title: Examining the disconnect between psychometric models and clinical reality of posttraumatic stress disorder.
abstract: There have been many factor analytic studies aimed at testing alternative latent structures of DSM-IV and DSM-5 posttraumatic stress disorder (PTSD) symptoms. The primary rationale for such studies is that determining the 'best' factor analytic model will result in better diagnoses if that structure is the basis for diagnostic decisions. However, there appears to be a disconnect between the factor analytic modelling and the diagnostic implications. In this study, we derived prevalence rates based on commonly reported models of PTSD, based on data from two clinical samples (N=434), and also assessed if the different models generated consistent risk estimates in relation to the effects of childhood maltreatment. We found that the different models produced different prevalence rates, ranging from 64.5% to 83.9%. Furthermore, we found that the relationship between childhood maltreatment and 'diagnosis' varied considerably depending upon which latent symptom profile was adopted. It is argued that, given the maturity of this area of research, factor analytic studies of PTSD should now include information on the diagnostic implications of their findings.
authors.affiliation: Ulster University, School of Psychology and Psychology Research Institute, Magee Campus, Derry, Northern Ireland, Ireland. Electronic address: m.shevlin@ulster.ac.uk.
authors.forename: Mark
authors.initials: M
authors.lastname: Shevlin
authors.affiliation: National College of Ireland, School of Business, Dublin, Ireland.
authors.forename: Philip
authors.initials: P
authors.lastname: Hyland
authors.affiliation: Edinburgh Napier University, School of Health and Social Care, Edinburgh, UK; NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK.
authors.forename: Thanos
authors.initials: T
authors.lastname: Karatzias
authors.affiliation: Cardiff University, School of Medicine, Cardiff, UK.
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Bisson
authors.affiliation: Psychology and Counselling Directorate, Cardiff and Vale University Health Board, Cardiff, UK.
authors.forename: Neil P
authors.initials: NP
authors.lastname: Roberts
mesh_terms: D000328:Adult; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D015995:Prevalence; D011594:Psychometrics; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology
keywords: Childhood maltreatment; Confirmatory factor analysis (CFA); Posttraumatic stress disorder (PTSD); Psychiatric diagnosis; Psychometric modelling.