title: The factor structure of complex posttraumatic stress disorder in traumatized refugees.
abstract: BACKGROUND
  The construct of complex posttraumatic stress disorder (CPTSD) has attracted much research attention in previous years, however it has not been systematically evaluated in individuals exposed to persecution and displacement. Given that CPTSD has been proposed as a diagnostic category in the ICD-11, it is important that it be examined in refugee groups.
  
  
  OBJECTIVE
  In the current study, we proposed to test, for the first time, the factor structure of CPTSD proposed for the ICD-11 in a sample of resettled treatment-seeking refugees.
  
  
  METHODS
  The study sample consisted of 134 traumatized refugees from a variety of countries of origin, with approximately 93% of the sample having been exposed to torture. We used confirmatory factor analysis to examine the factor structure of CPTSD in this sample and examined the sensitivity, specificity, positive predictive power and negative predictive power of individual items in relation to the CPTSD diagnosis.
  
  
  RESULTS
  Findings revealed that a two-factor higher-order model of CPTSD comprising PTSD and Difficulties in Self-Organization (χ2(47)=57.322,p=0.144, RMSEA=0.041, CFI=0.981, TLI=0.974) evidenced superior fit compared to a one-factor higher-order model of CPTSD (χ2(48)=65.745,p=0.045, RMSEA=0.053, CFI=0.968, TLI=0.956). Overall, items evidenced strong sensitivity and negative predictive power, moderate positive predictive power, and poor specificity.
  
  
  CONCLUSIONS
  Findings provide preliminary evidence for the validity of the CPTSD construct with highly traumatized treatment-seeking refugees.
authors.affiliation: School of Psychology, UNSW Australia, Sydney, NSW, Australia; anickerson@psy.unsw.edu.au.
authors.forename: Angela
authors.initials: A
authors.lastname: Nickerson
authors.affiliation: National Center for PTSD Dissemination and Training Division, Palo Alto, California, USA.
authors.forename: Marylene
authors.initials: M
authors.lastname: Cloitre
authors.affiliation: School of Psychology, UNSW Australia, Sydney, NSW, Australia.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Bryant
authors.affiliation: Department of Psychiatry and Psychotherapy, Zurich University Hospital, Zurich, Switzerland.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schnyder
authors.affiliation: Department of Psychiatry and Psychotherapy, Zurich University Hospital, Zurich, Switzerland.
authors.forename: Naser
authors.initials: N
authors.lastname: Morina
authors.affiliation: Department of Psychiatry and Psychotherapy, Zurich University Hospital, Zurich, Switzerland.
authors.forename: Matthis
authors.initials: M
authors.lastname: Schick
keywords: PTSD; Refugees; posttraumatic stress disorder; torture