Tay Alvin Kuowei, Mohsin Mohammed, Rees Susan, Steel Zachary, Tam Natalino, Soares Zelia, Baker Jessica, Silove Derrick
Psychiatry Research and Teaching Unit, Academic Mental Health Unit, School of Psychiatry, University of New South Wales, Cnr Forbes and Campbell Streets, Liverpool, NSW, 2170, Australia.
The Black Dog Institute, Sydney, Australia.
BMC Psychiatry. 2017 May 22;17(1):191. doi: 10.1186/s12888-017-1340-0.
Post-traumatic stress disorder (PTSD) is the most widely assessed form of mental distress in cross-cultural studies conducted amongst populations exposed to mass conflict and displacement. Nevertheless, there have been longstanding concerns about the universality of PTSD as a diagnostic category when applied across cultures. One approach to examining this question is to assess whether the same factor structure can be identified in culturally diverse populations as has been described in populations of western societies. We examine this issue based on an analysis of the Harvard Trauma Questionnaire (HTQ) completed by a large community sample in conflict-affected Timor-Leste.
Culturally adapted measures were applied to assess exposure to conflict-related traumatic events (TEs), ongoing adversities, symptoms of PTSD and psychological distress, and functional impairment amongst a large population sample (n = 2964, response rate: 82.4%) in post-conflict Timor-Leste.
Confirmatory factor analyses of the ICD-10, ICD-11, DSM-IV, four-factor Emotional Numbing and five-factor Dysphoric-Arousal PTSD structures, found considerable support for all these models. Based on these classifications, concurrent validity was indicated by logistic regression analyses which showed that being a woman, trauma exposure, ongoing adversity, severe distress, and functional impairment were all associated with PTSD.
Although symptom prevalence estimates varied widely based on different classifications, our study found a general agreement in PTSD assignments across contemporary diagnostic systems in a large conflict-affected population in Timor-Leste. Further studies are needed, however, to establish the construct and concurrent validity of PTSD in other cultures.
创伤后应激障碍(PTSD)是在遭受大规模冲突和流离失所的人群中进行的跨文化研究中评估最广泛的心理困扰形式。然而,当跨文化应用时,人们长期以来一直对PTSD作为一种诊断类别是否具有普遍性存在担忧。检验这个问题的一种方法是评估在不同文化背景的人群中是否能识别出与西方社会人群中所描述的相同的因素结构。我们基于对东帝汶一个受冲突影响的大型社区样本完成的哈佛创伤问卷(HTQ)的分析来研究这个问题。
采用经过文化调适的测量方法,对东帝汶冲突后大量人群样本(n = 2964,应答率:82.4%)中的冲突相关创伤事件暴露情况、持续逆境、PTSD症状和心理困扰以及功能损害进行评估。
对国际疾病分类第10版(ICD - 10)、国际疾病分类第11版(ICD - 11)、精神疾病诊断与统计手册第4版(DSM - IV)、四因素情感麻木和五因素烦躁 - 唤醒PTSD结构进行验证性因素分析,发现所有这些模型都得到了相当多的支持。基于这些分类,逻辑回归分析表明了同时效度,该分析显示女性、创伤暴露、持续逆境、严重困扰和功能损害都与PTSD相关。
尽管基于不同分类得出的症状患病率估计差异很大,但我们的研究发现,在东帝汶一个受冲突影响的大型人群中,当代诊断系统对PTSD的诊断基本一致。然而,还需要进一步研究以确定PTSD在其他文化中的结构效度和同时效度。