2014 SHRP Summer Research Student Fellowship
Date: 4-16-14
Project Director: Weili Lu, PhD
Department/Program: Psychiatric Rehabilitation and Counseling Professions
Contact Information: Weili Lu, PhD; Department of Psychiatric Rehabilitation,
SHRP-Rutgers, 1776 Raritan Road, Scotch Plains, NJ 07076; Tel: 9088892453;
Email: luwe1@shrp.rutgers.edu
TITLE OF PROJECTS:
1. Posttraumatic Cognitions Inventory (PTCI): Psychometric Properties in a
SMI Sample
2. Confirmatory Factor Analysis of PTSD Checklist among SMI Clients
SYNOPSIS Project 1.
Background: Studies have inferred that those with a diagnosis of an anxiety disorder such
as PTSD exhibit negative cognitions, i.e., a negative perception of self and negative
world view (e.g., Foa & Kozak, 1986; Brewin & Holmes, 2003; Ehlers & Clark, 2000;
Foa & Cahill, 2001; Foa & Jaycox, 1999; Brewin, Dalgleish, & Joseph, 1996; Ehlers &
Clark, 2000; Foa & Rothbaum, 1998). Numerous studies have investigated the role of
dysfunctional cognitions in PTSD and supported their importance. Studies have also
shown that those with PTSD are more likely to experience negative beliefs of self and the
world in general than their non-PTSD counterparts (e.g., Beck et al., 2004; Foa, Ehlers,
Clark, Tolin, & Orsillo, 1999; Startup, Makgekgenene, & Webster, 2007). Such beliefs
are predictive of PTSD severity (Dunmore, Clark, & Ehlers, 2001).
The PTCI is a commonly used instrument designed to measure trauma-related cognitions
and beliefs. The assessment contains 33 statements that are rated on a Likert scale.
Within the instrument are three subscales including negative thoughts of self (SELF),
negative cognitions about the world (WORLD) and self-blame (BLAME). These three
factors have shown excellent internal consistency, good test-retest reliability, and
moderate to high correlations with the posttraumatic stress diagnostic scale (PDS).
While studies of PTCI have validated its use among individuals exposed to various types
of trauma, there remains a need to investigate the factor structure of PTCI among
individuals with serious mental illness (SMI). People with SMI tend to have greater
exposure to trauma and tend to have higher rates of PTSD. In order to address this need,
Lu, Mueser, Rosenberg and Silverstein designed a study to examine the three-factor
structure of PTCI in a SMI sample, the internal consistency of the subscales, and to
examine its validity (concurrent and divergent) using measures of PTSD and depression,
and to examine the role of gender, diagnosis, and types of trauma in the relation between
posttraumatic cognitions and PTSD symptoms in the SMI sample.
Study Design: The study will be using existing data from two previous clinical trials
(funded by NIMH grant R01 MH064662). Participants in this study consisted of 308
individuals that had been diagnosed with SMI. The clinician administered PTSD scale
(CAPS) was utilized to assess for PTSD diagnosis and symptom severity. Participants
also completed the Posttraumatic Cognitions Inventory (PTCI), and an expanded version
of the Brief Psychiatric Rating Scale, which measures severity of psychiatric symptoms.
The Beck Depression Inventory was used to measure depression changes. Anxiety levels
were measured using the Beck Anxiety Inventory. Self-reported mental health and
physical functioning were assessed via Short Form-12, which is reliable and valid for
patients with severe mental illness. The therapeutic alliance with case managers (i.e., not
the therapist providing CBT treatment) was rated using the patient version of Working
Alliance.
Current State of Project 1: We have presented the poster at professional conferences. It
needs to be finalized into a manuscript for publication. Data analysis will need to be
refined as well.
RESEARCH WORK TO BE DONE:
Student will work with Lu in preparing manuscript for publication. Specific tasks would
involve making tables and assisting with data analysis.
TIME FRAME FOR COMPLETION:
May 1-August 31-2014
SYNOPSIS Project 2.
The PTSD Checklist (PCL; Blanchard, Buckley, Forneris, & Jones-Alexander, 1996) is
used as a tool to screen and identify individuals with PTSD and to assess PTSD symptom
severity. The checklist contains questions pertaining to PTSD symptoms. Items are rated
on a 5 point Likert scale. A large number of confirmatory factor analyses (CFAs) have
been run to test goodness of fit for various structural models of PTSD. In addition to the
DSM-IV’s three-factor model (Andrykowski, Cordova, Hann, Jacobsen, & Studts, 2000),
recent CFAs have suggested two competing four-factor models of PTSD, both of which
display better fitness than other proposed models. The first of these models involves
splitting the DSM-IV’s avoidance/numbing cluster into separate factors, creating
intrusions, effortful avoidance, emotional numbing, and hyper-arousal dimensions
(Leskin, King, D., King, L., & Weathers, 1998). The second proposed four-factor model
creates a separate avoidance factor, expands emotional numbing into a broader dysphoria
construct, and reduces hyper-arousal to a more specific, hyper-vigilance factor; thereby
creating the four factors of intrusions, avoidance, dysphoria, and hyper-vigilance
(Doebbeling, Simms, & Watson, 2002). The factor structure of PCL has been tested in
populations such as disaster workers from the World Trade Center, elderly hurricane
disaster.
Study Design: Lu and colleagues designed a study to examine the use of confirmatory
factor analysis to test three-factor and four-factor models of PTSD in a combined dataset.
The final sample consists of 2,162 clients with serious mental illness. The participant
sample was composed of the following: 1) 1,144 adults with serious mental illness
(psychotic disorder or severe mood disorder) who were drawn from a larger investigation
on risky behavior and sexually transmitted diseases in persons with severe mental illness
(Rosenberg, Lu, Mueser, Jankowski, & Cournos, 2007; Lu, Mueser, Rosenberg, &
Jankowski, 2008). All participants received treatment in a public mental health facility in
four North Eastern states. Mental health centers were located in rural, urban, or
metropolitan areas. Eight percent (8.4%) of the sample was located in urban and
metropolitan areas, 19.7% from Veterans Affairs Medical Center, and 42.7% from
inpatient services. 2) 1021 clients with SMI (defined by the State of New Jersey),
receiving services at five outpatient and partial hospitalization programs (Lu et al.,
2013).
Data will be analyzed using SPSS-Amos20.0. Three models of PTSD will be tested,
including the four-factor numbing model of Leskin et al (1998) and the four-factor
numbing dysphoria model of Doebbeling et al. (2002). The preliminary results of CFA
indicate that a four-factor numbing model, as proposed by Leskin et al. (1998), composed
of intrusion, avoidance, numbing and hyper-arousal, is the best fitting model compared to
the current DSM-IV three-factor model of PTSD and Doebbeling et al.’s
(2002) four-factor dysphoria model. The preliminary findings suggest that PTSD
symptoms can be best explained by the intrusion, avoidance, numbing and arousal
clusters. This lends support for the newer conceptualization of four-symptom-clusters of
PTSD proposed by the upcoming DSM-V. The findings provide more insight into the
underlying psychopathological processes of PTSD. Future studies may seek to clarify the
separate role of clusters in clinical presentation of PTSD among SMI clients.
Current State of Project 1: We have presented the poster at UMDNJ research day. It
needs to be finalized into a manuscript for publication. Data analysis will need to be
refined as well.
RESEARCH WORK TO BE DONE:
Student will work with Lu in preparing manuscript for publication. Specific tasks would
involve making tables and assisting with data analysis.
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Lu, W., Mueser, K. T., Rosenberg, S. D., & Jankowski, M. K. (2008). Correlates of
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Lu, W., Yanos, P. T., Silverstein, S. M., Mueser, K. T., Rosenberg, S. D., Gottlieb, J. D.,
Duva, S. D., Kularatne, T., Dove-Williams, S., Paterno, D., Hawthorne, D., &
Giacobbe, G. (2013). Public mental health clients with severe mental illness and
probable posttraumatic stress disorder: Trauma exposure and correlates of
symptom severity. Journal of Traumatic Stress, 26, 266-273.
Rosenberg, S. D., Lu, W., Mueser, K. T., Jankowski, M. K., & Cournos, F. (2007).
Correlates of Adverse Childhood Events among adults with schizophrenia
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