Center for Injury Research and Prevention, Children's Hospital of Philadelphia, 3535 Market Street, Suite 1150, Philadelphia, PA 19104, USA.
J Am Acad Child Adolesc Psychiatry. 2010 Jun;49(6):616-25, 625.e1-4. doi: 10.1016/j.jaac.2010.02.011. Epub 2010 Apr 9.
To examine the factor structure of posttraumatic stress disorder (PTSD) symptoms in children and adolescents who have experienced an acute single-incident trauma, associations between PTSD symptom clusters and functional impairment, and the specificity of PTSD symptoms in relation to depression and general distress.
Examined PTSD symptom structure in two samples of children (8 to 17 years of age) assessed an average of 6 months after unintentional injury: (1) a combined dataset of 479 children assessed with a PTSD symptom checklist, and (2) a sample of 204 children assessed via a standardized clinical interview. We evaluated the fit of six alternative models for the factor structure of PTSD symptoms, and the association of PTS symptom clusters with indicators of functional impairment. We then evaluated three models for the structure of PTSD and depression symptoms jointly, to examine specificity of PTSD versus general distress or mood symptoms.
In both samples, the DSM-IV 3-factor model fit the data reasonably well. Two alternative four-factor models fit the data very well: one that separates effortful avoidance from emotional numbing, and one that separates PTSD-specific symptoms from general emotional distress. Effortful avoidance and dysphoria symptoms were most consistently associated with impairment. The best-fitting model for PTSD and depression symptom clusters had three factors: PTSD-specific, depression-specific, and general dysphoria symptoms.
The DSM-IV model for PTSD symptom categories was a reasonable fit for these child data, but several alternative models fit equally well or better, and suggest potential improvements to the current diagnostic criteria for PTSD in children.
探讨经历急性单一创伤后儿童和青少年创伤后应激障碍（PTSD）症状的因素结构、PTSD 症状群与功能障碍之间的关系，以及 PTSD 症状与抑郁和一般痛苦的特异性。
在两组儿童（8 至 17 岁）中检查 PTSD 症状结构，这些儿童在意外受伤后平均 6 个月接受评估：（1）使用 PTSD 症状清单评估的 479 名儿童的综合数据集；（2）通过标准化临床访谈评估的 204 名儿童的样本。我们评估了 PTSD 症状结构的六种替代模型的拟合度，以及 PTS 症状群与功能障碍指标的关联。然后，我们评估了 PTSD 和抑郁症状结构的三个联合模型，以检查 PTSD 与一般痛苦或情绪症状的特异性。
在两个样本中，DSM-IV 的三因素模型对数据的拟合度都相当好。两种替代的四因素模型对数据的拟合度非常好：一种将努力回避与情感麻木分开，另一种将 PTSD 特异性症状与一般情绪困扰分开。努力回避和烦躁症状与损伤最一致相关。PTSD 和抑郁症状群的最佳拟合模型有三个因素：PTSD 特异性、抑郁特异性和一般烦躁症状。
DSM-IV 对 PTSD 症状类别的模型是这些儿童数据的合理拟合，但几种替代模型的拟合度同样好或更好，并建议对儿童 PTSD 的当前诊断标准进行可能的改进。
