Factor structure of posttraumatic stress disorder (PTSD) in persons with serious mental illness

Abstract

Background

Trauma and posttraumatic stress disorder (PTSD) are common among individuals with serious mental illness (SMI; e.g., schizophrenia, schizoaffective disorder, bipolar disorder, treatment refractory major depressive disorder), with resultant functional impairment. Previous studies have not evaluated the factor structure of the PTSD Checklist (PCL) among persons with SMI.

Aims

This study evaluated the factor structure of the PCL in two large SMI samples from public mental health treatment sectors screened for PTSD using the PCL.

Methods

Four different models of PTSD were tested using confirmatory factor analyses.

Results

Results indicated that the DSM-5 4-factor model (intrusion, avoidance, numbing, and hyperarousal) had the best fit. Further, the DSM-5 4-factor model demonstrated measurement invariance.

Conclusions

Results supported the suitability of the DSM-5 4-factor model of PTSD among people with SMI.

Keywords:

• PTSD
• serious mental illness (SMI)
• factor structure
• PTSD checklist
• trauma
• schizophrenia

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

Study 1 data were collected via three grants: P50-MH43703/MH/NIMH NIH HHS/United States, R01-MH48103-05/MH/NIMH NIH HHS/United States, and R01-MH50094-03S2/MH/NIMH NIH HHS/United States. Study 2 data is associated with: ClinicalTrials.gov/NCT00494650, R01MH064662. All study data is not available to share with the public because the funding agency did not require data sharing at the time of funding, and data sharing was not part of the consent.

Additional information

Funding

This research was supported by grants R01-MH-50094-03S2, P50-MH-43703, R01-MH-48103-05, P50-MH-51410-02, R24-MH-54446-05, R01-MH-52872, and R01 MH064662 (PI: Mueser) from the National Institute of Mental Health. This research was also supported by grant UNC-CHJ from the Duke Program on Services Research for People With Severe Mental Disorders, by grant CT DMH from Yale, and by grant EPP97-022 from the Veterans Affairs Epidemiologic Research Information Center, and Rutgers School of Health Professions Summer Intern Program. The authors acknowledge the contributions of the members of the five-site Health and Risk Study Research Committee: Susan M. Essock, Ph.D., and Jerilynn Lamb-Pagone, M.S.N., in Connecticut; Marvin Swartz, M.D., Jeffrey Swanson, Ph.D., and Barbara J. Burns, Ph.D., at Duke University, Durham, North Carolina; the late Marian I. Butterfield, M.D., Keith G. Meador, M.D., M.P.H., Hayden B. Bosworth, Ph.D., Mary E. Becker, Richard Frothingham, M.D., Ronnie D. Homer, Ph.D., Lauren M. McIntyre, Ph.D., Patricia M. Spivey, and Karen M. Stechuchak, M.S., in Durham, North Carolina; Fred C. Osher, M.D., Lisa A. Goodman, Ph.D., Lisa J. Miller, Jean S. Gearon, Ph.D., Richard W. Goldberg, Ph.D., John D. Herron, L.C.S.W., Raymond S. Hoffman, M.D., and Corina L. Riismandel in Maryland; and Patricia C. Auciello, M.S., George Wolford, Ph.D., Mark C. Iber, Ravindra Luckoor, M.D., Gemma R. Skillman, Ph.D., Rosemarie S. Wolfe, M.S., Robert M. Vidaver, M.D., and Michelle P. Salyers, Ph.D., in New Hampshire. We wish to thank the following individuals for their assistance with this project: Edward Kim, Lee Hyer, Rachael Fite, Kenneth Gill, Rosemarie Rosati, Christopher Kosseff, Karen Somers, John Swanson, Avis Scott, Rena Gitlitz, John Markey, Zygmond Gray, Marilyn Green, Alex Shay, Leila Hosseini, and Mariam Ishak.