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      Symptom structure of ICD-11 Complex Posttraumatic Stress Disorder (CPTSD) in trauma-exposed foster children: examining the International Trauma Questionnaire – Child and Adolescent Version (ITQ-CA) Translated title: Estructura de los síntomas del TEPT complejo de la CIE-11 en niños de crianza temporal expuestos a traumas: Revisión del Cuestionario Internacional sobre Traumatismos - Versión para niños y adolescentes (ITQ-CA) Translated title: 创伤暴露的寄养儿童中ICD-11复杂性PTSD的症状结构:对国际创伤问卷-儿童和青少年版 (ITQ-CA) 的考查

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          ABSTRACT

          Background: The 11th edition of the International Classification of Diseases (ICD-11) introduces Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD) as two distinct trauma-related disorders. Numerous studies support the proposed symptom structure of ICD-11 CPTSD in adults, but only a few studies have examined CPTSD symptom structure in children, reporting diverging results. To assess ICD-11 CPTSD in children, the International Trauma Questionnaire (ITQ) was recently adapted for children and adolescents (ITQ-CA), with no validated German version available yet.

          Objective: This study aimed (1) to test the symptom structure of ICD-11 CPTSD in a sample of trauma-exposed foster children using the ITQ-CA, and (2) to examine the concurrent, convergent and discriminant validity of the German ITQ-CA.

          Method: Altogether, 161 Austrian foster children completed a set of standardized measures, resulting in a final sample of 135 trauma-exposed foster children meeting the inclusion criteria. Psychometric properties of the ITQ-CA were assessed using confirmatory factor analysis (CFA), bivariate correlations and multivariate regression.

          Results: CFA supported ICD-11 CPTSD symptom structure in children as a two-factor higher-order model with PTSD and Disturbances in Self-Organization (DSO) as correlated factors with very good model fit, while a one-factor higher-order model also fitted the data very well. High factor loadings and excellent levels of internal reliability evidenced the psychometric adequacy of the ITQ-CA. Concurrent and convergent validity were evidenced by high correlations between ITQ-CA scales and criterion variables (PTSD symptoms, depression, anxiety, dissociation, lifetime traumatization). Discriminant validity was partly supported by PTSD and DSO being differently predicted by exogenous criterion variables.

          Conclusions: CPTSD symptom structure in children is in support of the ICD-11 conceptualization. The reliability and validity of the German ITQ-CA are evidenced for the first time, identifying it as an easy-to-use screening instrument to assess ICD-11 PTSD and CPTSD in children. Further implications and areas for upcoming studies are discussed.

          HIGHLIGHTS:

          • CPTSD symptom structure in children supports the ICD-11 conceptualization.• The German ITQ-CA was validated as a viable screening instrument to assess ICD-11 PTSD and CPTSD in children.• PTSD and DSO were associated with lifetime traumatization, depression, anxiety and dissociation.

          Antecedentes: La CIE-11 recientemente publicada presenta el trastorno de estrés postraumático (TEPT) y el trastorno de estrés postraumático complejo (TEPT-C) como dos trastornos distintos relacionados con trauma. Numerosos estudios apoyaron la estructura de síntomas propuesta de TEPT-C en adultos de la CIE-11, pero solo unos pocos estudios examinaron la estructura de síntomas de TEPT-C en niños, reportando resultados divergentes. Para evaluar TEPT-C en niños según la CIE-11, el Cuestionario Internacional de Trauma (ITQ) fue adaptado recientemente para niños y adolescentes (ITQ-CA), sin una versión alemana validada disponible todavía.

          Objetivo: El estudio actual se estableció para (1) probar la estructura de síntomas de TEPT-C según la CIE-11 en una muestra de niños de crianza temporal expuestos a traumas utilizando el ITQ-CA y para (2) examinar la validez concurrente, convergente y discriminante de la versión en alemán del ITQ-CA.

          Método: Ciento sesenta y un niños de crianza temporal austriacos completaron un conjunto de medidas estandarizadas, lo que resultó en una muestra final de 135 niños de crianza temporal expuestos a traumas que cumplieron con los criterios de inclusión. Las propiedades psicométricas del ITQ-CA se evaluaron mediante análisis factorial confirmatorio (AFC), correlaciones bivariadas y regresión de objetivos multivariados.

          Resultados: AFC respaldó la estructura de síntomas de TEPT-C según CIE-11 en niños como modelo de dos factores de orden superior con TEPT y DSO (Perturbaciones en la organización del sí mismo) como factores correlacionados con muy buen ajuste del modelo, mientras que un modelo de un factor de orden superior también se ajustó muy bien a los datos. Las altas cargas factoriales y los excelentes niveles de confiabilidad interna evidenciaron la adecuación psicométrica del ITQ-CA. La validez concurrente y convergente se evidenció por las altas correlaciones entre las escalas ITQ-CA y las variables de criterio (síntomas de TEPT, depresión, ansiedad, disociación, traumatismo de por vida). La validez discriminante fue apoyada en parte por el TEPT y DSO siendo diferenciadamente predicho por variables de criterio exógenas.

          Conclusiones: La estructura de los síntomas del TEPT-C en los niños respalda la conceptualización de la CIE-11. La confiabilidad y validez de la ITQ-CA alemana se evidencia por primera vez, identificándola como un instrumento de cribado fácil de usar para evaluar el TEPT y TEPT-C de la CIE-11 en niños. Se discuten más implicaciones y áreas para futuros estudios.

          背景: 最近发布的ICD-11引入了创伤后应激障碍 (PTSD) 和复杂性PTSD (CPTSD) 作为两种不同的创伤相关障碍。许多研究支持了成人中提出的ICD-11 CPTSD症状结构, 但只有极少数研究考查了儿童CPTSD症状结构, 并且报告的结果大不相同。为评估儿童的ICD-11 CPTSD, 最近针对儿童和青少年改编了国际创伤问卷 (ITQ-CA), 但尚无经过验证的德语版可用。

          目的:本研究旨在 (1) 使用ITQ-CA考查创伤暴露的寄养儿童样本中ICD-11 CPTSD的症状结构, 以及 (2) 考查德语版ITQ-CA的同时效度, 收敛效度和区分效度。

          方法: 161名奥地利寄养儿童完成了一套标准化测量, 最终获得了135名符合纳入标准的创伤暴露寄养儿童样本。使用验证性因子分析 (CFA), 双变量相关和多目标回归分析评估ITQ-CA的心理计量学性质。

          结果: CFA支持儿童ICD-11 CPTSD症状结构作为拟合良好的, 以PTSD和DSO为相关因子的两因子高阶模型, 而单因子高阶模型也很好地拟合了数据。高因子载荷和极好的内部信度证明了ITQ-CA在心理计量方面的合格性。同时效度和收敛效度由ITQ-CA量表与标准变量 (PTSD症状, 抑郁, 焦虑, 解离, 终身创伤) 之间的高度相关得到验证。外源标准变量对PTSD和DSO不同的预测程度部分支持了区分效度。

          结论: 儿童CPTSD症状结构支持ICD-11的概念化。首次证明了德语版ITQ-CA的信效度, 将其确定为评估儿童ICD-11 PTSD和CPTSD的简便易用的筛查工具。讨论了进一步的影响和即将开展的研究领域。

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          A brief measure for assessing generalized anxiety disorder: the GAD-7.

          Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
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            The PHQ-9: validity of a brief depression severity measure.

            While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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              Sensitivity of Goodness of Fit Indexes to Lack of Measurement Invariance

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                Author and article information

                Journal
                Eur J Psychotraumatol
                Eur J Psychotraumatol
                European Journal of Psychotraumatology
                Taylor & Francis
                2000-8198
                2000-8066
                5 November 2020
                2020
                : 11
                : 1
                : 1818974
                Affiliations
                [0001]Unit of Psychotraumatology, Faculty of Psychology, University of Vienna; , Vienna, Austria
                Author notes
                CONTACT A. Haselgruber alexander.haselgruber@ 123456univie.ac.at Unit of Psychotraumatology, Faculty of Psychology, University of Vienna; , ViennaA-1010, Austria
                Article
                1818974
                10.1080/20008198.2020.1818974
                7678682
                33244361
                2e8d0d69-4c21-4b3b-ba0e-92c6b1f2275b
                © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Figures: 1, Tables: 5, References: 38, Pages: 1
                Categories
                Research Article
                Basic Research Article

                Clinical Psychology & Psychiatry
                symptom structure,complex posttraumatic stress disorder (cptsd),icd-11,foster children,international trauma questionnaire –child and adolescent version (itq-ca),german,estructura de síntomas,trastorno de estrés postraumático complejo (tept-c),cie-11,niños de crianza temporal,cuestionario internacional de trauma - versión para niños y adolescentes (itq-ca),alemán,关键词:症状结构,复杂性创伤后应激障碍 (cptsd),寄养儿童国际创伤问卷-儿童和青少年版 (itq-ca),德语版

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