Validation of posttraumatic stress disorder (PTSD) and complex PTSD in Chinese children as per the ICD-11 proposals using the International trauma questionnaire

Figures & data

Figure 1. Seven alternative models of ICD-11 CPTSD in school children

Table 1. Mean and standard deviation for each item

	Total Mean (SD)	Boy Mean (SD)	Girl Mean (SD)	t (p)
Having upsetting dreams (RE1)	0.86 (1.21)	0.91(1.25)	0.81(1.15)	2.29 (0.02)
Having disturbing memories (RE1)	1.38 (1.16)	1.37 (1.19)	1.38 (1.11)	−0.15 (0.88)
Avoiding internal reminders (AV1)	0.96 (1.22)	0.94 (1.22)	0.99 (1.22)	−1.24 (0.21)
Avoiding external reminders (AV2)	0.79 (1.17)	0.75 (1.16)	0.84 (1.18)	−2.37 (0.02)
Being ‘super-alert’ (TH1)	0.82 (1.17)	0.79 (1.16)	0.84 (1.17)	−1.18(0.24)
Feeling jumpy or easily startled (TH2)	1.09 (1.28)	1.09 (1.29)	1.11 (1.26)	−0.51 (0.61)
Long time to calm down (AD1)	1.00 (1.08)	0.96 (1.09)	1.05 (1.06)	−2.28 (0.02)
Feeling numb (AD2)	0.78 (1.15)	0.70 (1.11)	0.88 (1.20)	−4.42 (<0.001)
Feeling like a failure (NSC1)	0.63 (1.10)	0.64 (1.12)	0.62 (1.08)	0.51 (0.61)
Feeling worthless (NSC2)	0.54 (1.07)	0.55 (1.10)	0.52 (1.03)	0.89 (0.37)
Feeling distant from people (DR1)	0.45 (0.94)	0.45 (0.95)	0.45 (0.93)	−0.21 (0.83)
Finding it hard to stay emotionally close to people (DR2)	0.52 (1.01)	0.51 (1.00)	0.53 (1.02)	−0.72 (0.47)

Table 2. Model fit statistics for confirmatory factor models of ICD-11 CPTSD

Model	Chi-square	df	RMSEA (90%CI)	CFI	TLI	SRMR
1	3185.193*	54	0.129 (0.125–0.133)	0.929	0.913	0.070
2	269.602*	39	0.041 (0.037–0.046)	0.995	0.991	0.017
3	1183.689*	48	0.082 (0.078–0.087)	0.974	0.965	0.042
4	646.531*	47	0.061((0.056–0.065)	0.986	0.981	0.029
5	1086.703*	50	0.077 (0.073–0.081)	0.977	0.969	0.038
6	1445.548*	50	0.090 (0.086–0.094)	0.968	0.958	0.043
7	1822.043*	53	0.098 (0.094–0.102)	0.960	0.950	0.049

* p < 0.05; df = degrees of freedom; RMSEA (90% CI) = the Root Mean Square Error of Approximation (90% confidence intervals); CFI = Comparative Fit Indices; TLI = Tucker-Lewis Index; SRMR = the Standardized Root square Mean Residual.

Table 3. Model fit statistics for latent class models of ICD-11 CPTSD

Classes	Loglikelihood	AIC	BIC	SS-BIC	BLRT	VLMRT
1	−12,115.826	40,984.003	41,057.853	41,019.723
2	−10,228.584	20,483.167	20,563.172	20,521.865	−12,115.826*	−12,115.826*
3	−10,064.795	20,169.591	20,292.675	20,229.125	−16,930.593*	−16,930.593*
4	−10,018.002	20,090.005	20,256.168	20,170.376	−16,397.337*	−16,397.337*
5	−10,007.547	20,083.095	20,292.338	20,184.304	−10,018.002*	−10,018.002

* p < 0.05; AIC = Akaike Information Criterion; BIC = Bayesian Information Criterion; SS-BIC = Sample Size Adjusted BIC; BLRT = Bootstrap Likelihood Ratio Test; VLMRT = Vuong-Lo-Mendell-Rubin test.

Figure 2. Profile Plot of Latent Classes of Diagnostic Variables from ITQ Scale. RE = Re-experiencing; AV = Avoidance; TH = Sense of threat; AD = Affective dysregulation; NSC = Negative self-concept; DR = Disturbed relationships

Table 4. Multinomial logistic regression between traumatic events and the different classes

	CPTSD class ^a OR (95% CI)	DSO class ^a OR (95% CI)	PTSD class ^a OR (95% CI)	CPTSD class ^b OR (95% CI)	DSO class ^b OR (95% CI)
Separation	2.66 (2.07, 3.40) ***	1.51 (1.06, 2.16) *	1.85 (1.54, 2.22) ***	1.44 (1.10, 1.88) **	0.82 (0.56, 1.19)
School violence	7.40 (5.62, 9.75) ***	4.54 (3.01, 6.84) ***	2.45 (1.87, 3.21) ***	3.02 (2.30, 3.96) ***	1.85 (1.23, 2.80) **
Life-threatening illness	1.79 (1.37, 2.34) ***	1.65 (1.10, 2.46) *	1.88 (1.53, 2.32) ***	0.95 (0.73 1.25)	0.88 (0.58, 1.32)
Abuse and neglect	2.49 (1.28, 4.82) **	2.85 (1.19, 6.85) *	1.68 (0.89, 3.16)	1.48 (0.79, 2.77)	1.70 (0.72, 4.03)
Road traffic accident	2.09 (1.67, 2.60) ***	1.23 (0.88, 1.73)	1.46 (1.23, 1.74) ***	1.43 (1.13, 1.80) **	0.84 (0.59, 1.19)
Fire and explosion	1.53 (1.19, 1.97) ***	1.15 (0.76, 1.72)	1.33 (1.08, 1.62) **	1.16 (0.89, 1.51)	0.86 (0.57, 1.31)
Natural disaster	1.36 (0.89, 2.08)	1.61 (0.87, 2.99)	1.49 (1.06, 2.07) *	0.91 (0.60, 1.40)	1.09 (0.58, 2.03)
Robbery	1.38 (0.66, 2.89)	0.24 (0.03, 1.91)	0.99 (0.49, 2.01)	1.39 (0.67, 2.89)	0.24 (0.03, 1.93)
Sexual assault	1.66 (0.68, 4.04)	3.56 (1.25, 10.14) *	1.36 (0.60, 3.09)	1.22 (0.53, 2.80)	2.61 (0.93, 7.31)
Community violence	2.35 (1.42, 3.88) ***	1.82 (0.81, 4.05)	1.88 (1.21, 2.94) **	1.25 (0.77, 2.01)	0.96 (0.43, 2.14)

OR, Odds Ratio; CI, Confidence Interval.

*p < .05; **p < .01; ***p < .001.

^aIn this set of analysis, the low symptom class was set as the reference category.

^bIn this set of analysis, the PTSD class was set as the reference category.