DSM-5 and ICD-11 as competing models of PTSD in preadolescent children exposed to a natural disaster: assessing validity and co-occurring symptomatology

Figures & data

Table 1. PTSD symptoms and items.

Symptom	DSM-IV	DSM-5	ICD-11	Item
Intrusive memories	RE	RE		RI #3: ‘I have upsetting thoughts, pictures, or sounds of what happened come into my mind when I do not want them to’
Nightmares	RE	RE	RE	RI #5: ‘I have dreams about the hurricane or other bad dreams’
Flashbacks	RE	RE	RE	RI #6: ‘I feel like I am back at the time when the bad thing happened, living through it again’
Psychological distress	RE	RE		RI #2: ‘When something reminds me of what happened, I get very upset, afraid or sad’
Physiological reactions	RE	RE		RI #18: ‘When something reminds me of the hurricane, I have strong feelings in my body, like my heart beats fast, my head aches, or my stomach aches’
Avoidance – internal cues	Avoid	Avoid	Avoid	RI #9: ‘I try not to talk about, think about, or have feelings about the hurricane’
Avoidance – external cues	Avoid	Avoid	Avoid	RI #17: ‘I try to stay away from people, places, or things that make me remember the hurricane’
Restricted range of affect	Avoid			RI #10 or #11: ‘I have trouble feeling happiness or love’ or ‘I have trouble feeling sadness or anger’
Shortened future	Avoid			RI #19: ‘I think that I will not live a long life’
Inability to recall trauma	Avoid	C/M		RI #15: ‘I have trouble remembering important parts of the hurricane’
Anhedonia	Avoid	C/M		RI #7: ‘I feel like staying by myself and not being with my friends’
Detachment/estrangement	Avoid	C/M		RI #8: ‘I feel alone inside and not close to other people’
Negative beliefs		C/M		CDI #5: ‘I am bad all the time’
Blame for event		C/M		RI #14: ‘I think that some part of the hurricane is my fault’
Negative emotional state		C/M		RCMAS #7: ‘I am afraid of a lot of things’
Inability to feel positive emotion		C/M		RI #10: ‘I have trouble feeling happiness or love’
Irritability/anger	Arousal	Arousal		RI #4: ‘I feel grouchy, angry or mad’
Reckless/self-destructive		Arousal		–
Hypervigilance	Arousal	Arousal	Arousal	RI #1: ‘I watch out for danger or things that I am afraid of’
Startle response	Arousal	Arousal	Arousal	RI #12: ‘I feel jumpy or startle easily, like when I hear a loud noise or when something surprises me’
Concentration	Arousal	Arousal		RI #16: ‘I have trouble concentrating or paying attention’
Insomnia	Arousal	Arousal		RI #13: ‘I have trouble going to sleep or I wake up often during the night’

Note: RE = re-experiencing, Avoid = avoidance, C/M = cognitions/mood.

Table 2. Model fit statistics from confirmatory factor analysis for the three DSM models and ICD-11.

PTSD Model	χ^2	d.f.	p	CFI	TLI	RMSEA (90% CI)	SRMR	AIC	BIC
DSM-IV	180.63	116	.0001	0.940	0.930	.042 (.030–.054)	0.046	18,419.35	18,621.13
DSM-5	205.64	146	.0008	0.947	0.938	.036 (.024–.048)	0.046	20,384.59	20,619.59
ICD-11	6.85	6	.33	0.997	0.991	.021 (.000–.079)	0.022	6723.46	6801.92

Note: χ² = chi-square goodness of fit statistics; d.f. = degrees of freedom; CFI = Comparative Fit Index; TLI = Tucker Lewis Index; RMSEA (90% CI) = root mean square error of approximation with 90% confidence intervals; SRMR = standardized root mean square residual; AIC = Akaike information criterion; BIC = Bayesian information criterion.

Figure 1. Model for DSM-5.

Figure 2. Model for ICD-11.

Table 3. Tests of gender invariance for DSM-IV, DSM-5 and ICD-11 models.

Model	χ^2	d.f.	p	CFI	TLI	RMSEA (90% CI)	SRMR	AIC	BIC
DSM-IV
Configural	279.76	232	.02	0.948	0.939	.036 (.016–.051)	0.061	18,451.64	18,855.19
Metric	288.64	246	.03	0.954	0.949	.033 (.011–.048)	0.062	18,431.17	18,782.41
Scalar	313.98	260	.01	0.941	0.939	.037 (.018–.050)	0.065	18,429.96	18,728.89
DSM-5
Configural	350.47	292	.01	0.940	0.930	.036 (.019–.049)	0.061	20,397.83	20,867.82
Metric	363.01	307	.02	0.943	0.936	.034 (.016–.048)	0.067	20,379.40	20,793.44
Scalar	399.58	322	.002	0.922	0.917	.039 (.025–.051)	0.069	20,387.35	20,745.44
ICD-11
Configural	10.64	12	.56	1.000	1.017	.000 (.000–.074)	0.030	6732.30	6889.24
Metric	12.99	15	.61	1.000	1.020	.000 (.000–.066)	0.036	6728.74	6874.47
Scalar	16.18	18	.58	1.000	1.015	.000 (.000–.064)	0.041	6726.07	6860.59

Note: χ² = chi-square goodness of fit statistics; d.f. = degrees of freedom; CFI = Comparative Fit Index; TLI = Tucker Lewis Index; RMSEA (90% CI) = root mean square error of approximation with 90% confidence intervals; SRMR = standardized square root mean residual; AIC = Akaike information criterion; BIC = Bayesian information criterion.

Table 4. Co-occurring symptomatology of children likely meeting criteria (including impairment) for DSM-5 or ICD-11 models of PTSD.

	Models of PTSD
	DSM-5 only	ICD-11 only	DSM-5 plus ICD-11	No PTSD	Significant effects
Number of children (%)	17 (5.2%)	12 (3.7%)	24 (7.3%)	274 (83.8%)
Demographics
Gender (% girls)	53%	67%	48%	51%	n.s.
Age (years)	8.59 (1.00)	8.52 (1.07)	8.38 (0.99)	8.78 (0.97)	n.s.
Minority (%)	88%	75%	87%	70%	n.s.
PTSD symptom severity^a	44.12 (5.87)	38.13 (6.68)	50.07 (8.07)	20.84 (12.03)	DSM-5: F(1) = 49.44, p < .001 ICD-11: F(1) = 21.13, p < .001 Interaction: F(1) = 4.62, p < .05
Co-occurring symptoms^a
Anxiety (RCMAS)	19.37 (6.88)	16.86 (4.81)	19.90 (5.15)	11.12 (7.38)	DSM-5: F(1) = 13.94, p < .001
Depression (CDI)	17.91 (5.97)	15.43 (5.48)	19.54 (5.83)	10.78 (7.41)	DSM-5: F(1) = 10.58, p < .01

Note: ^aControlling for gender, age and minority status in the analyses; N = 327.