Posttraumatic Stress Disorder Symptom Structure in Chinese Adolescents Exposed to a Deadly Earthquake

  • Li WangEmail author
  • Di Long
  • Zhongquan Li
  • Cherie Armour


This present study examined the structure of posttraumatic stress disorder (PTSD) symptoms in a large sample of Chinese adolescents exposed to a deadly earthquake. A total of 2,800 middle school students aged 12 to 18 years participated in the study 6 months after the “Wenchuan Earthquake”. Results of confirmatory factor analysis indicated that a five-factor intercorrelated model composed of intrusion, avoidance, numbing, dysphoric arousal, and anxious arousal, fit data significantly better than both the four-factor numbing model King et al. (Psychological Assessment 10:90–96, 1998) and the four-factor dysphoria model Simms et al. (Journal of Abnormal Psychology 111:637–647, 2002). Further examination of the external convergent and discriminant validity revealed that except for the dysphoric arousal factor, the remaining four PTSD factors yielded significantly different correlations with external measures of anxiety vs. depression. The findings add to the limited literature on the factor structure of PTSD in youths and on the five-factor PTSD model. In addition, they provide more detail into the latent psychopathological processes of PTSD, and inform the forthcoming DSM-5.


Posttraumatic stress disorder Confirmatory factor analysis Adolescents Earthquake China 



This study was supported by National Foundation of Natural Science (No.30900402), China Postdoctoral Science Found (No.200902143), and the Knowledge Innovation Project of the Chinese Academy of Sciences (No.KSCX2-EW-Q-18)


  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.Google Scholar
  2. Anthony, J. L., Lonigan, C. J., & Hecht, S. A. (1999). Dimensionality of posttraumatic stress disorder symptoms in children exposed to disaster: Results from confirmatory factor analyses. Journal of Abnormal Psychology, 108, 326–336.PubMedCrossRefGoogle Scholar
  3. Anthony, J. L., Lonigan, C. J., Vernberg, E. M., La Greca, A. M., Silverman, W. K., & Prinstein, M. J. (2005). Multisample cross-validation of a model of childhood posttraumatic stress disorder symptomatology. Journal of Traumatic Stress, 18, 667–676.PubMedCrossRefGoogle Scholar
  4. Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological Assessment, 10, 176–181.CrossRefGoogle Scholar
  5. Armour, C., & Shevlin, M. (2010). Testing the dimensionality of PTSD and the specificity of the dysphoria factor. Journal of Loss and Trauma, 15, 11–27.CrossRefGoogle Scholar
  6. Armour, C., Layne, C. M., Naifeh, J. A., Shevlin, M., Durakovic-Belko, E., Djapo, N., et al. (2011). Assessing the factor structure of posttraumatic stress disorder symptoms in war-exposed youths with and without Criterion A2 endorsement. Journal of Anxiety Disorders, 25, 80–87.PubMedCrossRefGoogle Scholar
  7. Ayer, L. A., Cisler, J. M., Danielson, C. K., Amstadter, A. B., Saunders, B. E., & Kilpatrick, D. G. (2011). Adolescent posttraumatic stress disorder: An examination of factor structure reliability in two national samples. Journal of Anxiety Disorders, 25, 411–421.PubMedCrossRefGoogle Scholar
  8. Barnes, V. A., Treiber, F. A., & Ludwig, D. A. (2005). African-American adolescents' stress responses after the 9/11/01 terrorist attacks. Journal of Adolescent Health, 36, 201–207.Google Scholar
  9. Beck, A. T. (1972). Depression: Causes and treatment. Philadelphia: University of Pennsylvania Press.Google Scholar
  10. Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., et al. (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8, 75–90.PubMedCrossRefGoogle Scholar
  11. Calderoni, M. E., Alderman, E. M., Silver, E. J., & Bauman, L. J. (2006). The mental health impact of 9/11 on inner-city high school students 20 miles north of Ground Zero. Journal of Adolescent Health, 39, 57–65.Google Scholar
  12. Carragher, N., Mills, K., Slade, T., Teesson, M., & Silove, D. (2010). Factor structure of posttraumatic stress disorder symptoms in the Australian general population. Journal of Anxiety Disorders, 24, 520–527.PubMedCrossRefGoogle Scholar
  13. Elhai, J. D., Gray, M. J., Docherty, A. R., Kashdan, T. B., & Kose, S. (2007). Structural validity of the Posttraumatic Stress Disorder Checklist among college students with a trauma history. Journal of Interpersonal Violence, 22, 1471–1478.PubMedCrossRefGoogle Scholar
  14. Elhai, J. D., Engdahl, R. M., Palmieri, P. A., Naifeh, J. A., Schweinle, A., & Jacobs, G. A. (2009a). Assessing posttraumatic stress disorder with or without reference to a single, worst traumatic event: Examining differences in factor structure. Psychological Assessment, 21, 629–634.PubMedCrossRefGoogle Scholar
  15. Elhai, J. D., Ford, J. D., Ruggiero, K. J., & Frueh, B. C. (2009b). Diagnostic alterations for post-traumatic stress disorder: Examining data from the National Comorbidity Survey Replication and National Survey of Adolescents. Psychological Medicine, 39, 1957–1966.PubMedCrossRefGoogle Scholar
  16. Elhai, J. D., Biehn, T. L., Armour, C., Klopper, J. J., Frueh, B. C., & Palmieri, P. A. (2011). Evidence for a unique PTSD construct represented by PTSD’s D1–D3 symptoms. Journal of Anxiety Disorders, 25, 340–345.PubMedCrossRefGoogle Scholar
  17. Elklit, A., Armour, C., & Shevlin, M. (2010). Testing alternative factor models of PTSD and the robustness of the dysphoria factor. Journal of Anxiety Disorders, 24, 147–154.PubMedCrossRefGoogle Scholar
  18. Foa, E. B., Riggs, D. S., Dancu, C. V., & Rothbaum, B. O. (1993). Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. Journal of Traumatic Stress, 6, 459–473.CrossRefGoogle Scholar
  19. Ford, J. D., Elhai, J. D., Ruggiero, K. J., & Frueh, B. C. (2009). Refining posttraumatic stress disorder diagnosis: Evaluation of symptom criteria with the National Survey of Adolescents. The Journal of Clinical Psychiatry, 70, 748–755.PubMedCrossRefGoogle Scholar
  20. Gloster, A. T., Rhoades, H. M., Novy, D., Klotsche, J., Senior, A., Kunik, M., et al. (2008). Psychometric properties of the Depression Anxiety and Stress Scale-21 in older primary care patients. Journal of Affective Disorders, 110, 248–259.PubMedCrossRefGoogle Scholar
  21. Goldberg, D. P. (1978). Manual of the general health questionnaire. London: NFER.Google Scholar
  22. Gong, X., Xie, X., Xu, R., & Yuejia, L. (2010). Psychometric properties of the Chinese versions of DASS-21 in Chinese college students. Chinese Journal of Clinical Psychology, 18, 443–446 (In Chinese).Google Scholar
  23. Heir, T., Piatigorsky, A., & Weisæth, L. (2010). Posttraumatic stress symptom clusters associations with psychopathology and functional impairment. Journal of Anxiety Disorders, 24, 936–940.PubMedCrossRefGoogle Scholar
  24. Hoven, C. W., Duarte, C. S., Turner, J. B., & Mandell, D. J. (2009). Child mental health in the aftermath of disaster: A review of PTSD studies. In Y. Neria, S. Galea, & F. H. Norris (Eds.), Mental health and disasters (pp. 218–232). New York: Cambridge University Press.Google Scholar
  25. Hoyt, T., & Yeater, E. A. (2010). Comparison of posttraumatic stress disorder symptom structure models in Hispanic and White college students. Psychological Trauma: Theory, Research, Practice, and Policy, 2, 19–30.CrossRefGoogle Scholar
  26. Hu, L., & Bentler, P. M. (1998). Fit indices in covariance structural modeling: Sensitivity to underparameterized model misspecification. Psychological Methods, 3, 424–453.CrossRefGoogle Scholar
  27. Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.CrossRefGoogle Scholar
  28. Jöreskog, K. G., & Sörbom, D. (2005). LISREL 8.72: Interactive LISREL for MS Windows. Lincolnwood: Scientific Software International.Google Scholar
  29. Kassam-Adams, N. L., Marsac, M. L., & Cirilli, C. (2010). Posttraumatic stress disorder symptom structure in injured children: functional impairment and depression symptoms in a confirmatory factor analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 616–625.PubMedGoogle Scholar
  30. King, D. W., Leskin, G. A., King, L. A., & Weathers, F. W. (1998). Confirmatory factor analysis of the clinician-administered PTSD Scale: Evidence for the dimensionality of posttraumatic stress disorder. Psychological Assessment, 10, 90–96.CrossRefGoogle Scholar
  31. King, L. A., King, D. W., Orazem, R. J., & Palmieri, P. A. (2006). Research on the latent structure of PTSD. PTSD Research Quarterly, 17, 1–7.Google Scholar
  32. Kline, R. B. (2004). Principles and practice of structural equation modeling (2nd ed.). New York: Guilford.Google Scholar
  33. Lancaster, S. L., Melka, S. E., & Rodriguez, B. F. (2009). A factor analytic comparison of five models of PTSD symptoms. Journal of Anxiety Disorders, 23, 269–274.PubMedCrossRefGoogle Scholar
  34. Li, H., Wang, L., Shi, Z., Zhang, Y., Wu, K., & Liu, P. (2010). Diagnostic utility of the PTSD Checklist in detecting PTSD in Chinese earthquake victims. Psychological Reports, 107, 733–739.PubMedCrossRefGoogle Scholar
  35. Liu, K. Y., Chen, E. Y. H., Chan, C. L. W., Lee, D. T. S., Law, Y. W., Conwell, Y., et al. (2006). Socio-economic and psychological correlates of suicidality among Hong Kong working-age adults: Results from a population-based survey. Psychological Medicine, 36, 1759–1767.PubMedCrossRefGoogle Scholar
  36. Liu, Z., Yang, Y., Ye, Y., Zeng, Z., Xiang, Y., & Yuan, P. (2010). One-year follow-up study of post-traumatic stress disorder among adolescents following the Wen-Chuan earthquake in China. BioScience Trends, 4, 96–102.Google Scholar
  37. Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the depression anxiety stress scales (2nd ed.). Sydney: Psychology Foundation.Google Scholar
  38. Mansfield, A. J., Williams, J., Hourani, L. L., & Babeu, L. A. (2010). Measurement invariance of posttraumatic stress disorder symptoms among U.S. military personnel. Journal of Traumatic Stress, 23, 91–99.PubMedGoogle Scholar
  39. Marshall, G. N., Schell, T. L., Glynn, S. M., & Shetty, V. (2006). The role of hyperarousal in the manifestation of posttraumatic psychological distress following injury. Journal of Abnormal Psychology, 115, 624–628.PubMedCrossRefGoogle Scholar
  40. McDonald, S. D., & Calhoun, P. S. (2010). The diagnostic accuracy of the PTSD Checklist: A critical review. Clinical Psychology Review, 30, 976–987.PubMedCrossRefGoogle Scholar
  41. McDonald, S. D., Beckham, J. C., Morey, R., Marx, C., Tupler, L. A., & Calhoun, P. S. (2008). Factorial invariance of posttraumatic stress disorder symptoms across three veteran samples. Journal of Traumatic Stress, 21, 309–317.PubMedCrossRefGoogle Scholar
  42. Miller, M. W. (2010). On comparing competing models of PTSD: Response to Simms. Journal of Traumatic Stress, 23, 642–644.CrossRefGoogle Scholar
  43. Miller, M. W., Wolf, E. J., Harrington, K. M., Brown, T. A., Kaloupek, D. G., & Keane, T. M. (2010). An evaluation of competing models for the structure of PTSD symptoms using external measures of comorbidity. Journal of Traumatic Stress, 23, 631–638.PubMedCrossRefGoogle Scholar
  44. Naifeh, J. A., Elhai, J. D., Kashdan, T. B., & Grubaugh, A. L. (2008). The PTSD Symptom Scale’s latent structure: An examination of trauma-exposed medical patients. Journal of Anxiety Disorders, 22, 1355–1368.PubMedCrossRefGoogle Scholar
  45. Naifeh, J. A., Richardson, J. D., Del Ben, K. S., & Elhai, J. D. (2010). Heterogeneity in the latent structure of PTSD symptoms among Canadian veterans. Psychological Assessment, 22, 666–674.PubMedCrossRefGoogle Scholar
  46. Norris, F. H., & Hamblen, J. L. (2004). Standardized self-report measures of civilian trauma and PTSD. In J. P. Wilson, T. M. Keane, & T. Martin (Eds.), Assessing psychological trauma and PTSD (pp. 63–102). New York: Guilford.Google Scholar
  47. Norton, P. J. (2007). Depression Anxiety and Stress Scales (DASS-21): Psychometric analysis across four racial groups. Anxiety, Stress, and Coping, 20, 253–265.PubMedCrossRefGoogle Scholar
  48. Oei, T. P. S., Lin, J., & Raylu, N. (2008). The relationship between gambling cognitions, psychological states, and gambling. Journal of Cross-Cultural Psychology, 39, 147–161.CrossRefGoogle Scholar
  49. Pietrzak, R. H., Goldstein, M. B., Malley, J. C., Rivers, A. J., & Southwick, S. M. (2010). Structure of posttraumatic stress disorder symptoms and psychosocial functioning in veterans of Operations Enduring Freedom and Iraqi Freedom. Psychiatry Research, 178, 323–329.PubMedCrossRefGoogle Scholar
  50. Raftery, A. E. (1995). Bayesian model selection in social research. Sociological Methodology, 25, 111–163.CrossRefGoogle Scholar
  51. Rasmussen, A., Smith, H., & Keller, A. S. (2007). Factor structure of PTSD symptoms among west and central African refugees. Journal of Traumatic Stress, 20, 271–280.PubMedCrossRefGoogle Scholar
  52. Satorra, A., & Bentler, P. M. (1988). Scaling corrections for chi-square statistics in covariance structure analysis. In American Statistical Association 1988 proceedings of the business and economic section (pp. 308–313). Alexandria, VA: American Statistical Association.Google Scholar
  53. Satorra, A., & Bentler, P. M. (2001). A scaled difference chi-square test statistic for moment structure analysis. Psychometrika, 66, 507–514.CrossRefGoogle Scholar
  54. Saul, A., Grant, K., & Carter, J. (2008). Post-traumatic reactions in adolescents: How well do the DSM-IV PTSD criteria fit the real life experience of trauma exposed youth? Journal of Abnormal Child Psychology, 36, 915–925.PubMedCrossRefGoogle Scholar
  55. Schafer, J. L., & Graham, J. W. (2002). Missing data: Our view of the state of the art. Psychological Methods, 7, 147–177.Google Scholar
  56. Schell, T. L., Marshall, G. N., & Jaycox, L. H. (2004). All symptoms are not created equal: The prominent role of hyperarousal in the natural course of posttraumatic psychological distress. Journal of Abnormal Psychology, 113, 189–197.Google Scholar
  57. Schwarz, G. (1978). Estimating the dimension of a model. Annals of Statistics, 6, 461–464.CrossRefGoogle Scholar
  58. Simms, L. J., Watson, D., & Doebbeling, B. N. (2002). Confirmatory factor analyses of posttraumatic stress symptoms in deployed and nondeployed veterans of the Gulf War. Journal of Abnormal Psychology, 111, 637–647.PubMedCrossRefGoogle Scholar
  59. Smith, M. Y., Redd, W., DuHamel, K., Vickberg, S. J., & Ricketts, P. (1999). Validation of the PTSD checklist-civilian version in survivors of bone marrow transplantation. Journal of Traumatic Stress, 12, 485–499.PubMedCrossRefGoogle Scholar
  60. Spielberger, C. D., Gorsuch, R., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the state-trait anxiety inventory (form Y). Palo Alto: Consulting Psychologists.Google Scholar
  61. Stewart, A. J., Steiman, M., Cauce, A. M., Cochran, B. N., Whitbeck, L. B., & Hoyt, D. R. (2004). Victimization and posttraumatic stress disorder among homeless adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 325–331.PubMedCrossRefGoogle Scholar
  62. Szabó, M. (2010). The short version of the Depression Anxiety Stress Scales (DASS-21): Factor structure in a young adolescent sample. Journal of Adolescence, 33, 1–8.PubMedCrossRefGoogle Scholar
  63. Taouk, M., Lovibond, P., & Laube, R. (2001). Psychometric properties of a Chinese version of the 21-item depression anxiety stress scales (DASS21). Sydney: Cumberland Hospital.Google Scholar
  64. Taylor, S., Kuch, K., Koch, W. J., Crockett, D. J., & Passey, G. (1998). The structure of posttraumatic stress symptoms. Journal of Abnormal Psychology, 107, 154–160.PubMedCrossRefGoogle Scholar
  65. Tully, P., Zajac, I., & Venning, A. (2009). The Structure of anxiety and depression in a normative sample of younger and older australian adolescents. Journal of Abnormal Child Psychology, 37, 717–726.PubMedCrossRefGoogle Scholar
  66. Wang, M., Dai, X., & Wan, J. (2009). Factor structure of PTSD Checklist: A confirmatory factor analysis study in adolescents from earthquake region. Chinese Journal of Clinical Psychology, 17, 420–423 (In Chinese).Google Scholar
  67. Wang, L., Zhang, J., Shi, Z., Zhou, M., Li, Z., Zhang, K., et al. (2011). Comparing alternative factor models of PTSD symptoms across earthquake victims and violent riot witnesses in China: Evidence for a five-factor model proposed by Elhai et al. (2011). Journal of Anxiety Disorders.Google Scholar
  68. Watson, D. (2005). Rethinking the mood and anxiety disorders: A quantitative hierarchical model for DSM-V. Journal of Abnormal Psychology, 114, 522–536.PubMedCrossRefGoogle Scholar
  69. Watson, D. (2009). Differentiating the mood and anxiety disorders: A quadripartite model. Annual Review of Clinical Psychology, 5, 221–247.PubMedCrossRefGoogle Scholar
  70. Weathers, F., Litz, B., Herman, D., Juska, J., & Keane, T. (1993). The PTSD checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the Annual meeting of the International Society for Traumatic Stress Studies.Google Scholar
  71. Weiss, D. S., & Marmar, C. R. (1997). The impact of event scale-revised. In J. P. Wilson & T. M. Keane (Eds.), Assessing psychological trauma and PTSD: A handbook for practitioners (pp. 399–411). New York: Guilford.Google Scholar
  72. Willemsen, J., Markey, S., Declercq, F., & Vanheule, S. (2011). Negative emotionality in a large community sample of adolescents: the factor structure and measurement invariance of the short version of the depression anxiety stress scales (DASS-21). Stress and Health. Google Scholar
  73. Wu, K. K., Chan, S. K., & Yiu, V. F. (2008). Psychometric properties and confirmatory factor analysis of the posttraumatic stress disorder checklist for Chinese survivors of road traffic accidents. Hong Kong Journal of Psychiatry, 18, 144–151.Google Scholar
  74. Yang, X., Yang, H., Liu, Q., & Yang, L. (2007). The research on the reliabil ity and validity of PCL-C and influence factors. China Journal of Health Psychology, 15, 6–8 (In Chinese).Google Scholar
  75. Yufik, T., & Simms, L. J. (2010). A meta-analytic investigation of the structure of posttraumatic stress disorder symptoms. Journal of Abnormal Psychology, 119, 764–776.PubMedCrossRefGoogle Scholar
  76. Yule, W. (2001). Post-traumatic stress disorder in children and adolescents. International Review of Psychiatry, 13, 194–200.CrossRefGoogle Scholar
  77. Zhao, G., Yang, Y., Zhang, Q., Zhang, S., Deng, H., Zhu, Y., et al. (2009). Prevalence and related factors for PTSD in community residents after Wenchuan earthquake. Chinese Mental Health Journal, 23, 478–483 (In Chinese).Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Li Wang
    • 1
    • 5
    Email author
  • Di Long
    • 1
  • Zhongquan Li
    • 2
  • Cherie Armour
    • 3
    • 4
  1. 1.Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of SciencesBeijingChina
  2. 2.Department of Psychology, School of Social and Behavioral SciencesNanjing UniversityNanjingChina
  3. 3.National Centre for PsychotraumatologyUniversity of Southern DenmarkFunnenDenmark
  4. 4.School of Psychology, Faculty of Life and Health SciencesUniversity of Ulster at Magee CampusL’DerryUK
  5. 5.Institute of Psychology, Chinese Academy of SciencesBeijingChina

Personalised recommendations