• 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.
    • First Responders: Behavioral Health Concerns, Emergency Response, and Trauma

      United States. Substance Abuse and Mental Health Services Administration (Substance Abuse and Mental Health Services Administration (SAMHSA), 2018-05)
      This issue of the Supplemental Research Bulletin focuses on mental health and substance use (behavioral health) concerns in first responders. It is estimated that 30 percent of first responders develop behavioral health conditions including, but not limited to, depression and posttraumatic stress disorder (PTSD), as compared with 20 percent in the general population (Abbot et al., 2015). In a study about suicidality, firefighters were reported to have higher attempt and ideation rates than the general population (Stanley et al., 2016). In law enforcement, the estimates suggest between 125 and 300 police officers commit suicide every year (Badge of Life, 2016). First responders are usually the first on the scene to face challenging, dangerous, and draining situations. They are also the first to reach out to disaster survivors and provide emotional and physical support to them. These duties, although essential to the entire community, are strenuous to first responders and with time put them at an increased risk of trauma. The purposes of this publication are to discuss the challenges encountered by first responders during regular duty as well as following disasters; shed more light on the risks and behavioral health consequences (such as PTSD, stress, and depression) of serving as a first responder; and present steps that can be taken to reduce these risks either on the individual or institutional levels. Those who are among the first to respond to a disaster are referred to by different terms, depending on whether the speaker and audience are part of federal government, state and local government, or other entities, and they may not be clearly defined at all. According to Title 6—Domestic Security of the U.S. Code, first responders include these individuals and groups: The term “emergency response providers” includes Federal, State, and local governmental and nongovernmental emergency public safety, fire, law enforcement, emergency response, emergency medical (including hospital emergency facilities), and related personnel, agencies, and authorities (Domestic Security, 2010). The terms “first responders” and “public health workers” (the term used in some papers) are somewhat arbitrary; the terms include police, firefighters, search and rescue personnel, and emergency and paramedical teams (Benedek, Fullerton, & Ursano, 2007). For the purpose of this publication we will concentrate on three major groups that will be discussed separately—whenever possible—or combined under the term first responders: Emergency medical services (EMS) • Firefighters • Police officers This issue of the Supplemental Research Bulletin is based on literature and scientific publications found through the National Center for Biotechnology Information and U.S. National Library of Medicine (PubMed). All research cited in this issue was published in English, and most was conducted in the United States (with a few exceptions where investigations in other countries proved useful to the topic). We did not include literature on trauma related to military service, as the challenges and types of danger and training are different. We also did not include literature on nontraditional first responders because the literature was not robust.
    • 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.