Are posttraumatic stress disorder (PTSD) and complex-PTSD distinguishable within a treatment-seeking sample of Syrian refugees living in Lebanon?

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Gender was not statistically significantly associated with PTSD and CPTSD class membership, but was robustly and positively associated.

“Although not reaching the level of statistical significance, gender, unemployment status and traumatic history were robustly and positively associated with PTSD and CPTSD class membership.”

May combine two claims.

Class 1 (13.6%, n = 15) was the smallest class and was characterised by low probabilities of meeting the diagnostic criteria for each of the PTSD and DSO symptom clusters, with the exception of Avoidance symptoms which were moderate.

“Class 1 (13.6%, n = 15) was the smallest class and was characterised by low probabilities of meeting the diagnostic criteria for each of the PTSD and DSO symptom clusters.”

• Also stated in: § Discussion · plain

  “Finally, a small class (13.6%) was characterised by low probabilities of meeting the diagnostic criteria for both PTSD and DSO clusters, with the exception of the Avoidance symptoms which were moderate.”

May combine two claims.

The LCA results were somewhat equivocal in that the BIC favoured a two-class solution and the BLRT favoured a three-class solution.

“The LCA results (Table 2) were somewhat equivocal in that the BIC favoured a two-class solution and the BLRT favoured a three-class solution.”

May combine two claims.

Positive diagnostic status was high for each PTSD cluster and slightly lower for the DSO clusters.

“Positive diagnostic status was high for each PTSD cluster and slightly lower for the DSO clusters.”

Probably not a substantial claim: may not pass S3 (load-bearing).

All participants indicated exposure to a traumatic life event.

“In line with traumatic exposure being a diagnostic requirement for PTSD and CPTSD, all participants indicated exposure to a traumatic life event.”

Classified as probably not a substantial claim.

The sample consisted of 110 treatment-seeking Syrian refugees living in Lebanon.

“Participants were 110 treatment-seeking Syrian refugees living in Lebanon (80.2% female, mean age = 33.02, s.d. = 8.94).”

May combine two claims.

Class 3 (64.5%, n = 71) was the largest class and was characterised by high probabilities of meeting the diagnostic criteria for each of the PTSD and DSO symptom clusters.

“Class 3 (64.5%, n = 71) was the largest class and was characterised by high probabilities of meeting the diagnostic criteria for each of the PTSD and DSO symptom clusters.”

May combine two claims.

Traumatic history was not statistically significantly associated with PTSD and CPTSD class membership, but was robustly and positively associated.

“Although not reaching the level of statistical significance, gender, unemployment status and traumatic history were robustly and positively associated with PTSD and CPTSD class membership.”

May combine two claims.

Current estimates of PTSD/CPTSD prevalence align with figures from treatment-seeking adults in Denmark (49.1%: Hyland et al., 2017b) and the UK (64.5%: Hyland et al., 2017c).

“Moreover, current estimates of PTSD/CPTSD prevalence align with figures from treatment-seeking adults in Denmark (49.1%: Hyland et al., 2017b) and the UK (64.5%: Hyland et al., 2017c).”

• cites Hyland et al., 2017bNot checked yet

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• cites Hyland et al., 2017cNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Unemployment status was not statistically significantly associated with PTSD and CPTSD class membership, but was robustly and positively associated.

“Although not reaching the level of statistical significance, gender, unemployment status and traumatic history were robustly and positively associated with PTSD and CPTSD class membership.”

May combine two claims.

The prevalence of PTSD and CPTSD in this sample were similar to those observed in culturally distinct contexts, supporting the cross-cultural validity of the ICD-11 proposals.

“In support of the cross-cultural validity of the ICD-11 proposals, the prevalence of PTSD and CPTSD were similar to those observed in culturally distinct contexts.”

Classified as probably not a substantial claim. May combine two claims.

The ICD-11 will include a refined model of PTSD and a new diagnosis of CPTSD.

“The ICD-11 will include a refined model of posttraumatic stress disorder (PTSD) and a new diagnosis of complex PTSD (CPTSD).”

• Also stated in: § Conclusion · plain

  “The ICD-11 will also introduce complex-PTSD (CPTSD) into the diagnostic nomenclature for the first time (Maercker et al., 2013).”

• cites Maercker et al., 2013Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Females are twice as likely as males to be diagnosed with PTSD and CPTSD.

“Additionally, females are twice as likely as males to be diagnosed with PTSD and CPTSD (Karatzias et al., 2017).”

• cites Karatzias et al., 2017Not checked yet

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May combine two claims.

Individuals with CPTSD are more likely to be unemployed, unmarried and living alone.

“Individuals with CPTSD are more likely to be unemployed, unmarried and living alone (Hyland et al., 2017c; Karatzias et al., 2017).”

• cites Hyland et al., 2017cNot checked yet

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• cites Karatzias et al., 2017Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

The ICD-11 will introduce complex-PTSD (CPTSD) into the diagnostic nomenclature for the first time.

“The ICD-11 will also introduce complex-PTSD (CPTSD) into the diagnostic nomenclature for the first time (Maercker et al., 2013).”

• cites Maercker et al., 2013Not checked yet

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Classified as probably not a substantial claim.

LCA/LPA are person-centred statistics that allow for the identification of homogeneous classes of individuals through patterns of responses to categorical or continuous data.

“LCA/LPA are referred to as ‘person-centred’ statistics and allow for the identification of homogeneous ‘classes’ of individuals through the examination of patterns of responses to categorical (LCA) or continuous (LPA) data (Debowska et al., 2017).”

• cites Debowska et al., 2017Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Empirical assessments of the discriminant validity of ICD-11 PTSD and CPTSD have generally relied on latent class analysis (LCA) or latent profile analysis (LPA).

“Empirical assessments of the discriminant validity of ICD-11 PTSD and CPTSD have generally relied on the use of a statistical technique called latent class analysis (LCA) (or latent profile analysis (LPA)).”

• cites Debowska et al., 2017Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Individuals diagnosed with CPTSD experience significantly higher levels of psychosocial impairment.

“Individuals diagnosed with CPTSD are also repeatedly found to experience significantly higher levels of psychosocial impairment (Elklit et al., 2014; Murphy et al., 2016).”

• cites Elklit et al., 2014Not checked yet

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• cites Murphy et al., 2016Not checked yet

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May combine two claims.

The two studies with quantitative differences suggest that CPTSD is not distinguishable from PTSD and that differences are best explained by varying degrees of symptom severity on a single underlying condition.

“These studies, therefore, suggest that CPTSD is not distinguishable from PTSD and that differences in classes are best explained varying degrees of symptom severity on a single, underlying, condition (i.e. PTSD).”

Classified as probably not a substantial claim.

Both of these studies support the distinguishability of these diagnoses.

“While both of these studies support the distinguishability of these diagnoses, further studies are required to support the use of this scale for the assessment of these diagnoses.”

• cites Murphy et al., 2016Not checked yet

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• cites Karatzias et al., 2017Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

The ICD-11 puts forward substantial revisions, guided by key organising principles regarding cross-cultural validity and clinical utility.

“The ICD-11 puts forward substantial revisions, guided by key organising principles regarding cross-cultural validity and clinical utility (see Maercker et al., 2013).”

• cites Maercker et al., 2013Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

The six ICD-11 PTSD symptoms are grouped into three clusters: re-experiencing, avoidance, and sense of threat, with two symptoms per cluster.

“These six symptoms are grouped into three clusters: (i) Re-experiencing of the trauma in the here and now (Re); (ii) deliberate avoidance of traumatic reminders (Av); and (iii) a sense of current threat (Th) (Maercker et al., 2013), with two symptoms represented under each cluster.”

• cites Maercker et al., 2013Not checked yet

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May combine two claims.

Traumatic exposure is a diagnostic requirement for PTSD and CPTSD, but it is considered a risk-factor, rather than a determining factor, for a differential diagnosis of PTSD or CPTSD.

“While traumatic exposure is a diagnostic requirement for PTSD and CPTSD, it is considered a risk-factor, rather than a determining factor, for a differential diagnosis of PTSD or CPTSD (Cloitre et al., 2013).”

• cites Cloitre et al., 2013Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The ICD-11 model of PTSD includes only six symptoms, markedly fewer than the 20 symptom model of PTSD in DSM-5.

“Notably, the ICD-11 model of post-traumatic stress disorder (PTSD) includes only six symptoms; markedly fewer than the 20 symptom model of PTSD outlined within the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association [APA], 2013).”

• cites American Psychiatric Association [APA], 2013Not checked yet

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• cites Maercker et al., 2013Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

To date, ten LCA/LPA-based studies have been conducted across different countries and with samples exposed to varying forms of traumatic exposure.

“To date, there have been ten LCA/LPA-based studies conducted across different countries (e.g. USA, Germany, Denmark, UK and Uganda), and with samples exposed to varying forms of traumatic exposure (e.g. institutional child abuse, sexual assault, bereavement, child soldiering).”

May combine two claims.

The conceptualisation of traumatic exposure as a risk-factor allows for CPTSD after a single-incident trauma and PTSD after multiple or early-life traumas.

“This conceptualisation of traumatic exposure as a risk-factor (rather than a requirement) for a differential diagnosis allows for the occurrence of CPTSD within a particularly vulnerable individual following a single-incident trauma, and the occurrence of PTSD (or no diagnosis) within a resilient individual following exposure to multiple and/or early-life traumas.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The ITQ was professionally translated into Arabic and back-translated into English to ensure consistency.

“The ITQ was professionally translated into Arabic and back-translated into English to ensure consistency and that nothing was lost in translation.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Several demographic and psychosocial factors have been identified as risk factors for CPTSD.

“In addition to trauma history, several demographic and psychosocial factors have also been identified as risk factors for CPTSD.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Exposure to multiple forms of trauma, particularly early-life interpersonal trauma, elevates the risk of CPTSD.

“Specifically, exposure to multiple forms of trauma, particularly early-life interpersonal trauma, has been shown to elevate the risk of CPTSD (Hyland et al., 2017b)”

• cites Hyland et al., 2017bNot checked yet

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Classified as probably not a substantial claim. May combine two claims.

Evidence from simulation studies indicates that the BIC is the best information criterion for identifying the correct number of classes, and the BLRT is the optimal test to select the correct class solution.

“Evidence from simulation studies indicates that the BIC is the best information criterion for identifying the correct number of classes, and the BLRT is the optimal test to select the correct class solution (Nylund et al., 2007).”

• cites Nylund et al., 2007Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Several factor analytic studies have provided support for the proposed factorial validity of CPTSD, including one study of refugees.

“Several factor analytic studies have provided support for the proposed factorial validity of CPTSD (e.g. Hyland et al., 2017b, c), including one study of refugees (Nickerson et al., 2016).”

• cites Hyland et al., 2017b, cNot checked yet

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• cites Nickerson et al., 2016Not checked yet

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May combine two claims.

The three latent classes correspond to a PTSD class, a CPTSD class, and a low symptom class.

“Latent class analysis results identified three distinct groups: (1) a PTSD class, (2) a CPTSD class and (3) a low symptom class.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Single-incident traumatic exposure, particularly when occurring later in development, elevates risk of PTSD.

“whereas single-incident traumatic exposure, particularly when occurring later in development, has been shown to elevate risk of PTSD (Cloitre et al., 2013).”

• cites Cloitre et al., 2013Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

All psychotherapists were trained to administer the ITQ during a one-day workshop.

“All psychotherapists were trained to administer the ITQ during a one-day workshop held in Beirut in November 2015, during which case managers were also trained on how to obtain informed consent.”

Probably not a substantial claim: may not pass S3 (load-bearing).

To avoid solutions based on local maxima, 500 random sets of starting values were used, followed by 50 final stage optimisations.

“To avoid solutions based on local maxima, 500 random sets of starting values were used, followed by 50 final stage optimisations.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Several studies have provided empirical support for the proposed factor structure of PTSD within diverse trauma samples.

“To date, several studies have provided empirical support for the proposed factor structure of PTSD within diverse trauma samples (e.g. Hansen et al., 2015; Hyland et al., 2017a; La Greca et al., 2017).”

• cites Hansen et al., 2015Not checked yet

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• cites Hyland et al., 2017aNot checked yet

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• cites La Greca et al., 2017Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

A recent study among former child soldiers in Uganda also found no gender differences in risk for PTSD and CPTSD diagnosis (Murphy et al., 2016).

“Interestingly, a recent study among former child soldiers in Uganda also found no gender differences in risk for PTSD and CPTSD diagnosis (Murphy et al., 2016).”

• cites Murphy et al., 2016Not checked yet

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May combine two claims.

Despite gender, unemployment status and type of traumatic exposure not reaching statistical significance, the odds ratios for each of these variables were of a substantial magnitude and suggest the possibility of Type II errors.

“Despite the fact that gender, unemployment status and type of traumatic exposure did not reach the level of statistical significance, the odds ratios for each of these variables were of a substantial magnitude and suggests the possibility of Type II errors.”

May combine two claims.

The small sample size limits the interpretability and generalisability of the findings.

“First, the small sample size limits the interpretability and generalisability of the findings.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Previous studies indicate that CPTSD class membership is associated with the highest levels of impairment and distress.

“This finding is consistent with previous studies (Cloitre et al., 2013; Elklit et al., 2014; Murphy et al., 2016; Karatzias et al., 2017), which indicate CPTSD class membership is associated with the highest levels of impairment and distress.”

• cites Cloitre et al., 2013Not checked yet

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• cites Elklit et al., 2014Not checked yet

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• cites Murphy et al., 2016Not checked yet

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May combine two claims.

In previous studies, being female, unemployed and exposure to highly distressing traumatic events all demonstrated similar associations with PTSD and CPTSD class membership.

“In previous studies, being female, unemployed and exposure to highly distressing traumatic events (e.g. Hyland et al., 2017b) all demonstrated similar associations with PTSD and CPTSD class membership.”

• cites Hyland et al., 2017bNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

The finding of no significant gender differences stands in contradiction with the majority of the existing trauma literature (Christiansen & Hansen, 2014).

“a finding that stands in contradiction with the majority of the existing trauma literature (Christiansen & Hansen, 2014).”

• cites Christiansen & Hansen, 2014Not checked yet

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May combine two claims.

The time and resource demands associated with data collection limited the numbers of questions that could be asked of participants, and consequently it was not possible to measure a number of important correlates of PTSD/CPTSD, such as total number of traumatic life events, commonly co-occurring psychological distress factors, and risk and protective factors.

“Second, and relatedly, the time and resource demands associated with data collection limited the numbers of questions that could be asked of participants. Consequently, it was not possible to measure a number of important correlates of PTSD/CPTSD, such as the total number of (childhood and adulthood) traumatic life events, commonly co-occurring psychological distress factors (i.e. depression and”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The minor inconsistency between the BIC and BLRT statistics suggests that these results should be interpreted with caution, and may be the result of a limited sample size.

“The minor inconsistency between the BIC and BLRT statistics suggests that these results should be interpreted with caution, and may be the result of a limited sample size.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

There is an emerging literature supporting the efficacy of phased-based interventions for CPTSD, which have been recognised within the Guidelines for the Treatment of CPTSD in adults developed by the International Society for Traumatic Stress Studies.

“There is an emerging literature supporting the efficacy of phased-based interventions for CPTSD (e.g. ‘Skills Training in Affective and Interpersonal Regulation’: Cloitre et al., 2002) which have been recognised within the Guidelines for the Treatment of CPTSD in adults, and developed by the International Society for Traumatic Stress Studies (Cloitre et al., 2012).”

• cites Cloitre et al., 2002Not checked yet

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• cites Cloitre et al., 2012Not checked yet

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