Al Barathie Josleen, Karam Elie G
Institute for Development, Research, Advocacy, and Applied Care (IDRAAC), Beirut, Lebanon.
Department of Psychiatry and Clinical Psychology, Saint George University Beirut, Beirut, Lebanon.
PLoS One. 2025 May 8;20(5):e0323422. doi: 10.1371/journal.pone.0323422. eCollection 2025.
Post Traumatic Stress Disorder (PTSD), a psychological condition linked to traumatic events, sees continuous Diagnostic Statistical Manual (DSM) criteria adjustments. The PTSD Checklist (PCL-5) is a favored screening tool for its versatility. Exploratory and Confirmatory Factor Analysis (EFA/CFA) studies on PCL-5's utility across languages and settings reveal varied models, with conflicting outcomes attributed to methodological differences. Prompted by lack of research on PCL-5 in populations exposed to multiple collective traumas, we aim to conduct an EFA among a Lebanese nationally representative sample. To our knowledge, this study represents the first attempt at PCL-5 construct validation in Arabic. Recruitment involved 1,000 Lebanese adults aged 18 +. EFA with Promax rotation, aimed to identify the minimal number of factors among PCL-5 items, supported by Kaiser-Meyer-Olkin (KMO) and Bartlett's test of sphericity. Eigenvalues above 1 indicate appropriateness for EFA with two retained factors (trauma specific vs non-trauma specific), supported by the scree plot with loadings ranging from 0.532 to 0.775. Understanding PCL-5's structural factors is crucial, as it directly impacts diagnostic algorithms in clinical and research settings and informs knowledge about PTSD's comorbidities. This, in turn, affects disorder prevalence, etiology, and intervention formulation. Our paper offers suggestions to tackle PCL-5 performance amidst comorbidity, categorized into DSM and non-DSM related recommendations. DSM-related recommendations include grouping PTSD, depression, and anxiety into a single "distress" disorder or eliminating non-specific PTSD symptoms. Non-DSM-related recommendations propose a shift towards a transdiagnostic approach and advocating for nuanced clinical interviews over self-report questionnaires to address symptom complexity and potential double counting in individuals with significant emotional distress.
创伤后应激障碍（PTSD）是一种与创伤性事件相关的心理状况，其诊断统计手册（DSM）标准一直在持续调整。PTSD检查表（PCL-5）因其多功能性而成为一种受欢迎的筛查工具。对PCL-5在不同语言和环境中的效用进行的探索性和验证性因素分析（EFA/CFA）研究揭示了不同的模型，由于方法上的差异，结果相互矛盾。由于缺乏对遭受多重集体创伤人群中PCL-5的研究，我们旨在对黎巴嫩具有全国代表性的样本进行探索性因素分析。据我们所知，本研究是首次对阿拉伯语版PCL-5进行结构效度验证的尝试。招募了1000名18岁及以上的黎巴嫩成年人。采用Promax旋转的探索性因素分析旨在确定PCL-5各项目中的最少因素数量，并得到了Kaiser-Meyer-Olkin（KMO）和Bartlett球形检验的支持。特征值大于1表明适合进行探索性因素分析，保留两个因素（创伤特异性与非创伤特异性），碎石图显示载荷范围为0.532至0.775，支持这一结果。了解PCL-5的结构因素至关重要，因为它直接影响临床和研究环境中的诊断算法，并为有关PTSD共病的知识提供信息。这反过来又会影响疾病的患病率、病因和干预措施的制定。我们的论文针对合并症情况下PCL-5的表现提出了建议，分为与DSM相关和与非DSM相关的建议。与DSM相关的建议包括将PTSD、抑郁症和焦虑症归为单一的“痛苦”障碍，或消除非特异性PTSD症状。与非DSM相关的建议提出转向跨诊断方法，并提倡进行细致入微的临床访谈，而不是自我报告问卷，以解决症状复杂性以及有严重情绪困扰的个体中可能存在的重复计数问题。
