Skip to main content

Advertisement

SpringerLink
Log in

A Bayesian Structural Equation Modeling Factor Analysis of the UCLA Posttraumatic Stress Disorder Reaction Index for DSM-5 in a Polyvictimized Sample of Adolescents

  • Published:
Journal of Psychopathology and Behavioral Assessment Aims and scope Submit manuscript

Abstract

The revised criteria for posttraumatic stress disorder (PTSD) in the fifth edition of the Diagnostic and Statistical Manual necessitated the development of new screening tools for youth, one of the most widely used of which is the UCLA Posttraumatic Stress Disorder Reaction Index for DSM-5 (RI-5). Thus far, the few studies that have investigated the RI-5’s factor structure have supported a four-factor model. However, to date this research has been limited to youth with histories of exposure to single-event traumatic stressors, a significant limitation as evidence suggests many trauma-exposed youth report exposure to multiple types of traumatic stressors, or polyvictimization. It is imperative to determine the generalizability of previous factor models to specific populations which they are purported to represent. We investigated whether the RI-5’s four-factor model replicated in a sample of 455 polyvictimized justice-involved adolescents. Initial confirmatory factor analysis demonstrated that the four-factor model did not converge. Therefore, we utilized Bayesian Structural Equations Modeling (BSEM) to determine why the previously proposed factor structure did not converge. The BSEM model suggested that the global factor structure was acceptable and did not require addition or subtraction of any factor or cross-factor loadings. However, small and moderate residual covariances resulted in model misspecification, suggesting there may be additional associations not captured by the current DSM-5 model for polyvictimized youth. Future work should continue examining the RI-5’s factor structure in order to better understand whether the current results are unique and how measurements assessing DSM-5 PTSD symptom criteria perform in diverse trauma-exposed youth populations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (fifth). American Psychiatric Publishing.

  • Angold, A., Costello, J., Van Kämmen, W., & Stouthamer-Loeber, M. (1995). Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. International Journal of Methods in Psychiatric Research, 5, 237–249.

    Google Scholar 

  • Armour, C., Elhai, J. D., Richardson, D., Ractliffe, K., Wang, L., & Elklit, A. (2012). Assessing a five factor model of PTSD: is dysphoric arousal a unique PTSD construct showing differential relationships with anxiety and depression? Journal of Anxiety Disorders, 26, 368–376. https://doi.org/10.1016/j.janxdis.2011.12.002.

    Article  PubMed  Google Scholar 

  • Armour, C., Contractor, A. A., Palmieri, P. A., & Elhai, J. D. (2014). Assessing latent level associations between PTSD and dissociative factors: is depersonalization and derealization related to PTSD factors more so that alternative dissociative factors? Psychological Injury and Law, 7(2), 131–142. https://doi.org/10.1007/s12207-014-9196-9.

    Article  Google Scholar 

  • Armour, C., Tsai, J., Durham, T. A., Charak, R., Biehn, T. L., Elhai, J. D., & Pietrzak, R. H. (2015). Dimensional structure of DSM-5 posttraumatic stress symptoms: support for a hybrid anhedonia and externalizing behaviors model. Journal of Psychiatric Research, 61, 106–113. https://doi.org/10.1016/j.jpsychires.2014.10.012.

    Article  PubMed  Google Scholar 

  • Asparouhov, T., & Muthén, B. (2010). Bayesian analysis using Mplus: technical implementation. Technical appendix. Los Angeles: Muthén & Muthen.

    Google Scholar 

  • Asparouhov, T., Muthén, B., & Morin, A. J. S. (2015). Bayesian structural equation modeling with cross-loadings and residual covariances: comments on Stromeyer et al. Journal of Management, 41, 1561–1577. https://doi.org/10.1177/0149206315591075.

    Article  Google Scholar 

  • Bennett, D. C., Kerig, P. K., Chaplo, S. D., McGee, A. B., & Baucom, B. R. (2014). Validation of the five-factor model of PTSD symptom structure among delinquent youth. Psychological Trauma: Theory, Research, Practice, and Policy, 6(4), 438–447. https://doi.org/10.1037/a0035303.

    Article  Google Scholar 

  • Bennett, D. C., Modrowski, C. A., Kerig, P. K., & Chaplo, S. D. (2015). Investigating the dissociative subtype of posttraumatic stress disorder in a sample of traumatized detained youth. Psychological Trauma: Theory, Research, Practice, and Policy, 7(5), 465–472. https://doi.org/10.1037/tra0000057.

    Article  Google Scholar 

  • Briere, J. (1996). Trauma symptom checklist for children: Professional manual. Psychological Assessment Resources, Inc.

  • Charak, R., Ford, J. D., Modrowski, C. A., & Kerig, P. K. (2019). Polyvictimization, emotion dysregulation, symptoms of posttraumatic stress disorder, and behavioral health problems among justice-involved youth: a latent class analysis. Journal of Abnormal Child Psychology, 47, 287–298. https://doi.org/10.1007/s10802-018-0431-9.

    Article  PubMed  Google Scholar 

  • Chorpita, B. F., Moffitt, C. E., & Gray, J. (2005). Psychometric properties of the revised child anxiety and depression scale in a clinical sample. Behaviour Research and Therapy, 43(3), 309–322. https://doi.org/10.1016/j.brat.2004.02.004.

    Article  PubMed  Google Scholar 

  • Cramer, A. O. J., Leertouwer, I., Lanius, R. A., & Frewen, P. (2020). A network approach to studying the associations between posttraumatic stress disorder symptoms and dissociative experiences. Journal of Traumatic Stress, 33, 19–28. https://doi.org/10.1002/jts.22488.

    Article  PubMed  PubMed Central  Google Scholar 

  • D’Andrea, W., Ford, J. D., Stolbach, B. C., Spinazzola, J., & van der Kolk, B. A. (2012). Understanding interpersonal trauma in children: why we need a developmentally appropriate trauma diagnosis. American Journal of Orthopsychiatry, 82(2), 187–200. https://doi.org/10.1111/j.1939-0025.2012.01154.x.

    Article  Google Scholar 

  • Dierkhising, C. B., Ford, J. D., Branson, C., Grasso, D. J., & Lee, R. (2019). Developmental timing of polyvictimization: continuity, change, and association with adverse outcomes in adolescence. Child Abuse and Neglect, 87, 40–50. https://doi.org/10.1016/j.chiabu.2018.07.022.

    Article  PubMed  Google Scholar 

  • Doric, A., Stevanovic, D., Stupar, D., Vostanis, P., Atilola, O., Moreira, P., Dodig-Curkovic, K., Franic, T., Davidovic, V., Avicenna, M., Noor, M., Nussmaum, L., Thabet, A., Ubalde, D., Petrov, P., Delikovic, A., Antonio, M. L., Ribas, A., Oliveira, J., & Knez, R. (2019). UCLA PTSD reaction index for DSM-5 (PTSD-RI-5): a psychometric study of adolescents samples from communities in eleven countries. European Journal of Psychotraumatology, 10, 1605282. https://doi.org/10.1080/20008198.2019.1605282.

    Article  PubMed  PubMed Central  Google Scholar 

  • Finkelhor, D., Ormrod, R. K., & Turner, H. A. (2007a). Polyvictimization and trauma in a national longitudinal cohort. Development and Psychopathology, 19, 149–166. https://doi.org/10.1017/S0954579407070083.

    Article  PubMed  Google Scholar 

  • Finkelhor, D., Ormrod, R. K., & Turner, H. A. (2007b). Poly-victimization: a neglected component in child victimization. Child Abuse and Neglect, 31(1), 7–26. https://doi.org/10.1016/j.chiabu.2006.06.008.

    Article  PubMed  Google Scholar 

  • Ford, J. D., Elhai, J. D., Connor, D. F., & Frueh, B. C. (2010). Poly-victimization and risk of posttraumatic, depressive, and substance use disorders and involvement in delinquency in a national sample of adolescents. Journal of Adolescent Health, 46, 545–552. https://doi.org/10.1016/j.jadohealth.2009.11.212.

    Article  Google Scholar 

  • Ford, J. D., Grasso, D. J., Greene, C., Levine, J., Spinazzola, J., & Van Der Kolk, B. A. (2013a). Clinical significance of a proposed developmental trauma disorder diagnosis: results of an international survey of clinicians. Journal of Clinical Psychiatry, 74, 841–849. https://doi.org/10.4088/JCP.12m08030.

    Article  Google Scholar 

  • Ford, J. D., Grasso, D. J., Hawke, J., & Chapman, J. F. (2013b). Poly-victimization among juvenile justice-involved youths. Child Abuse and Neglect, 37(10), 788–800. https://doi.org/10.1016/j.chiabu.2013.01.005.

    Article  PubMed  Google Scholar 

  • Ford, J. D., Charak, R., Modrowski, C. A., & Kerig, P. K. (2018a). PTSD and dissociation symptoms as mediators of the relationship between polyvictimization and psychosocial and behavioral problems among justice-involved adolescents. Journal of Trauma and Dissociation, 19(3), 325–346. https://doi.org/10.1080/15299732.2018.1441354.

    Article  PubMed  Google Scholar 

  • Ford, J. D., Spinazzola, J., van der Kolk, B., & Grasso, D. J. (2018b). Toward an empirically based developmental trauma disorder diagnosis for children: factor structure, item characteristics, reliability, and validity of the developmental trauma disorder semi-structured interview. Journal of Clinical Psychiatry, 79, 17m11675. https://doi.org/10.4088/JCP.17m11675.

    Article  Google Scholar 

  • Grasso, D. J., Dierkhising, C. B., Branson, C. E., Ford, J. D., & Lee, R. (2016). Developmental patterns of adverse childhood experiences and current symptoms and impairment in youth referred for trauma-specific services. Journal of Abnormal Child Psychology, 44, 871–886. https://doi.org/10.1007/s10802-015-0086-8.

    Article  PubMed  Google Scholar 

  • Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55. https://doi.org/10.1080/10705519909540118.

    Article  Google Scholar 

  • Kaplow, J. B., Howell, K. H., & Layne, C. M. (2014). Do circumstances of the death matter? Identifying socioenvironmental risks for grief-related psychopathology in bereaved youth. Journal of Traumatic Stress, 27, 42–49. https://doi.org/10.1002/jts.21877.

    Article  PubMed  Google Scholar 

  • Kaplow, J. B., Rolon-Arroyo, B., Layne, C. M., Rooney, E., Oosterhoff, B., Hill, R., Steinberg, A. M., Lotterman, J., Gallagher, K. A. S., & Pynoos, R. S. (2020). Validation of the UCLA PTSD reaction index for DSM-5: a developmentally-informed assessment tool for youth. Journal of the American Academy of Child & Adolescent Psychiatry Adolescent Psychiatry, 59(1), 186–194. https://doi.org/10.1016/j.jaac.2018.10.019.

    Article  Google Scholar 

  • Kisiel, C. L., Fehrenbach, T., Torgersen, E., Stolbach, B. C., McClelland, G. M., Griffin, G., & Burkman, K. (2014). Constellations of interpersonal trauma and symptoms in child welfare: Implications for a developmental trauma framework. Journal of Family Violence, 29(1), 1–14. https://doi.org/10.1007/s10896-013-9559-0.

    Article  Google Scholar 

  • Muthén, B., & Asparouhov, T. (2012). Bayesian structural equation modeling: a more flexible representation of substantive theory. Psychological Methods, 17, 313–335. https://doi.org/10.1037/a0026802.

    Article  PubMed  Google Scholar 

  • Pai, A., Suris, A. M., & North, C. S. (2017). Posttraumatic stress disorder in the DSM-5: controversy, change, and conceptual considerations. Behavioral Sciences, 7. https://doi.org/10.3390/bs7010007.

  • Plattner, B., Silvermann, M. A., Redlich, A. D., Carrion, V. G., Feucht, M., Friedrich, M. H., & Steiner, H. (2003). Pathways to dissociation: intrafamilial versus extrafamilial trauma in juvenile delinquents. The Journal of Nervous and Mental Disease, 191, 781–788. https://doi.org/10.1097/01.nmd.0000105372.88982.54.

    Article  PubMed  Google Scholar 

  • Pynoos, R. S., & Steinberg, A. M. (2014). UCLA child/adolescent PTSD reaction index for DSM-5. Los Angeles: University of California at Los Angeles.

  • Pynoos, R. S., Steinberg, A. M., Layne, C. M., Briggs, E. C., Ostrowski, S. A., & Fairbank, J. A. (2009). DSM-V PTSD diagnostic criteria for children and adolescents: a developmental perspective and recommendations. Journal of Traumatic Stress, 22(5), 391–398. https://doi.org/10.1002/jts.20450.

    Article  PubMed  Google Scholar 

  • Pynoos, R. S., Weathers, F. W., Steinberg, A. M., Marx, B. P., Layne, C. M., Kaloupek, D. G., Schnurr, P. P., Keane, T. M., Blake, D. D., Newman, E., Nader, K. O., & Kriegler, J. A. (2015). Clinican-Adminstered PTSD Scale for DSM-5 - Child/Adolescent Version. www.ptsd.va.gov

  • Rasmussen, A., Verkuilen, J., Jayawickreme, N., Wu, Z., & McCluskey, S. T. (2019). When did posttraumatic stress disorder get so many factors? Confirmatory factor models since DSM–5. Clinical Psychological Science, 7(2), 234–248. https://doi.org/10.1177/2167702618809370.

    Article  Google Scholar 

  • Ross, J., Armour, C., Kerig, P. K., Kidwell, M., & Kilshaw, R. (2020). A network analysis of posttraumatic stress disorder and dissociation in trauma-exposed adolescents. Journal of Anxiety Disorders, 72, 102222. https://doi.org/10.1016/j.janxdis.2020.102222.

    Article  PubMed  Google Scholar 

  • Schmitt, T. A., Sass, D. A., Chappelle, W., & Thompson, W. (2018). Selecting the “best” factor structure and moving measurement validation forward: an illustration. Journal of Personality Assessment, 100, 345–362. https://doi.org/10.1080/00223891.2018.1449116.

    Article  PubMed  Google Scholar 

  • Silverstein, M. W., Dieujuste, N., Kramer, L. B., Lee, D. J., & Weathers, F. W. (2018). Construct validation of the hybrid model of posttraumatic stress disorder: distinctiveness of the new symptom clusters. Journal of Anxiety Disorders, 54, 17–23. https://doi.org/10.1016/j.janxdis.2017.12.003.

    Article  PubMed  Google Scholar 

  • Soler, L., Paretilla, C., Kirchner, T., & Forns, M. (2012). Effects of poly-victimization on self-esteem and post-traumatic stress symptoms in Spanish adolescents. European Child and Adolescent Psychiatry, 21, 645–653. https://doi.org/10.1007/s00787-012-0301-x.

    Article  PubMed  Google Scholar 

  • Steiger, J. H. (1990). Structural model evaluation and modification: an interval estimation approach. Multivariate Behavioral Research, 25, 173–180. https://doi.org/10.1207/s15327906mbr2502_4.

    Article  PubMed  Google Scholar 

  • Steinberg, A. M., Brymer, M. J., Kim, S., Briggs, E. C., Ghosh-Ippen, C., Ostrowski, S. A., Gully, K. J., & Pynoos, R. S. (2013). Psychometric properties of the UCLA PTSD reaction index: part I. Journal of Traumatic Stress, 26(1), 1–9. https://doi.org/10.1002/jts.21780.

    Article  PubMed  Google Scholar 

  • Takada, S., Kameoka, S., Okuyama, M., Fujiwara, T., Yagi, J., Iwadare, Y., Honma, H., Mashiko, H., Nagao, K., Fujibayashi, T., Asano, Y., Yamamoto, S., Osawa, T., & Kato, H. (2018). Feasibility and psychometric properties of the UCLA PTSD reaction index for DSM-5 in japanese youth: a multi-site study. Asian Journal of Psychiatry, 33, 93–98. https://doi.org/10.1016/j.ajp.2018.03.011.

    Article  PubMed  Google Scholar 

  • Terr, L. C. (1991). Childhood traumas: an outline and overview. American Journal of Psychiatry, 148, 10–20. https://doi.org/10.1176/foc.1.3.322.

    Article  Google Scholar 

  • Tsai, J., Harpaz-Rotem, I., Armour, C., Southwick, S. M., Krystal, J. H., & Pietrzak, R. H. (2015). Dimensional structure of DSM-5 posttraumatic stress disorder symptoms: results from the national health and resilience in veterans study. Journal of Clinical Psychiatry, 76(5), 546–553. https://doi.org/10.4088/JCP.14m09091.

    Article  Google Scholar 

  • Turner, H. A., Shattuck, A., Finkelhor, D., & Hamby, S. (2017). Effects of poly-victimization on adolescent social support, self-concept, and psychological distress. Journal of Interpersonal Violence, 32, 755–780. https://doi.org/10.1177/0886260515586376.

    Article  PubMed  Google Scholar 

  • van der Kolk, B. A. (2005). Developmental trauma disorder: towards a rational diagnosis for chronically traumatized children. Psychiatric Annals, 35(5), 401–408.

    Article  Google Scholar 

  • van der Kolk, B. A., Pynoos, R. S., Cicchetti, D., Cloitre, M., D’Andrea, W., Ford, J. D., Lieberman, A. F., Putnam, F. W., Saxe, G. N., Spinazzola, J., Stolbach, B. C., & Teicher, M. H. (2009). Proposal to include a developmental trauma disorder diagnosis for children and adolescents in DSM-V. http://www.traumacenter.org/announcements/DTD_papers_Oct_09.pdf. Accessed 9 Aug 2019.

  • Wood, J., Foy, D. W., Goguen, C. A., Pynoos, R. S., & James, C. B. (2002). Violence exposure and PTSD among delinquent girls. Journal of Aggression, Maltreatment & Trauma, 6(1), 109–126. https://doi.org/10.1300/J146v06n01_06.

    Article  Google Scholar 

  • Yufik, T., & Simms, L. J. (2010). A meta-analytic investigation of the structure of posttraumatic stress disorder symptoms. Journal of Abnormal Psychology, 119(4), 764–776. https://doi.org/10.1037/a0020981.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This research was supported by a training grant awarded to the first author (T32MH078788). Data collection was supported by a grant awarded to the third author (NIJ 2014-R2-CX-0020).

Author information

Authors and Affiliations

  1. Alpert Medical School of Brown University/Bradley Hasbro Children’s Research Center, 1 Hoppin Street, Suite 204, Providence, RI, 02903, USA

    Crosby A. Modrowski

  2. Department of Psychology, University of Utah, 380 s 1530 e, Salt Lake City, UT, 84112, USA

    Ascher K. Munion, Patricia K. Kerig & Robyn E. Kilshaw

Authors
  1. Crosby A. Modrowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ascher K. Munion
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patricia K. Kerig
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robyn E. Kilshaw
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Crosby A. Modrowski.

Ethics declarations

Potential Conflicts of Interest

Crosby A. Modrowski, Ascher K. Munion, Patricia K. Kerig, Robyn E. Kilshaw declare that they no conflict of interest.

Experiment Participants

Informed consent was obtained from all individual participants included in the study.

Ethical Approval of Research Involving Human Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study procedures were approved by the University of Utah and Utah Department of Human Services institutional review boards.

Informed Consent

Legal guardians provided informed consent and adolescents provided assent prior to participation in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

ESM 1

(DOCX 29 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Modrowski, C.A., Munion, A.K., Kerig, P.K. et al. A Bayesian Structural Equation Modeling Factor Analysis of the UCLA Posttraumatic Stress Disorder Reaction Index for DSM-5 in a Polyvictimized Sample of Adolescents. J Psychopathol Behav Assess 43, 119–130 (2021). https://doi.org/10.1007/s10862-020-09854-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10862-020-09854-z

Keywords

Search

Navigation