重新评估 PTSD 清单的维度结构：基于 DSM-IV 的 PCL-C 的经验教训。
Reappraising the dimensional structure of the PTSD Checklist: lessons from the DSM-IV-based PCL-C.
机构信息
Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil.
Programa de Mestrado em Saúde da Família, Universidade Estácio de Sá, Rio de Janeiro, RJ, Brazil.
出版信息
Braz J Psychiatry. 2018;40(2):154–162. doi: 10.1590/1516-4446-2017-2239. Epub 2017 Oct 19.
OBJECTIVE
The dimensional structure of posttraumatic stress disorder (PTSD) has been extensively debated, but the literature is still inconclusive and contains gaps that require attention. This article sheds light on hitherto unvisited methodological issues, reappraising several key models advanced for the DSM-IV-based civilian version of the PTSD Checklist (PCL-C) as to their configural and metric structures.
METHODS
The sample comprised 456 women, interviewed at 6-8 weeks postpartum, who attended a high-complexity facility in Rio de Janeiro, Brazil. Confirmatory factor analysis (CFA) and exploratory structural equation models (ESEM) were used to evaluate the dimensional structure of the PCL-C.
RESULTS
The original three-factor solution was rejected, along with the four-factor structures most widely endorsed in the literature (PTSD-dysphoria and PTSD-numbing models). Further exploration supported a model comprised of two factors (re-experience/avoidance and numbing/hyperarousal).
CONCLUSION
These findings are at odds with the dimensional structure proposed in both DSM-IV and DSM-5. This also entails a different presumption regarding the latent structure of PTSD and how the PCL should be operationalized.
目的
创伤后应激障碍（PTSD）的维度结构一直存在广泛争议，但文献仍不明确，存在需要关注的空白。本文揭示了迄今未被涉及的方法学问题，重新评估了为基于 DSM-IV 的平民版 PTSD 检查表（PCL-C）提出的几个关键模型，以评估其组态和度量结构。
方法
该样本包括 456 名女性，在巴西里约热内卢的一家高复杂度机构接受了产后 6-8 周的访谈。采用验证性因子分析（CFA）和探索性结构方程模型（ESEM）来评估 PCL-C 的维度结构。
结果
最初的三因素解决方案以及文献中最广泛认可的四因素结构（PTSD 烦躁不安和 PTSD 麻木模型）被拒绝。进一步的探索支持了一个由两个因素（再体验/回避和麻木/过度警觉）组成的模型。
结论
这些发现与 DSM-IV 和 DSM-5 提出的维度结构不一致。这也意味着对 PTSD 的潜在结构以及 PCL 的操作化方式有不同的假设。
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