The structure of PTSD. Development of the Post Traumatic Symptom scale from a clinician-based perspective

BACKGROUND: Nations marked by a Marxist-Leninist ideology have suffered greatly due to a culture of abuse emphasized by the absolute absence of psychology, thus contributing to a diminished ability in recognizing the consequences of traumatic experiences. OBJECTIVE: To improve the assessment of the presence and severity of posttraumatic stress disorder (PTSD) in such a cultural context, our paper aimed at developing an alternative self-report measure for PTSD - the Post Traumatic Symptom Scale (PTSs), developed by clinicians with wide relevant expertise, based on the natural language people use to describe its subjective experience. This research used multiple samples consistent with the corresponding objectives. Mokken Scale Analysis and the Classical Test Theory were both employed. The proposed scale was tested against five competing PTSD models, whilst also investigating the symptoms’ clusters in two different samples by using, to our knowledge, a network analysis approach for the first time. METHOD: The results indicated excellent psychometric properties regarding internal consistency and temporal reliability, as well as convergent and discriminant validity. The results of MSA showed that the scale fully conforms to the assumptions of the monotone homogeneity model, interpreted as positive evidence for its use in clinical purposes. The factor analyses pointed that the newer models outperformed the standard DSM-5 model, with bifactor models displaying better fit indexes than second-order models. Finally, a distinct pattern of symptom activation in the high-risk group (i.e. first-responders) was found, bringing support for symptoms overlapping between PTSD and affective disorders, thus reinforcing the idea of bridge symptoms which has significant clinical implications. RESULTS: This study presents an alternative sound instrument for measuring PTSD symptomatology focused on how people naturally describe their subjective experiences. Theoretical and practical implications are discussed alongside limitations. HIGHLIGHTS: The construction of PTSs encompasses cultural trauma and one’s subjective experience. PTSs was tested against the five major competing models of PTSD. Network analyses suggest different patterns in a student sample vs. a first-responders one, with the accent on the negative alterations in cognitions and mood (NACM) model.