• Exploration of cross-cultural adaptability of PTSD among trauma survivors in Northern Iraq, Thailand, and the Democratic Republic of Congo: Application of item response theory and classical test theory

      Michalopoulos, Lynn Theresa Murphy; Cornelius, Llewellyn Joseph, 1959- (2013)
      Background: There has been an ongoing debate in the trauma field regarding the validity of Post-Traumatic Stress Disorder (PTSD) as a construct among trauma-affected populations displaced from or living in non-Western, low and middle income countries. Some researchers argue that PTSD is a Western construct that is only relevant in Western settings, while others assert that PTSD may be a universal concept. Purpose: To determine if there are a core set of PTSD symptoms that are applicable across three non-Western low and middle income countries (LMIC). Methods: Secondary data analysis was conducted from baseline, screening and validity studies among torture survivors in Northern Iraq, sexual violence survivors in the Democratic Republic of Congo (DRC), and Burmese survivors of mass human rights violations in Thailand. Item response theory (IRT) and confirmatory factor analysis (CFA) was conducted to explore core PTSD symptoms. Results: Confirmatory factor analyses indicated that the best fitting model for the whole sample was a 4-factor "numbing" model (with effortful avoidance, arousal, numbing and intrusion factors). Results from the multidimensional IRT rating scale model indicated four core items across the whole sample. Accounting for multidimensionality with the "numbing" PTSD model, the four items were from the effortful avoidance and arousal domains. Results revealed that seven items demonstrated differential item functioning were from the re-experiencing, numbing, and arousal domains. All items demonstrated statistically significant differential item functioning but small to moderate effect size. Conclusions: Core items found across the three countries are indicative of culturally relevant items that are concrete in nature, as well as relatively easy to measure and operationalize. The small effect size in the potential DIF items suggests that there is little meaningful/clinical difference of the items across country for general screening of PTSD symptoms. However, in clinical settings where a specific assessment for culture is developed or utilized, DIF items should potentially be accounted for and analyzed as having item bias. In general, findings suggest that measurement PTSD has universal as well as country-specific aspects.
    • Sociocultural Mechanisms Associated with Posttraumatic Stress Disorder: An Analysis of Latino Veterans

      LeFevre, Ann L.; Harrington, Donna; Gioia, Deborah (2011)
      Although numerous risk factors are related to the development of PTSD and the severity of PTSD symptoms, ethnicity - especially factors related to Latino ethnicity - has recently been reported as a risk factor in numerous studies. The purpose of this study was to identify and examine social and cultural factors that may contribute to the development of PTSD and increased PTSD symptom severity among Latino veterans through the development of a cultural model of traumatic stress. Grounded in stress and coping theory, the cultural model was broken down into three phases: 1) pre-trauma; 2) peri-trauma; and 3) post-trauma. Mail surveys were used to gather information from a sample of Latino veterans enrolled in the VA Palo Alto Health Care System. Approximately half of the respondents met criteria for PTSD and the other half did not, with a total of 146 completed surveys. Bivariate analyses, hierarchical logistic regression, and hierarchical multiple regression were used to analyze the data. Variables analyzed in this study included demographics, childhood adversity, acculturation, familialism, perceived racial and ethnic discrimination, combat exposure, combat injury, peri-trauma coping (i.e., dissociation), post-trauma coping (i.e., emotion-focused, problem-focused, dysfunctional), post-trauma social support, and fatalism. Although most of the cultural variables were correlated with PTSD in the bivariate analyses, they were no longer significant in the multivariate models when stronger predictors were included. Combat exposure and stress appraisal predicted the development of PTSD and PTSD symptom severity in both multivariate models. Whereas combat injury predicted PTSD development, it was not a strong predictor of PTSD symptom severity. Peri-trauma dissociation and dysfunctional post-trauma coping predicted PTSD symptom severity, but were not strongly correlated with the development of PTSD. Although the cultural factors and many of the social factors did not individually predict PTSD or severity of PTSD symptoms in the full models, the conceptual model as a whole performed well and the individual predictors worked well together as sets to predict PTSD and PTSD symptom severity. This indicates that factors related to ethnicity may be of importance in models predicting PTSD and PTSD symptom severity and should be considered.