The validity of ICD-11 PTSD and complex PTSD in North Korean defectors using the International Trauma Questionnaire

Figures & data

Figure 1. First- and second-order models of ICD-11 PTSD and CPTSD using the ITQ.

Table 1. Fit statistics for CFA of the ITQ.

Model	X^2	df	p-value	AIC	BIC	SABIC	CFI	TLI	RMSEA (90% CI)	SRMR
First-order	105.97	39	<.001	14112.7	14328.0	14166.0	0.984	0.973	0.058 (0.045–0.072)	0.023
Second-order	198.17	47	<.001	14222.1	14403.6	14267.1	0.964	0.950	0.080 (0.069–0.092)	0.065

Note: AIC, Akaike information criterion; BIC, Bayesian information criterion; SABIC, sample-size adjusted BIC; CFI, Comparative Fit Index; TLI, Tucker-Lewis Index; RMSEA, Root-Mean-Square-Error of Approximation; SRMR, Standard Root-Mean-Square.

Table 2. Fit statistics for latent class analysis.

No. of classes	Pearson Chi-square p-value	Likelihood Ratio Chi-Square p-value	AIC	BIC	SABIC	Entropy	LMRT		BLRT
							2LL	p-value	2LL	p-value
One class	<.001	<.001	3997.33	4022.66	4003.61
Two class	<.001	<.001	3239.43	3294.30	3253.04	0.805	771.90	.004	754.57	.005
Three class	<.001	<.001	3059.79	3144.20	3080.72	0.824	193.65	<.001	189.30	<.001
Four class	.774	.619	3021.13	3135.09	3049.39	0.840	52.65	.001	51.47	.001
Five class	.855	.654	3027.74	3171.24	3063.32	0.875	7.39	.209	7.23	.215
Six class	.671	.605	3035.92	3208.96	3078.83	0.893	5.87	.367	5.74	.376

Note: AIC, Akaike information criterion; BIC, Bayesian information criterion; SABIC, sample-size adjusted BIC; LMRT, Lo-Mendell-Rueben Test; BLRT, Bootstrap Likelihood Ratio Test.

Figure 2. Mean scores on ICD-11 PTSD and CPTSD symptom LCA classes in North Korean defectors who were exposed to traumatic events (N = 503).

Note: Re: re-experiencing; AV: avoidance; TH: sense of current threat; AD: affective dysregulation; NSC: negative self-concept; DR: disturbances in relationship.

Table 3. Unadjusted multinomial regression for PTSD and CPTSD symptom LCA classes (N = 503).

Variables	DSO		PTSD		CPTSD
	(N = 20)		(N = 175)		(N = 153)
	OR	95% CI	OR	95% CI	OR	95% CI
Age (ref: 20–39)
40–49	1.75	(0.59–5.19)	2.13**	(1.22–3.71)	2.59**	(1.43–4.68)
50–59	0.73	(0.15–3.66)	3.05***	(1.68–5.55)	4.04***	(2.16–7.56)
60–79	1.90	(0.45–8.00)	3.13**	(1.52–6.43)	4.17***	(1.98–8.80)
Gender (ref: men)
Women	2.53	(0.56–11.44)	1.69	(0.95–2.98)	2.25*	(1.20–4.23)
Education in North Korea
(ref: None/elementary/middle school)
High school	2.42	(0.75–7.80)	2.70**	(1.48–4.90)	3.47***	(1.80–6.72)
College or higher	0.22	(0.02–2.04)	2.13*	(1.13–4.03)	2.79**	(1.39–5.60)
Years spent in South Korea (ref: <5)
5–10	1.09	(0.25–4.72)	1.03	(0.52–2.02)	0.73	(0.36–1.46)
≥10	1.10	(0.29–4.27)	1.08	(0.58–2.01)	1.00	(0.54–1.87)
Employment status, ref: employed
Not employed	1.94	(0.76–4.95)	1.30	(0.84–2.02)	2.90***	(1.83–4.61)
Economic level satisfaction	0.61	(0.35–1.05)	0.89	(0.70–1.13)	0.40***	(0.30–0.53)
Psychiatric medication, yes	10.64***	(3.03–37.42)	5.99***	(2.44–14.7)	20.94***	(8.72–50.29)
No. of traumatic event experiences	1.06	(0.94–1.19)	1.18***	(1.12–1.25)	1.28***	(1.21–1.37)

Note: The low-symptom class is the reference category.

*p < .05 **p < .01 ***p < .001

Table 4. Difference on psychological state and quality of life across ICD-11 PTSD and CPTSD symptom LCA classes (N = 503)

Variables		Low-symptom^1		DSO^2		PTSD^3		CPTSD^4		Overall p-value	Pairwise Post hoc comparison (p < .05)
		N=155		N=20		N=175		N=153
DSSS	Depression	7.5	(4.6)	14.6	(5.7)	11.8	(5.9)	18.3	(7.3)	< .001	1 < 2, 3 <4
	Somatic symptom	5.7	(5.3)	10.6	(5.2)	9.9	(5.7)	15.0	(7.1)	< .001	1 < 2, 3 <4
	Total	13.2	(9.3)	25.1	(10.0)	21.7	(11.0)	33.3	(13.7)	< .001	1 < 2, 3 <4
WHOQOL-BREF	Overall quality of life*	3.4	(0.8)	2.6	(0.7)	3.3	(0.7)	2.6	(0.9)	< .001	2, 4 < 1, 3
	Overall quality of health*	3.3	(0.9)	2.5	(0.9)	2.9	(0.9)	2.2	(0.8)	< .001	2 < 1; 4 < 3 < 1
	Physical health^†	13.8	(2.9)	10.9	(1.6)	12.2	(2.6)	9.6	(2.8)	< .001	2 < 1; 4 < 3 < 1
	Psychological state^†	14.5	(2.6)	11.4	(2.3)	13.6	(2.3)	10.3	(2.9)	< .001	2, 4 < 3 < 1
	Social relationships^†	13.7	(2.6)	11.1	(1.9)	13.0	(2.4)	10.6	(2.6)	< .001	2, 4 < 1, 3
	Environment^†	13.0	(2.3)	11.2	(1.8)	12.5	(2.1)	10.6	(2.2)	< .001	2 < 1; 4 < 1, 3

Note: All tests were one-way ANOVAs and pairwise post hoc comparisons utilizing the Bonferroni correction.

* Variable ranged from 1 to 5.

† Variable ranged from 4 to 20.

Data availability statement

The data that support the findings of this study are not publicly available due to privacy and sensitive information of the participants. Moreover, the data contain potentially identifiable participants. The restricted data are available from the corresponding author upon reasonable request.