(PS6-55) PTSD Symptom Structure in Youth Exposed to Interpersonal Violence: Support for a Four-factor Model

Until 1987, the diagnosis of posttraumatic stress disorder (PTSD) was reserved for adult trauma survivors (Friedman, 2013). In 1987, the American Psychiatric Association (APA) introduced developmental considerations for PTSD (Cohen & Scheeringa, 2009) and organized symptoms into three clusters—re-experiencing, avoidance and numbing, and physiological arousal (APA, 1987). The APA added an additional cluster—negative alterations in cognition and mood—in Diagnostic and Statistical Manual of Mental Disorders-5^th edition (DSM-V). Although abundant research exists on proposed factor models of PTSD in adults (e.g., King et al., 1990; Simms et al., 2002), the literature on youth is scarce and inconsistent as to whether a multi-factor solution with the 4 symptom clusters outperforms a one-factor solution (Espinosa et al., 2018; Hermosilla et al., 2021; Stewart et al., 2014). For clinicians to effectively target PTSD symptoms in youth, it is critical to understand the symptom structure and how it may differ from that of adult survivors. Thus, for the proposed poster, we aim to evaluate the structure of relationships between PTSD symptoms in youth via Exploratory Factor Analysis (EFA). Bottom of Form

Participants are traumatized youth (N = 117; ages 4-17) who are in an ongoing study of trauma-specific cognitive-behavioral therapy at a community clinic. Participants completed the Child PTSD Symptom Scale for DSM-Fifth Edition (CPSS-V; Foa & Capaldi, 2013) to assess symptoms from DSM-V’s four clusters. Pre-treatment CPSS-V scores were analyzed using Principal Axis Factoring (Suhr, 2005). Based on known correlations between PTSD symptoms in youth (Ayer et al., 2011), a direct oblimin rotation was used. Factors were determined by evaluation of the eigenvalues (λ > 1) and scree plot. Item loadings above 0.32 were accepted, and items that loaded significantly onto multiple factors were removed (Tabachnick & Fidell, 2007).

Four factors emerged and explain 57.5% of the variance. Factor 1, which explains 37.5% of the variance, includes negative feelings about self, others, or the world, self-blame, negative emotions, anhedonia, feelings of detachment, inability to experience positive emotions, difficulty concentrating, and sleep disturbances. Factor 2, which explains 7.6% of the variance, includes both items from the DSM-V’s Avoidance cluster. Items from the Re-Experiencing cluster, excluding nightmares, from Factor 3 and explain 6.4% of the variance. Nightmares, irritability, reckless behavior, hypervigilance, and exaggerated startle loaded onto Factor 4, which explains 6.1% of the variance.  

Our results support a four-factor model of PTSD in youth exposed to IPV. Symptoms of depression comprised the strongest factor, consistent with findings that IPV yields higher rates of depression than other trauma types in both youth and adults (Hedkte et al., 2008; Vibhakar, 2019) Future research should explore whether symptom structure of PTSD in youth is impacted by age, trauma type, or chronicity.