydney, Australia. jackchen@unsw.edu.au.|South Western Sydney Clinical School, Liverpool Hospital, Faculty of Medicine, University of New South Wales, Sydney, Australia. jackchen@unsw.edu.au.
authors.forename: Jack
authors.initials: J
authors.lastname: Chen
authors.affiliation: Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, Australia. iskareth@yahoo.com.
authors.forename: Moses
authors.initials: M
authors.lastname: Kareth
authors.affiliation: Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, Australia. D.Silove@unsw.edu.au.|The Ingham Institute, Liverpool Hospital, Faculty of Medicine, University of New South Wales, Sydney, Australia. D.Silove@unsw.edu.au.
authors.forename: Derrick
authors.initials: D
authors.lastname: Silove
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D018864:Cultural Diversity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005008:Ethnopsychology / Q000379:methods; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D008016:Life Change Events; D008297:Male; D010219:Papua New Guinea; D012036:Refugees / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology; D009626:Terminology as Topic