Palmieri Patrick A, Weathers Frank W, Difede JoAnn, King Dainel W
Center for the Treatment and Study of Traumatic Stress and Department of Psychiatry, St. Thomas Hospital, Summa Health System, Akron, OH 44310, USA.
J Abnorm Psychol. 2007 May;116(2):329-41. doi: 10.1037/0021-843X.116.2.329.
Although posttraumatic stress disorder (PTSD) factor analytic research has yielded little support for the DSM-IV 3-factor model of reexperiencing, avoidance, and hyperarousal symptoms, no clear consensus regarding alternative models has emerged. One possible explanation is differential instrumentation across studies. In the present study, the authors used confirmatory factor analysis to compare a self-report measure, the PTSD Checklist (PCL), and a structured clinical interview, the Clinician-Administered PTSD Scale (CAPS), in 2,960 utility workers exposed to the World Trade Center Ground Zero site. Although two 4-factor models fit adequately for each measure, the latent structure of the PCL was slightly better represented by correlated reexperiencing, avoidance, dysphoria, and hyperarousal factors, whereas that of the CAPS was slightly better represented by correlated reexperiencing, avoidance, emotional numbing, and hyperarousal factors. After accounting for method variance, the model specifying dysphoria as a distinct factor achieved slightly better fit. Patterns of correlations with external variables provided additional support for the dysphoria model. Implications regarding the underlying structure of PTSD are discussed.
尽管创伤后应激障碍（PTSD）的因素分析研究几乎没有为《精神疾病诊断与统计手册》第四版（DSM-IV）中关于再体验、回避和过度警觉症状的三因素模型提供支持，但对于替代模型尚未形成明确的共识。一种可能的解释是各研究中测量工具的差异。在本研究中，作者运用验证性因素分析，对2960名接触过世贸中心遗址的公共事业工人，比较了一种自我报告测量工具——创伤后应激障碍检查表（PCL），以及一种结构化临床访谈工具——临床医生管理的创伤后应激障碍量表（CAPS）。虽然两种四因素模型对每种测量工具都拟合得较好，但PCL的潜在结构由相关的再体验、回避、烦躁和过度警觉因素能稍好地体现，而CAPS的潜在结构由相关的再体验、回避、情感麻木和过度警觉因素能稍好地体现。在考虑了方法方差后，将烦躁作为一个独立因素的模型拟合得稍好。与外部变量的相关模式为烦躁模型提供了额外支持。文中讨论了关于创伤后应激障碍潜在结构的意义。
