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Several questions still exist in the literature on the relationship between cumulative exposure to work-related incidents and posttraumatic stress disorder (PTSD) in First Responders (FR).
To address three unanswered questions in the field.
(1) Are different cumulative exposure scoring algorithms similarly related to PTSD?
(2) Is PTSD associated only with incidents rated as severe and traumatic?
(3) Can we identify cut-off scores of cumulative exposure that maximize sensitivity and specificity to predict PTSD?
To better characterize the relationship between cumulative exposure and PTSD in FR.
The association between exposure and PTSD was examined with logistic and linear regression and with receiver operating characteristic analysis in 349 FR.
(1) The strength of the association between PTSD and total cumulative exposure indexes varied across different scoring algorithms.
(2) Compared to total cumulative exposure indexes and to sub-scores of exposure to non-traumatic and/or less severe incidents, sub-scores indexing exposure to severe traumatic events only were more strongly and significantly associated with PTSD.
(3) The use of two cut-off scores maximizes sensitivity and specificity to predict PTSD.
(1) The relationship between current PTSD and cumulative exposure is partially dependent on the approach used to quantify exposure.
(2) Focusing on the assessment of cumulative exposure to severe traumatic events is sufficient to predict PTSD, and might be more useful and effective in research and clinical decision-making.
(3) Sensitivity and specificity of exposure scores might help improve secondary prevention (early detection and effective intervention) of individuals at risk.
The heterogeneity in the manifestation of PSTD symptomatology has never been described in a developmental period spanning from middle childhood through adolescence. The examination of developmental influences on PTSD symptomatic expression is a high priority for DSM-V and could inform research on the etiology and treatment of PTSD.
To examine the symptom structure of PTSD across different age, gender, and exposure groups, and in association with impairment and other disorders.
To identify homogeneous latent classes of PTSD symptoms in children and adolescents.
Latent class analysis (LCA) was applied to 6,733 New York City students (4th–12th grades) exposed to 9/11-related potentially traumatic events. LCA was first applied to PTSD symptoms only, stratified by age, gender and empirically defined exposure groups, and then in combination with impairment indicators. The resultant classes were studied in association with other disorders.
LCA identified 4 classes that vary in severity and symptom configuration. Only the most severe profile, qualitatively characterized by the presence of traumatic memories in combination with avoidance and sleep-related problems, showed high levels of impairment and high rates of other disorders. Girls after puberty and subjects indirectly exposed to 9/11 are at increased risk of severe disturbance.
The 4-class model describes quantitative and qualitative differences in the structure of PTSD across age, gender and exposure. These findings support the inclusion of developmental considerations into DSM-V PTSD diagnostic criteria and suggest that also gender and the nature of traumatic exposure inflence PTSD phenomenology in children and adolescents.
Item Response Theory (IRT) allows for dimensional scaling of the severity of a disorder, and comparison of symptoms’ properties across different measures of the same trait and across groups. IRT has never been applied to Posttraumatic Stress Disorder (PTSD).
To determine discrimination and severity parameters of PTSD symptoms measured with two instruments, and to examine gender- and age-related Differential Item Functioning (DIF) of PTSD indicators.
To inform the dimensional scaling of PTSD in youth.
IRT was applied to PTSD items measured with the DPS and the PTSD-RI in 6,733 9/11-exposed youths. DIF analysis was performed in the sample stratified by gender and age (8-13; 14-21).
DPS and PTSD-RI items are most informative at intermediate and severe levels of PTSD, respectively. Across instruments, discrimination was greatest for insomnia and nightmares, and lowest for 9/11-related thoughts. Severity parameters were highest for avoidance and numbing symptoms, and lowest for 9/11-related thoughts. The majority of PTSD symptoms showed significant DIF across subgroups.
DPS and PTSD-RI criteria are informative at different levels of PTSD severity. PTSD symptoms differentially discriminate among individuals along the PTSD continuum, and are most informative at different levels of PTSD severity. These results could inform dimensional scaling of PTSD, and allow for flexibility in assigning cut-off points for facilitating clinical decision-making. PTSD criteria do not provide the same information across subgroups defined by gender and age, suggesting that symptoms differ in the way they represent severe post-traumatic stress reactions across groups.
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