Examining specific and non-specific symptoms of the best-fitting posttraumatic stress disorder model in conflict-exposed adolescents.

BACKGROUND: The 5th revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) construes PTSD symptoms into 4 clusters (intrusion, avoidance, negative alterations in cognitions and mood, alterations in arousal and reactivity; Model 1). However, recent literature has shown that this symptom structure does not best represent PTSD. Unfortunately, the findings of studies investigating the proposed alternative models are from consensus. Adding to the complexity of the issue of symptom-grouping models is the identification of specific and non-specific symptoms of PTSD. The present study aims to address these gaps by identifying the best-fitting PTSD model and subsequently examining what symptoms are considered specific and non-specific to PTSD in adolescent-survivors of armed political conflict and violence. METHODS: The study utilized a sample of 641 adolescent victim survivors. We conducted CFA analyses and compared nested models through the scaled χ2 difference test, while comparison of non-nested models was done using the Bayesian information criterion (BIC). The best-fitted model was used in the consequent analysis, where we statistically controlled for the effect of non-specific psychological distress on PTSD by comparing the factor loadings and factor correlations before and after accounting for distress using the Aroian z-test. RESULTS: The results provide support for the 7-factor hybrid model of PTSD over other proposed models for the current sample. Moreover, the data reveal that only 7 items could be construed as core symptoms, while the rest of the symptoms can be considered non-PTSD specific. CONCLUSIONS: Overall, the findings provide support for the validity of the hybrid PTSD model among political conflict-exposed adolescents. The results also show that the DSM-5 PTSD has both specific and non-specific features in the present sample of conflict-exposed adolescents. This has potential implications for theory, practice, and treatment of the disorder.

Positive mental health literacy for teachers: adaptation and construct validation.

Mental health promotion has been gaining recognition as an important teacher competency. Hence, it is imperative that teachers have adequate mental health literacy (MHL). However, most studies and programs on teacher MHL focus on teachers' knowledge of mental disorders, whereas very few have explored their knowledge of positive mental health, perhaps due to the lack of measures for this construct. In this study, we adapted and validated the Mental Health-Promoting Knowledge Scale (MHPKS), a measure of positive MHL, for teachers. We looked into its factor structure and examined its relationships with knowledge of mental disorders, and mental health and teaching-related outcomes. The sample included 470 Filipino preservice teachers. Results of the confirmatory factor analysis provided support for the single-factor model of the MHPKS. Positive MHL was found to be positively associated with knowledge of mental disorders, well-being, teaching engagement, and teaching satisfaction. It predicted well-being, teaching engagement, and teaching satisfaction above and beyond the variance accounted for by knowledge of mental disorders, indicating construct validity. MHPKS is a valid tool that can be used to complement measures of knowledge of mental disorders for a more holistic assessment of teacher mental health knowledge.

A comparison of DSM-5 and ICD-11 models of PTSD: Measurement invariance and psychometric validation in Filipino trauma samples.

This study examined and compared the factor structure of DSM-5 and ICD-11 PTSD models and their relationships with transdiagnostic symptoms (i.e., anxiety, depression, negative affect, and somatic symptoms) in eight trauma samples: (1) natural disaster relocatees; (2) Typhoon Haiyan survivors; (3) indigenous people exposed to armed conflict; (4) internally displaced persons due to armed conflict; (5) soldiers regularly involved in armed conflict; (6) police exposed to work-related traumatic events; (7) abused women; and (8) college students with diverse trauma experiences. Results showed that while the ICD-11 PTSD has better model fit than that of DSM-5, the DSM-5 PTSD model has stronger relationships with all transdiagnostic symptoms in almost all of the samples. The study highlights that in choosing which PTSD nomenclature to use, both the factor structure and comorbidity with other symptoms must be considered.

To Leave is to Die a Little: Assessing the Symptom Structure of Separation Anxiety Disorder in Left-Behind Emerging Adults.

The literature on separation anxiety disorder (SAD) presented two contentious issues relating to its assessment. First, studies are scarce in assessing the symptom structure of DSM-5 SAD among the adult population. Second, the accuracy in assessing the severity of SAD through measuring the intensity of disturbance and the frequency of occurrence of symptoms is yet to be studied. To address these limitations, the present study aimed to: (1) examine the latent factor structure of the newly developed separation anxiety disorder symptom severity inventory (SADSSI); (2) evaluate the necessity of using frequency or intensity formats through comparison of differences in the latent level; and (3) investigate SAD latent class analysis. Utilizing 425 left-behind emerging adults (LBA), the findings showed that a general factor with two dimensions (i.e., response formats) measuring frequency and intensity symptom severity separately has excellent fit and good reliability. Finally, the latent class analysis yielded a three-class solution best fitting to the data. Overall, the data provided evidence for the psychometric soundness of SADSSI as an assessment tool for separation anxiety symptoms among LBA.

Examining the Latent Dimensions of Social Anxiety Disorder.

While the body of literature has investigated the latent dimensions of Social Anxiety Disorder (SAD), only few have directly anchored in the DSM-5 SAD symptoms. Similarly, a continuing issue on measuring mental health disorders pertains to whether a symptom's frequency, intensity, or both, are appropriate and sufficient indicators of severity. To address this gap, the present study developed and validated a DSM-5-based measurement tool, the Social Anxiety Symptom Severity Inventory (SASSI), which assesses both the intensity (intensity of disturbance) and frequency (frequency of occurrence) of SAD symptoms. In study 1 (n = 6458, college students), the results revealed a two-factor structure using exploratory structural equation modeling. In study 2 (n = 425, left-behind emerging adults), confirmatory factor analysis, measurement invariance testing, and latent class analysis were used. Findings demonstrated the importance of using both frequency and intensity of symptoms in assessing SAD severity. Moreover, a five-class solution best fitted the sample. Studies 1 and 2 demonstrated the good psychometric properties of SASSI and filled an important gap among available measures in assessing SAD severity through symptom frequency and intensity.

Validating the Suicide Behavior Questionnaire-Revised among Filipino adults during the COVID-19 pandemic.

The study aimed to examine the validity of the Suicide Behavior Questionnaire-Revised (SBQ-R) among adult Filipinos experiencing severe depression symptoms during the COVID-19-related lockdowns in 2020. Results support SBQ-R's internal reliability. Confirmatory factor analyses supported SBQ-R's one-factor structure and its measurement invariance across gender and age. The SBQ-R's positive relationship with negative affect and its negative relationships with positive affect and family support demonstrate the questionnaire's criterion-related validity. The SBQ-R's cutoff of ≥8 shows that 78% of the sample were at-risk for suicide. The SBQ-R is valid in assessing suicide risk among severely depressed adults during the COVID-19 pandemic.

Parental migration status moderates the link between parent-child relationship and children's well-being through psychological distress.

The effects of parental migration on the well-being of left-behind children (LBC) are varied. Several studies demonstrated that parental migration reduces children's psychological health but other research showed contradictory results. This study sought to clarify this issue by examining the mediating role of psychological distress and the moderating role of parental migration status in the association between the parent-child relationship and children's psychological distress. A total of 743 LBC and 688 non-LBC self-reported their parent-child relationship, psychological distress, and well-being. Findings showed that psychological distress mediated the association between parent-child relationship and children's well-being. This denotes that greater parent-child relationship results into lowered levels of psychological distress, and in turn, increases children's emotional, psychological, and social well-being. Moreover, the link between parent-child relationship and psychological distress was found to be contingent to parental migration status. Specifically, the negative association between parent-child relationship and psychological distress was especially strong among LBC in contrast to non- LBC. This implies that children with higher quality relationships with their parents tend to exhibit decreased severity of psychological distress symptoms, especially in children whose parents are working overseas. These results underscore the dynamic role of parent-child relationship in the well-being of LBC, and suggest ways to develop intervention programs that include cultivating skills in managing psychological distress and improving the emotional, psychological, and social well-being of LBC.

DSM-5-Based ASD Models: Assessing the Latent Structural Relations with Functionality in War-Exposed Individuals.

There is a dearth of studies investigating the latent structure of Acute Stress Disorder (ASD) following the changes in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5). To date, there is no consensus on the best representation of ASD. This study addressed this gap by examining four latent ASD models in a sample of war-exposed individuals (N = 424). Investigation on the relationship of the best-fitting model to functionality in the latent level was also conducted. The five-factor model, composed of intrusion, avoidance, numbing, dysphoric arousal, and anxious arousal factors, yielded the best-fitting model. Latent associations between the factors of the model and functionality suggest that symptoms of functionality do not significantly affect the factor structure of ASD. These findings have implications for understanding the underlying mechanism of ASD and can inform the development of more nuanced trauma-related interventions, particularly addressing ASD symptoms and functionality separately.

Investigating the latent dimensions of posttraumatic stress disorder and the role of anxiety sensitivity in combat-exposed Filipino soldiers.

Identifying the optimal factor structure of posttraumatic stress disorder (PTSD) has recently been reinvigorated in literature due to the substantial changes to its diagnostic criteria in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Currently, six models of PTSD are supported in literature, but there is no consensus on the best-fitting factor structure. Additionally, the extant literature examining the relationship between PTSD symptom-grouping and AS in the latent level has been scarce. The present study's objectives are two-fold: first, we aimed to identify the best-fitted model of PTSD by comparing the six empirically-supported models, and; second, we examined the relationship between the best-fitting model with anxiety sensitivity (AS). Utilizing a sample of 476 combat-exposed soldiers, the results suggest that both the anhedonia and hybrid models provide the best fit to the data, with the anhedonia model achieving slightly better fit indices. Further, the examination on the influence of AS to PTSD reveal that while there is a pattern of decreasing factor loadings and factor correlations when accounting for AS, the changes are not significant to alter the PTSD symptom-structure. Based on these results, our findings suggest further investigation on the possible mediating or moderating mechanisms by which AS may influence PTSD.

The factor structure of complex PTSD in combat-exposed Filipino soldiers.

The World Health Organization recently released the 11th revision of the International Classification of Diseases with the inclusion of Complex Posttraumatic Stress Disorder (CPTSD). Despite the emerging research examining the symptom structure of CPTSD, to date, none so far have reached consensus on what best represents CPTSD, particularly in soldiers who are exposed regularly in combat situations. This study examined seven latent CPTSD models in a sample of Filipino combat-exposed soldiers (n = 450). Results of confirmatory factor analyses indicated that the correlated 6 factor first-order model (model 2), comprising of re-experiencing, avoidance, persistent sense of current threat, affective dysregulation, negative self-concept, and disturbances in relationships, has the best fit. These findings have implications for understanding CPTSD as a diagnostic entity and provide information on the assessment and crafting of complex trauma interventions, particularly among Filipino combat-exposed soldiers.

Personal psychological resources mediate parent-child relationship and mental health among left-behind children.

Discrepant findings on the impact of parental migration on left-behind children's (LBC) psychological health have been noted in the literature. While several studies have shown the negative effects of parental migration, burgeoning research has demonstrated contradictory findings. The present study aimed to clarify this issue by examining the association between family resources and mental health as mediated by personal psychological resources (PPRs). A sample comprised of 466 LBC (aged 11-17 years) answered a set of questionnaires assessing parent-child relationship, PPRs, and mental health symptoms. The results showed that PPRs, particularly emotional resources, significantly mediated the link between family resources and mental health. This suggests that LBC who have rich family resources (i.e., close parent-child relationship) have lower mental health problems due to higher emotional resources (i.e., satisfaction in life). Conversely, those who reported having poor family resources experienced a lower level of PPRs (i.e., emotional well-being), which in turn, increased their risk of having psychological distress. The "caravanning" of resources from family to personal resources is vital in protecting LBC's mental health.

Centrality of Event and Mental Health Outcomes in Child and Adolescent Natural Disaster Survivors.

The experience of trauma could be considered a central event in one's life, such that it could be a core component of one's identity and life story. Indeed, trauma memories are well-remembered, vivid, intense, and easily accessible (Berntsen & Rubin, 2006). The present study investigated the mediating role of sensory-based trauma memory quality in the relationship between centrality of event and mental health outcomes among child and adolescent survivors of a natural disaster (N = 225) in its immediate aftermath. Results of mediation analyses revealed that centrality of trauma event is related to symptoms of acute stress disorder and depression through sensory-based trauma memory quality (indirect effect 95% C.I. [.06, .11] and [.04, .10], respectively). These findings support the contention that centrality of event is associated to heightened accessibility and vividness of sensory-based trauma memory quality, which in turn is related to an increase in trauma-related symptoms in the immediate aftermath of a natural disaster, where the reminders of trauma are particularly salient in the survivors' environment and daily activities.

The latent structure of major depressive symptoms and its relationship with somatic disorder symptoms among Filipino female domestic workers in China.

Emerging research have investigated the factor structure of major depressive disorder (MDD) symptoms based on DSM-5 nomenclature. However, to date, results have been inconsistent on what symptom-structure best represent MDD. This study examines the best fitting MDD among four competing models in a sample of overseas Filipino domestic helpers (N = 232). The results show that a two-factor model (Model 2b; Krause et al., 2010) provided the best fit. The model consist of two factors: somatic and non-somatic/affective symptoms. Somatic component includes sleep difficulties, fatigue, appetite changes, concentration difficulties, and psychomotor agitation/retardation while non-somatic/affective component covers anhedonia, depressed mood, feelings of worthlessness, and thoughts of death. Further, the results reveal a pattern where PHQ-15 somatic symptom-items have a higher significant relationship with MDD's somatic symptoms than with the MDD's non-somatic/affective symptoms. These findings suggest that the items of model 2b are appropriately embedded in their respective factors. Differentiating MDD factors have important clinical implications, particularly in the diagnosis and treatment of depression among overseas Filipino domestic helpers.

Assessing the Latent Structure of Posttraumatic Growth and Its Relationship With Cognitive Processing of Trauma Among Filipino Women Victims of Intimate Partner Abuse.

The study intends to find out which model best represents posttraumatic growth's (PTG) latent factor structure in a sample of Asian, particularly Filipino, women victims of intimate partner abuse (IPA) using Posttraumatic Growth Inventory (PTGI). In addition, it also aims to find out the differential relationships of the components of the best-fitting PTG model with cognitive processing strategies. Confirmatory factor analyses were conducted with the one-factor, three-factor, and five-factor models of PTG in a sample of 217 Filipino women who have history of IPA within the last 6 months of a previous or current relationship. Results revealed that the five-factor model comprised of appreciation of life, new possibilities, personal strength, spiritual change, and relating to others best fits the sample. Furthermore, all the components of the five-factor model were found to be positively correlated with cognitive processing of trauma strategies, including positive cognitive restructuring, denial, downward comparison, regret, and resolution/acceptance, albeit in varying degrees. These findings confirmed the robustness of the five-factor model of PTG compared with other models in a sample of women victims of IPA. In addition, the findings demonstrated the relationship of PTG with cognitive processing of trauma. These findings would be useful in developing cognitive interventions for women who experienced IPA.

Centrality of event and mental health outcomes in child and adolescent natural disaster survivors

The experience of trauma could be considered a central event in one's life, such that it could be a core component of one's identity and life story. Indeed, trauma memories are well-remembered, vivid, intense, and easily accessible (Berntsen & Rubin, 2006). The present study investigated the mediating role of sensory-based trauma memory quality in the relationship between centrality of event and mental health outcomes among child and adolescent survivors of a natural disaster (N = 225) in its immediate aftermath. Results of mediation analyses revealed that centrality of trauma event is related to symptoms of acute stress disorder and depression through sensory-based trauma memory quality (indirect effect 95% C.I. [.06, .11] and [.04, .10], respectively). These findings support the contention that centrality of event is associated to heightened accessibility and vividness of sensory-based trauma memory quality, which in turn is related to an increase in trauma-related symptoms in the immediate aftermath of a natural disaster, where the reminders of trauma are particularly salient in the survivors' environment and daily activities

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DSM-5-based latent PTSD models: Assessing structural relations with GAD in Filipino post-relocatees.

An increasing number of studies investigated the latent factor structure of posttraumatic stress disorder (PTSD) symptomatology following the new fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). To date, there is no consensus on the best representation of PTSD. This study examined six latent PTSD models in a sample of Filipino post-disaster relocatees (N = 523). Further investigation on the relationship of the best-fitting model to generalized anxiety disorder (GAD) in the latent level was conducted. The seven-factor hybrid model consisting of intrusion, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal, was the best fitting model. Latent associations between the factors in the hybrid model and GAD suggest there are core and transdiagnostic features of PTSD. These findings have implications for understanding the underlying mechanism of PTSD and can inform the development of trauma-related interventions, particularly among post-disaster relocatees.

Evidence of the paradoxical effect of social network support: A study among Filipino domestic workers in China.

Labor migrants are at an increased risk for poor mental health. Post-migration stressors contribute significantly to this risk. Social network supports are vitally important to protect health but little is known about the role of social network supports among labor migrants. The current study evaluated the role of migration stressors on poor mental health among Filipino female domestic workers (FDW) and whether family and friend social network support (SNS) modified this relationship. Data were collected from 261 FDWs in Macau, China from May to September 2013. Hierarchical multiple regression was conducted to test for direct and moderating effects of social networks on psychological distress. Post-migration stress was associated with increased anxiety, depression, somatization, and post-traumatic stress disorder symptoms. SNS from family was not associated with the four psychological symptoms nor did it modify the association between stress and these symptoms. SNS from friends was positively associated with these symptoms, and significantly moderated the relationship between stress and these symptoms. Counterintuitive to the known buffering effects of SNS, greater SNS was associated with greater psychological symptoms among FDWs exposed to post-migration stressors. The present findings suggest that reliance on SNS to cope with post-migration stressors may worsen psychological distress.

Examining the dimensional structure models of secondary traumatic stress based on DSM-5 symptoms.

Latent factor structure of Secondary Traumatic Stress (STS) has been examined using Diagnostic Statistic Manual-IV (DSM-IV)'s Posttraumatic Stress Disorder (PTSD) nomenclature. With the advent of Diagnostic Statistic Manual-5 (DSM-5), there is an impending need to reexamine STS using DSM-5 symptoms in light of the most updated PTSD models in the literature. The study investigated and determined the best fitted PTSD models using DSM-5 PTSD criteria symptoms. Confirmatory factor analysis (CFA) was conducted to examine model fit using the Secondary Traumatic Stress Scale in 241 registered and practicing Filipino nurses (166 females and 75 males) who worked in the Philippines and gave direct nursing services to patients. Based on multiple fit indices, the results showed the 7-factor hybrid model, comprising of intrusion, avoidance, negative affect, anhedonia, externalizing behavior, anxious arousal, and dysphoric arousal factors has excellent fit to STS. This model asserts that: (1) hyperarousal criterion needs to be divided into anxious and dysphoric arousal factors; (2) symptoms characterizing negative and positive affect need to be separated to two separate factors, and; (3) a new factor would categorize externalized, self-initiated impulse and control-deficit behaviors. Comparison of nested and non-nested models showed Hybrid model to have superior fit over other models. The specificity of the symptom structure of STS based on DSM-5 PTSD criteria suggests having more specific interventions addressing the more elaborate symptom-groupings that would alleviate the condition of nurses exposed to STS on a daily basis.

PTSD's Underlying Dimensions in Typhoon Haiyan Survivors: Assessing DSM-5 Symptomatology-Based PTSD Models and Their Relation to Posttraumatic Cognition.

The recent changes in posttraumatic stress disorder (PTSD) symptomatology in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) call for a re-examination of PTSD's latent factor structure. The present study assessed six competing models of PTSD based on DSM-5 symptomatology using confirmatory factor analysis in a sample of young adult Filipino survivors of typhoon Haiyan, one of the strongest typhoons in the world ever recorded at the time of its landfall (N = 632). Furthermore, the differential relationships of the factors of the best-fitting model with posttraumatic cognitions were also investigated. Results showed the 7-factor hybrid model of PTSD comprised of intrusion, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal, to be the best fitting model. In addition, the varying degrees of relationship with posttraumatic cognitions support the distinctiveness of each factor. These findings are pertinent in light of the changes in DSM-5 PTSD symptomatology, as well as in understanding the underlying dimensions of PTSD among Asian, particularly Filipino, survivors of a natural disaster.

PTSD factor structure and relationship with self-construal among internally displaced persons.

The present study examined the factor structure of six competing posttraumatic stress disorder (PTSD) models based on the recent changes in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in a sample that, while highly vulnerable to PTSD, very few studies have focused on-Asians, particularly Filipino internally displaced persons (IDPs). In recognition of the role of culture in PTSD factor structure, we also investigated the associations of the factors of the best-fitting model with self-construal. A sample of 460 IDPs in government resettlement communities participated in the study. Results of confirmatory factor analyses revealed the seven-factor hybrid model composed of intrusion, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal as the best-fitting model. Furthermore, it was found that associations between independent self-construal and PTSD factors were higher than that of interdependent self-construal and PTSD factors.