Showing papers by "Mark Shevlin published in 2017"

Validation of post-traumatic stress disorder (PTSD) and complex PTSD using the International Trauma Questionnaire.

Abstract: Objective The 11th version of the International Classification of Diseases (ICD-11) has proposed two related trauma diagnoses: Post-traumatic stress disorder (PTSD) and Complex PTSD (CPTSD). Using a newly developed, disorder-specific measure of PTSD and CPTSD called the International Trauma Questionnaire (ITQ) the current study will (i) assess the factorial validity of ICD-11 PTSD and CPTSD; (ii) provide the first test of the discriminant validity of these constructs; and (iii) provide the first comparison of ICD-11, and Diagnostic and Statistical Manual, Fifth Edition (DSM-5), PTSD diagnostic rates using disorder-specific measures. Method ICD-11 and DSM-5 PTSD-specific measures were completed by a British clinical sample of trauma-exposed patients (N = 171). The structure and validity of ICD-11 PTSD and CPTSD were assessed by means of factor analysis and assessing relationships with criterion variables. Results Diagnostic rates under ICD-11 were significantly lower than those under DSM-5. A two-factor second-order model reflecting the distinction between PTSD and CPTSD best represented the data from the ITQ; and the PTSD and CPTSD factors differentially predicted multiple psychological variables. Conclusion The factorial and discriminant validity of ICD-11 PTSD and CPTSD was supported, and ICD-11 produces fewer diagnostic cases than DSM-5.

PTSD and Complex PTSD: ICD-11 updates on concept and measurement in the UK, USA, Germany and Lithuania.

Abstract: The 11th revision to the World Health Organization's International Classification of Diseases (ICD-11) proposes two distinct sibling conditions: Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). In this paper, we aim to provide an update on the latest research regarding the conceptual structure and measurement of PTSD and CPTSD using the International Trauma Questionnaire (ITQ) as per ICD-11 proposals in the USA, UK, Germany and Lithuania. Preliminary findings suggest that CPTSD is common in clinical and population samples, although there may be variations across countries in prevalence rates. In clinical samples, preliminary evidence suggests that CPTSD is a more commonly observed condition than PTSD. Preliminary evidence also suggests that the ITQ scores are reliable and valid and can adequately distinguish between PTSD and CPTSD. Further cross-cultural work is proposed to explore differences in PTSD and CPTSD across different countries with regard to prevalence, incidence, and predictors of PTSD and CPTSD.

Variation in post-traumatic response: the role of trauma type in predicting ICD-11 PTSD and CPTSD symptoms

Abstract: The World Health Organization’s 11th revision to the International Classification of Diseases manual (ICD-11) will differentiate between two stress-related disorders: PTSD and Complex PTSD (CPTSD). ICD-11 proposals suggest that trauma exposure which is prolonged and/or repeated, or consists of multiple forms, that also occurs under circumstances where escape from the trauma is difficult or impossible (e.g., childhood abuse) will confer greater risk for CPTSD as compared to PTSD. The primary objective of the current study was to provide an empirical assessment of this proposal. A stratified, random probability sample of a Danish birth cohort (aged 24) was interviewed by the Danish National Centre for Social Research (N = 2980) in 2008–2009. Data from this interview were used to generate an ICD-11 symptom-based classification of PTSD and CPTSD. The majority of the sample (87.1%) experienced at least one of eight traumatic events spanning childhood and early adulthood. There was some indication that being female increased the risk for both PTSD and CPTSD classification. Multinomial logistic regression results found that childhood sexual abuse (OR = 4.98) and unemployment status (OR = 4.20) significantly increased risk of CPTSD classification as compared to PTSD. A dose–response relationship was observed between exposure to multiple forms of childhood interpersonal trauma and risk of CPTSD classification, as compared to PTSD. Results provide empirical support for the ICD-11 proposals that childhood interpersonal traumatic exposure increases risk of CPTSD symptom development.

An Assessment of the Construct Validity of the ICD-11 proposals for Complex Posttraumatic Stress Disorder

Abstract: Background: A new diagnosis, complex posttraumatic stress disorder (CPTSD), is set to be introduced in the 11th revision to the International Classification of Diseases (ICD-11). Studies have supported a unique group of trauma-exposed individuals who exhibit symptoms consistent with CPTSD proposals. No studies have yet tested the proposed latent symptom structure of CPTSD proposed for ICD-11. This study tests the factorial validity of CPTSD and assesses the role of a range of risk factors to predict CPTSD. Method: A large sample (N = 453) of treatment-seeking adult victims of childhood sexual abuse completed self-report measures of CPTSD. Confirmatory factor analysis (CFA) was used to compare a set of alternative factor models of CPTSD. Results: Just less than half of the sample met the diagnostic criteria for CPTSD (42.8%). CFA results supported the factorial validity of the ICD-11 proposals for CPTSD. Being female and experiencing a greater number of sexual abuse acts during childhood were more strongly associated with PTSD than CPTSD symptoms. Regarding symptoms, anxiety was more strongly associated with PTSD than CPTSD, whereas higher levels of dysthymia were more strongly associated with CPTSD than PTSD symptoms. Conclusions: Results provide initial evidence regarding the factorial validity of the proposed ICD-11 model of CPTSD. In addition, current results support the proposals of the ICD-11 that exposure to abuse during early development is associated with a greater likelihood of CPTSD than PTSD. The study contributes to a growing body of empirical data supporting the construct validity of CPTSD as a unique diagnostic entity.

The Psychosis Continuum: Testing a Bifactor Model of Psychosis in a General Population Sample.

Abstract: Although the factor structure of psychosis continues to be debated by taxonomists, recent studies have supported a bifactor model consisting of a general psychosis factor and 5 uncorrelated symptom-specific factors. While this model has received support in clinical samples, it has not been tested at the general population level. Analysis was conducted on Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N = 34 653). Twenty-two psychotic symptoms were used as observed indicators of psychosis. These items were chosen based on their conceptual similarity to the items used in a similar study based on clinical samples. Confirmatory factor analysis and confirmatory bifactor modeling were used to test a variety of competing models. The best fitting model consisted of a general psychosis factor that was uncorrelated with 5 specific factors: positive, negative, disorganization, mania, and depression. These findings suggest that the bifactor model can be extended to general population samples, supporting the continuity between clinical and subclinical psychotic experiences. Theoretical and practical implications are discussed.

Alternative models of disorders of traumatic stress based on the new ICD-11 proposals

Abstract: Objective Although there is emerging evidence for the factorial validity of the distinction between post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) proposed in ICD-11, such evidence has been predominantly based on using selected items from individual scales that describe these factors. We have attempted to address this gap in the literature by testing a range of alternative models of disorders of traumatic stress using a broader range of symptoms and standardized measures. Method Participants in this cross-sectional study were a sample of individuals who were referred for psychological therapy to a National Health Service (NHS) trauma centre in Scotland (N = 195). Participants were recruited over a period of 18 months and completed measures of stressful life events, DSM-5 PTSD, emotion dysregulation, self-esteem and interpersonal difficulties. Results Overall, results indicate that a structural model incorporating six first-order factors (re-experiencing, avoidance of traumatic reminders, sense of threat, affective dysregulation, negative self-concept and disturbances in relationships) and two second-order factors (PTSD and disturbances in self-organization [DSO]) was the best fitting. The model presented with good concurrent validity. Childhood trauma was found to be more strongly associated with DSO than with PTSD. Conclusion Our results are in support of the ICD-11 proposals for PTSD and CPTSD.

Homotypic and heterotypic psychopathological continuity: a child cohort study

Abstract: Heterotypic psychopathological continuity (ie one disorder predicting another at a later time point) contradicts the conventional view that psychiatric disorders are discrete, static entities Studying this phenomenon may help to tease out the complex mechanisms that underpin psychiatric comorbidity To date, no studies have explicitly compared heterotypic effects within and across higher order dimensions of psychopathology Patterns of homotypic and heterotypic psychopathological continuity were examined using cohort data from the Avon Longitudinal Study of Parents and Children (ALSPAC, N = 4815) Eight common psychiatric disorders were assessed at age 75 and again at age 14 years using the maternal report version of the Development and Well-Being Assessment (DAWBA) Cross-lagged models were used to compare patterns of homotypic and heterotypic continuity within and across three higher order dimensions of psychopathology; internalizing-fear, internalizing-distress, and externalizing Homotypic continuity was universal Considerable heterotypic continuity was observed even after controlling for homotypic continuity and the presence of all disorders at baseline Heterotypic continuity was more common within higher order dimensions, but a number of significant cross-dimension effects were observed, with ADHD acting as a strong predictor of subsequent internalizing disorders Heterotypic continuity may reflect elements of shared aetiology, or local-level interactions between disorders

Typologies of child sexual abuse: An analysis of multiple abuse acts among a large sample of Danish treatment-seeking survivors of childhood sexual abuse.

Abstract: Objective: The deleterious psychological effects of childhood sexual abuse (CSA) have been extensively documented in the research literature. A limitation of this research, however, has been a reliance on overly restrictive and limiting measurements of CSA. Researchers have most commonly referred to discrete instances of rape and molestation; however, evidence suggests that sexual abuse in childhood can include a wide array of acts and that individual survivors can endure many of these. Method: This study employed latent class analysis to identify homogeneous groups of adult CSA survivors characterized by similar typologies of sexual trauma within a large sample of Danish, treatment-seeking survivors of CSA and incest (N = 454). In total, 18 separate contact and noncontact abuse acts were modeled. Furthermore, the association between abuse-related variables (victim gender, the age at which the abuse started, duration of abuse, and perpetrator of abuse) and the resultant CSA groups, or classes, was estimated. Results: Four homogeneous CSA groups were identified: an intercourse group, a high-verbal/low-contact group, a high-sexual-contact group, and a sexual-touch group. Some of the groups were distinguishable from others in terms of the frequency of the abuse and the type of perpetrator identified. Conclusions: The results show that “typologies” of CSA may provide a useful way to describe complex patterns of abuse while also facilitating future investigations of CSA outcome and treatment need.

A cross-lagged panel study of dissociation and posttraumatic stress in a treatment-seeking sample of survivors of childhood sexual abuse

Abstract: Objective The current prospective study assessed the temporal relations between dissociation and posttraumatic stress (PTS) in a sample of treatment-seeking female survivors of childhood sexual abuse. PTS refers to symptoms associated with posttraumatic stress disorder (PTSD) in the absence of a clinical diagnosis of PTSD. Method Initial assessment was on average 23 years after the onset of abuse (N = 405), and participants were followed-up after 6 months (N = 245) and 12 months (N = 119). Results Findings indicated that dissociative experiences and PTS were highly correlated within each wave of data collection. Cross-lagged panel analysis revealed that at each assessment period dissociative symptoms and PTS levels, respectively, were primarily explained by scores on the same variable at the previous assessment period. Although further reciprocal relations between dissociation and PTS were evident, these associations were relatively weak in magnitude. Conclusion Current results provide important insights into the temporal relations between dissociative symptoms and PTS. The high correlations between dissociative experiences and PTS several years after trauma exposure have important clinical implications that may affect their treatment and trauma recovery.

Alternative models of DSM-5 PTSD: Examining diagnostic implications.

Abstract: The factor structure of DSM-5 posttraumatic stress disorder (PTSD) has been extensively debated with evidence supporting the recently proposed seven-factor Hybrid model. However, despite myriad studies examining PTSD symptom structure few have assessed the diagnostic implications of these proposed models. This study aimed to generate PTSD prevalence estimates derived from the 7 alternative factor models and assess whether pre-established risk factors associated with PTSD (e.g., transportation accidents and sexual victimisation) produce consistent risk estimates. Seven alternative models were estimated within a confirmatory factor analytic framework using the PTSD Checklist for DSM-5 (PCL-5). Data were analysed from a Malaysian adolescent community sample (n = 481) of which 61.7% were female, with a mean age of 17.03 years. The results indicated that all models provided satisfactory model fit with statistical superiority for the Externalising Behaviours and seven-factor Hybrid models. The PTSD prevalence estimates varied substantially ranging from 21.8% for the DSM-5 model to 10.0% for the Hybrid model. Estimates of risk associated with PTSD were inconsistent across the alternative models, with substantial variation emerging for sexual victimisation. These findings have important implications for research and practice and highlight that more research attention is needed to examine the diagnostic implications emerging from the alternative models of PTSD.

The prevalence of non-cardiac chest pain (NCCP) using emergency department (ED) data: a Northern Ireland based study

Abstract: The aim of this study was to assess the frequency of chest pain presentations and the subsequent non-cardiac chest pain diagnoses in an emergency department (ED) over a 3 year period. Administrative data on ED attendances to an urban general hospital in Northern Ireland between March 2013 and March 2016 were used. Data were coded and analysed to estimate frequencies of ‘chest pain’ presentation and the subsequent diagnoses for each year. Both chest pain presentations and chest pain presentations with a subsequent diagnosis of unknown cause increased each year. In total, 58.7% of all chest presentations across 3 years resulted in a non-cardiac diagnosis of either ‘anxiety’, ‘panic’ or ‘chest pain of unknown cause’. There is a significant amount of patients in the ED leaving with a non-cardiac diagnosis, following an initial presentation with chest pain. Given the link between non-cardiac chest pain and frequent use of services, the degree of repeat attendance should be investigated.

Training the next generation of psychotraumatologists: COllaborative Network for Training and EXcellence in psychoTraumatology (CONTEXT)

Abstract: In this paper we present a description of the Horizon2020, Marie Sklodowska-Curie Action funded, research and training programme CONTEXT: COllaborative Network for Training and EXcellence in psychoTraumatology. The three objectives of the programme are put forward, each of which refers to a key component of the CONTEXT programme. First, we summarize the 12 individual research projects that will take place across three priority populations: (i) refugees and asylum seekers, (ii) first responders, and (iii) perpetrators and survivors of childhood and gender-based violence. Second, we detail the mentoring and training programme central to CONTEXT. Finally, we describe how the research, together with the training, will contribute towards better policy, guidelines, and practice within the field of psychotraumatology.

Anger, Guilt and Shame as Mediators in the Relationship Between war Experiences and PTSD: Testing the Moderating Role of Child Soldier Status

Abstract: Previous research has identified strong associations between war experiences and posttraumatic stress disorder (PTSD). Few studies, however, have explored the underlying mechanisms of these associations in an integrated model. This study explored whether feelings of anger, shame, and guilt mediated the effects of war experiences and PTSD and if this association is heightened in former child soldiers from Northern Uganda. Nearly 40% of the sample were former child soldiers (N = 122), and 189 were civilians. A total of 35.5% met the proposed ICD-11 criteria for PTSD. Findings indicated previous war experiences were directly associated with PTSD. Anger and guilt were significant mediators of this effect, child soldier status did not moderate the mediated effects. This study provides an alternative framework of assessing the association between trauma and PTSD using a sample of young adults exposed to mass conflict.

Predicting Time Spent in Treatment in a Sample of Danish Survivors of Child Sexual Abuse

Abstract: The aim of this study was to identify significant predictors of length of time spent in treatment. In a convenience sample of 439 Danish survivors of child sexual abuse, predictors of time spent in treatment were examined. Assessments were conducted on a 6-month basis over a period of 18 months. A multinomial logistic regression analysis revealed that the experience of neglect in childhood and having experienced rape at any life stage were associated with less time in treatment. Higher educational attainment and being male were associated with staying in treatment for longer periods of time. These factors may be important for identifying those at risk of terminating treatment prematurely. It is hoped that a better understanding of the factors that predict time spent in treatment will help to improve treatment outcomes for individuals who are at risk of dropping out of treatment at an early stage.

Cannabis and psychosis: the impact of polydrug use

Abstract: Purpose While research has consistently identified an association between cannabis use and psychosis, few studies have examined this relationship in a polydrug context (i.e. combining cannabis with other illicit substances). Design/methodology/approach The present study sought to examine the association between recreational drug use (cannabis only v. polydrug) and psychotic disorders. Analysis was conducted on a large, representative survey of young Danish people aged 24 (N = 4,718). Participants completed self-report measures of lifetime drug use and this information was linked to the Danish psychiatric registry system. Findings Multivariate binary logistic regression analysis was used to examine the association between drug use (no drug use, cannabis only, cannabis and other drug) and ICD-10 psychotic disorders, while controlling for gender and parental history of psychosis. Compared with no drug use, the use of cannabis only did not increase the risk of psychosis while the odds ratio for cannabis and other drug were statistically significant. Research limitations/implications Psychosis risk may be associated with the cumulative effect of polydrug use. Practical implications Cannabis use may be a proxy for other drug use in research studies. Originality/value This study is innovative as it uses linked self-report and administrative data for a large sample. Administrative data was used to as an objective mental health status indicator.

A New Mental Health Service Model for NI: Evaluating the Effectiveness of Low Intensity CBT (LI-CBT)

Abstract: The prevalence of mental health problems in Northern Ireland (NI) is 19%, and this is 25% higher than in England (DHSSPS, 2014). In recent years, there have been extensive consultations, and subsequent recommendations made in NI, in an effort to address this issue and to support an improved infrastructure for the training and development of those working within mental health services (DHSSPS, 2012, 2015). Reform within mental health services in NI has been informed over the past decade by the Bamford review from which two action plans have been proposed (DHSSPS, 2012, 2015). In response to this, researchers at Ulster University wanted to demonstrate an evidence base for the implementation of a new primary care/community based psychological therapies service model in NI, based on the UK ‘Improving Access to Psychological Therapies’ (IAPT) service model. This was informed by the National Institute of Clinical Excellence (NICE) guidelines, which advocates the use of low intensity cognitive behavioural therapy (LI-CBT) for mild to moderate anxiety and depression (NICE 2004a, 2004b). Evidence from IAPT sites suggest that the model is clinically effective (Clark, Layard, Smithies, Richards, Suckling & Wright, 2009) but that the appropriate resourcing of steps one and two is a more cost effective way to manage the high demands placed on health services. Hence, the current study aims to evaluate the effectiveness of implementing an IAPT service model using LI-CBT in primary and community care settings in NI. Two clinically valid routine outcome measures were used, which evaluate every client in every session, with data collection for the first phase of the study taking place between January 2015 and October 2016. Preliminary reliable change outcomes for the pilot cohorts showed recovery rates of 47.9%, improvement rates of 76.7% and deterioration rates of 6%. These findings indicate that the IAPT service model is clinically effective in a NI population. Data collection for the study is continuing between November 2016 and November 2017, using the same outcome measures, and additional follow-up data will also be examined in order to determine if the psychological benefits of interventions are maintained over time. Future analyses will also aim to identify individual and service level factors which potentially impact the effectiveness of the intervention.

Experiences of workplace bullying among 'non-traditional' students: Cause for concern for both business and education?

Abstract: Workplace bullying (WPB) has been identified as an insidious aspect of the contemporary work environment (Einarsen, Hoel, zapf, & Cooper, 2003). The present study had three related aims (i) to determine current and prior personal experience of WPB among a sample of 295 adults returning to tertiary education, (ii) to further explore the 'work environment hypothesis' (Einarsen, Raknes, & Matthiesen, 1994; Mc Guckin, Lewis, & Shevlin, under review) as an antecedent in the WPB process by examining the relationship between the 'psychosocial workplace' and exposure to WPB (v arhama & Bjorkqvist, 2004a, b; varhama et al., 2010), and (iii) to explore the relationship between exposure to WPB and salient work and life attitude variables (Mc Guckin et al., under review). Overall, 32.4% (n = 93) of the respondents had been bullied in the pre- vious 6 months, 42.1% (n = 120) had witnessed colleagues being bullied during this period, and 56.8% (n = 162) had been bullied in their previous career. The collective influence of the hypothesised antecedent variables (i.e., 'Challenge', 'Social Climate', 'Leadership', 'Work Control', 'Work Load', 'Role Conflict', and 'Role Ambiguity') explained a significant proportion of the variance in re- lation to self-reported personal experience of workplace bullying. Exposure to workplace bullying was significantly related to impaired 'work and life attitu - des'.