The present study introduced a modernized approach to Jacobson and Truax's (1991) methods of estimating treatment effects on individual‐level (a) movement from the clinical to the normative range and (b) reliable change on posttraumatic stress disorder (PTSD) severity. Participants were 450 trauma‐exposed women (M age = 39.2 years, SD = 8.9, range: 18–65 years) who presented to seven geographically diverse community mental health and substance use treatment centers. Data from 53 of these women, none of whom met the criteria for full or subthreshold PTSD, were used to establish the normative range. Using moderated nonlinear factor analysis (MNLFA) scale scoring, which weights symptoms by their clinical relevance, a significantly larger proportion of participants moved into the normative range for PTSD severity scores and/or exhibited reliable changes after treatment compared to the same individuals’ movement when using symptom counts. Further, approximately 24% of the participants showed discrepant judgments on reliable change indices (RCI) between MNLFA scores and symptom counts, likely due to the false assumption that the standard error of measurement is equal for all levels of underlying PTSD severity when estimating RCIs with symptom counts. An MNLFA approach to estimating underlying PTSD severity can provide clinically meaningful information about individual‐level change without the de facto assumption that PTSD symptoms have equivalent weight. Study implications are discussed with regard to a joint emphasis on (a) measurement models that highlight differential symptom weighting and (b) treatment‐arm differences in individual‐level outcomes rather than the current overemphasis of treatment‐arm differences on group‐averaged trajectories.

中文翻译：

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让患者重回临床意义：用于估计创伤后应激障碍治疗的临床显着变化的适度非线性因素分析

本研究介绍了 Jacobson 和 Truax (1991) 方法的一种现代化方法，用于估计治疗对个体水平 (a) 从临床到规范范围的移动和 (b) 创伤后应激障碍 (PTSD) 严重程度的可靠变化。参与者是 450 名遭受创伤的女性（M年龄 = 39.2 岁，SD= 8.9，范围：18-65 岁）曾就诊于七个不同地域的社区心理健康和药物滥用治疗中心。来自这些女性中的 53 名女性的数据被用来建立规范范围，她们中没有人符合完全或亚阈值 PTSD 的标准。使用适度非线性因素分析 (MNLFA) 量表评分，根据症状的临床相关性对症状进行加权，与相同个体的运动相比，显着更大比例的参与者进入 PTSD 严重程度评分的规范范围和/或在治疗后表现出可靠的变化使用症状计数。此外，大约 24% 的参与者对 MNLFA 评分和症状计数之间的可靠变化指数 (RCI) 的判断存在差异，这可能是由于错误的假设，即在使用症状计数估计 RCI 时，所有潜在 PTSD 严重程度的测量标准误差都相等。用于估计潜在 PTSD 严重程度的 MNLFA 方法可以提供有关个人水平变化的具有临床意义的信息，而无需事实上假设 PTSD 症状具有相同的权重。就联合强调（a）强调不同症状权重的测量模型和（b）个体水平结果中的治疗组差异而不是当前过分强调治疗组平均轨迹上的差异来讨论研究意义。用于估计潜在 PTSD 严重程度的 MNLFA 方法可以提供有关个人水平变化的具有临床意义的信息，而无需事实上假设 PTSD 症状具有相同的权重。就联合强调（a）强调不同症状权重的测量模型和（b）个体水平结果中的治疗组差异而不是当前过分强调治疗组平均轨迹上的差异来讨论研究意义。用于估计潜在 PTSD 严重程度的 MNLFA 方法可以提供有关个人水平变化的具有临床意义的信息，而无需事实上假设 PTSD 症状具有相同的权重。就联合强调（a）强调不同症状权重的测量模型和（b）个体水平结果中的治疗组差异而不是当前过分强调治疗组平均轨迹上的差异来讨论研究意义。