Factor structure of PTSD, and relation with gender in trauma survivors from India

The factor structure of posttraumatic stress disorder (PTSD) has been extensively studied in Western countries. Some studies have assessed its factor structure in Asia (China, Sri Lanka, and Malaysia), but few have directly assessed the factor structure of PTSD in an Indian adult sample. Furthermore, in a largely patriarchal society in India with strong gender roles, it becomes imperative to assess the association between the factors of PTSD and gender. The purpose of the present study was to assess the factor structure of PTSD in an Indian sample of trauma survivors based on prevailing models of PTSD defined in the DSM-IV-TR (APA, 2000), and to assess the relation between PTSD factors and gender. The sample comprised of 313 participants (55.9% female) from Jammu and Kashmir, India, who had experienced a natural disaster (<i>N</i>=200) or displacement due to cross-border firing (<i>N</i>=113). Three existing PTSD models—two four-factor models (Emotional Numbing and Dysphoria), and a five-factor model (Dysphoric Arousal)—were tested using Confirmatory Factor Analysis with addition of gender as a covariate. The three competing models had similar fit indices although the Dysphoric Arousal model fit significantly better than Emotional Numbing and Dysphoria models. Gender differences were found across the factors of Re-experiencing and Anxious arousal. Findings indicate that the Dysphoric Arousal model of PTSD was the best model; albeit the fit indices of all models were fairly similar. Compared to males, females scored higher on factors of Re-experiencing and Anxious arousal. Gender differences found across two factors of PTSD are discussed in light of the social milieu in India.

创伤后应激障碍（Posttraumatic Stress Disorder, PTSD）的因子结构在西方国家已得到广泛且深入的研究。已有部分研究针对亚洲地区（中国、斯里兰卡与马来西亚）的人群开展了PTSD因子结构的评估，但极少有研究直接以印度成年人群为样本，对PTSD因子结构进行系统性测评。此外，印度作为一个性别角色刻板鲜明的典型父权社会，评估PTSD因子与性别之间的关联显得尤为必要。本研究旨在基于《精神障碍诊断与统计手册第四版修订版》（美国精神病学协会，2000）中确立的主流PTSD诊断模型，对印度创伤幸存者样本的PTSD因子结构进行测评，并分析PTSD各因子与性别的关联。本研究的样本取自印度查谟与克什米尔地区，共纳入313名参与者，其中女性占比55.9%；所有参与者均曾遭遇自然灾害（*N*=200）或因跨境炮击流离失所（*N*=113）。本研究采用验证性因子分析（Confirmatory Factor Analysis, CFA），对三种已发表的PTSD模型进行检验：两种四因子模型（情感麻木与精神痛苦）与一种五因子模型（烦躁不安唤醒），并将性别作为协变量纳入分析框架。尽管五因子烦躁不安唤醒模型的拟合优度显著优于两种四因子模型，但三种竞争模型的拟合指数整体较为接近。研究发现，在闯入性再体验与焦虑唤醒两个因子上存在显著的性别差异。研究结果显示，PTSD的烦躁不安唤醒五因子模型为最优拟合模型，尽管所有模型的拟合指数均较为相近。相较于男性，女性在闯入性再体验与焦虑唤醒因子上的得分显著更高。本研究结合印度的社会文化环境背景，对PTSD两个因子上发现的性别差异进行了深入讨论。