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The ICD-11 introduced distinct criteria for Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD), necessitating validated assessment tools. While the International Trauma Questionnaire (ITQ) is a widely used self-report measure, the International Trauma Interview (ITI) is a structured clinician-administered interview considered a gold standard. This study investigated the correspondence between ITQ and ITI symptom and diagnostic classifications in a treatment-seeking veteran population. A sample of 108 Danish veterans completed both the ITQ and ITI. We calculated descriptive statistics, bivariate correlations, and Cohen's values to assess agreement for individual symptom items and diagnostic categories (ICD-11 PTSD, CPTSD, and PTSD or CPTSD combined), using the ITI as the reference standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were also determined. ITQ scores were consistently higher than ITI scores across all symptom domains. Total symptom scores for PTSD, DSO, and CPTSD showed strong associations between instruments (  = .74 to .82, all  < .001). Agreement for individual symptom items varied from fair to substantial (  = .33 to .70). The combined diagnosis of PTSD or CPTSD showed moderate agreement (  = .60) with high sensitivity (0.94) and PPV (0.90). However, agreement for ICD-11 PTSD alone was fair (  = .38), with low PPV (0.39) despite good sensitivity (0.65). The ITQ consistently reported higher symptom endorsement than the ITI. While the ITQ shows strong convergent validity for overall symptom burden and high sensitivity for screening trauma-related psychopathology (PTSD or CPTSD combined), its limited agreement for standalone ICD-11 PTSD diagnosis suggests it should not be used as a sole diagnostic tool. Comprehensive clinical interviews remain crucial for definitive diagnosis, while the ITQ can serve as an effective screening instrument.

Background Network analysis has been extensively used to study posttraumatic stress disorder (PTSD), but only a few studies have examined the network structure of ICD-11 complex PTSD (CPTSD). Currently, no networks of all CPTSD symptoms have been estimated on military samples. Therefore, this study aims to (1) explore the connections of CPTSD symptoms and (2) identify the most central symptoms in a clinical sample of military veterans presenting with CPTSD symptomatology. Method Danish treatment-seeking soldiers and veterans completed the International Trauma Questionnaire prior to commencing treatment at the Military Psychology Department in the Danish Defense. Network psychometrics were used to analyze the symptom structure and centrality strength index of self-reported CPTSD symptoms in veterans meeting criteria for CPTSD ( N  = 279). Stability of our results was assessed following the recommended guidelines to ensure reliability. Results Consistent with prior research, symptoms within the same CPTSD cluster were most strongly connected, except for affective dysregulation. Across all CPTSD symptoms, ‘external avoidance’ and ‘feelings of worthlessness’ emerged as the most central. Conclusion These findings are consistent with prior networks reported in non-military samples (e.g., community samples) and may support the generalizability of the CPTSD symptom network across trauma-exposed groups. Clinical trial number Not applicable.

A number of studies have tested the factor structure of the suggested ICD-11 symptom criteria for PTSD and complex PTSD (CPTSD) across various trauma populations, finding support for two different models in line with the ICD-11 theoretical rationale. Here, we aim to explore the factor structure of the Danish version of the International Trauma Questionnaire (ITQ) by testing two alternative factor models that have previously gained support in a large sample of treatment-seeking veterans. Treatment-seeking Danish soldiers and veterans (  = 599) recruited from the Military Psychology Department in the Danish Defence completed the International Trauma Questionnaire (ITQ). Confirmatory factor analysis (CFA) was used to assess fit of a first-order and a second-order model. Both models fit the data well but displayed latent variable correlations above 1 and negative variances (known as Heywood cases), indicating model misspecification or other problems. The specification problems included the latent variable Affect Dysregulation. Based on our results and results reported in previous CFAs of the ITQ, we suggest consideration of the proposed models. While many previous studies did find support for the models with no indications of misfit, others find Heywood cases concerning the same items and latent variables as our analysis. Hence, models of (C)PTSD based on the ITQ should be carefully evaluated and interpreted.

Sexual assault (SA) is associated with a high risk of posttraumatic stress disorder (PTSD), and delayed disclosure of SA may exacerbate psychological distress. Attachment theory provides a useful framework for understanding individual differences in trauma response. However, little is known about how attachment styles impact symptom severity and psychotherapy outcomes in late disclosers of SA. This study aimed to examine the relationship between adult attachment styles, posttraumatic stress symptoms, and psychotherapy outcomes in a clinical sample of adult survivors of SA. This study investigated (1) the association between attachment styles and posttraumatic stress symptoms prior to treatment, (2) whether attachment style at baseline predicted treatment outcomes, and (3) whether changes in attachment security were associated with symptom reduction. Sixty-seven adult survivors of SA (66 women, 1 man) seeking treatment an average of 47.5 months after the assault completed the Revised Adult Attachment Scale and the Posttraumatic Diagnostic Screening at baseline and post-treatment. General linear models were used to assess relationships between attachment dimensions and symptom severity. Attachment avoidance, but not attachment anxiety, was significantly associated with posttraumatic stress symptoms at baseline, accounting for 23% of the variance in overall post-traumatic distress. Neither attachment avoidance nor attachment anxiety predicted treatment outcomes. However, greater reductions in attachment avoidance during therapy were significantly correlated with improvement in posttraumatic stress symptoms, accounting for 10% of the variance in post-treatment symptoms. These findings suggest attachment avoidance is associated with posttraumatic stress symptoms among late disclosers of SA and that reduction in avoidance during therapy is related to improved outcomes. Given the interpersonal nature of SA, addressing attachment avoidance in psychotherapy may enhance recovery.

: Posttraumatic stress disorder (PTSD) is a serious and debilitating condition among military veterans. Exposure to potentially traumatic events (PTEs) may lead to PTSD and PTE sensitivity may be influenced by the personality trait neuroticism. : The current investigation aims to test whether exposure to PTEs during deployment is associated with changes in PTSD symptoms, and whether individual levels of neuroticism are related to resilience or sensitivity to such exposures. : The study sample included 701 Danish soldiers deployed to Afghanistan in 2009. PTSD symptoms were measured pre-, peri- and post-deployment (T1-T3) with the PTSD Checklist-Civilian Version. PTSD symptom load was modelled in a mixed linear model along with an extensive list of covariates. Interactions between time, exposure, and neuroticism were tested in order to assess whether neuroticism moderated the effect of PTEs upon PTSD symptoms. : On average, PTSD symptoms decreased from T1 through T3. Factors associated with higher PTSD symptom levels included number of past trauma, neuroticism, and low age at deployment. Interaction analyses showed that individuals with low and medium neuroticism levels displayed no significant change in PTSD symptoms, and individuals with high neuroticism displayed a significant decrease in PTSD symptoms. These changes were consistent across levels of perceived exposure to danger and combat and witnessing the consequences of war. : Results indicate that low levels of neuroticism appear to be related to resilience. Individuals with high levels of neuroticism displayed elevated PTSD symptoms across all time points, but contrary to expectations, they reported a significant decrease in PTSD symptoms from pre- to post-deployment.

The International Trauma Interview (ITI) is the first clinician-administered diagnostic tool developed to assess posttraumatic stress disorder (PTSD) and Complex PTSD (CPTSD), both recently recognized in the ICD-11. The current study aims to test the construct and discriminant validity of the ITI in a population of treatment-seeking veterans. 124 Danish veterans seeking psychological treatment were interviewed by a group of trained clinicians for ICD-11 PTSD and CPTSD before beginning treatment at the Military Psychological Department in the Danish Defense. A series of confirmatory factor models were estimated in order to identify the extent to which latent variable operationalizations provide potential explanations for the associations between symptoms. Results indicate that symptoms of CPTSD, as measured by the ITI, are best represented by a single higher-order factor. We also found that a bifactor model provided adequate fit to the data. The commonly identified two-factor higher-order model was rejected due to the lack of discriminant validity between PTSD and DSO. The higher order model was found to explain associations between symptoms of CPTSD and symptoms of depression, stress, anxiety, and well-being. The ITI does not fit a two-factor higher-order model in a sample of treatment-seeking Danish veterans. Rather, a single higher order factor shows excellent fit, and is found to explain associations between ITI symptoms and other internalizing symptoms.

Background: While empirical support for the ICD-11 distinction between posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) is growing, empirical research into the ICD-11 model of CPTSD in military populations is scarce and inconsistent. Objective: To replicate a study from our own group identifying distinct classes based on CPTSD symptoms using the International Trauma Questionnaire (ITQ) and to identify predictors and functional outcomes associated with a potential distinction between PTSD and CPTSD. Method: Formerly deployed treatment-seeking Danish soldiers (N = 294) completed the ITQ and self-report measures of traumatic life events prior to treatment. Latent profile analysis (LPA) was used to extract classes based on CPTSD symptoms. Results: LPA revealed four classes; (1) high CPTSD symptoms ('CPTSD', 28.7%); (2) high PTSD symptoms and lower DSO symptoms ('PTSD', 23.5%); (3) high DSO symptoms ('DSO', 17.3%); and (4) low symptoms ('Low Symptoms', 30.5%). In comparison to the PTSD-class, CPTSD-class membership was not predicted by traumatic events in adult life and in childhood. The CPTSD class was more often single/divorced/widowed compared to the PTSD class. Moreover, the CPTSD class more often used psychotropic medicine compared to the DSO-class and Low Symptoms-class. Conclusion: Using the ITQ, this study yields empirical support for the ICD-11 model of CPTSD within a clinical sample of veterans. The results replicate findings from our previous study that also identified distinct profiles of ICD-11 PTSD and CPTSD. The study identified separate classes representing CPTSD, PTSD, DSO and Low Symptoms in treatment-seeking military veterans based on the International Trauma Questionnaire. CPTSD is a more debilitating condition than PTSD. Findings replicate a previous LPA study of treatment-seeking Danish veterans.

Background: The WHO International Classification of Diseases, 11th version (ICD-11), includes a trauma-related diagnosis of complex posttraumatic stress disorder (CPTSD) distinct from posttraumatic stress disorder (PTSD). Results from previous studies support the validity of this distinction. However, no studies to date have evaluated the ICD-11 model of PTSD and CPTSD in treatment-seeking military veterans. Objective: To determine if the distribution of symptoms in treatment-seeking Danish veterans was consistent with the ICD-11 PTSD and CPTSD symptom profiles. Based on previous studies, we hypothesized that separate classes representing PTSD and CPTSD would be found that membership of a potential CPTSD-class would be predicted by a larger number of childhood traumas, and that a potential distinction between PTSD and CPTSD would be supported by differences in sociodemographic and functional outcomes. Method: Participants (N = 1,541) were formerly deployed Danish soldiers who completed proxy measures of ICD-11 PTSD and disturbances in self-organization (DSO) symptoms, along with self-report measures of traumatic life events, prior to starting treatment at the Military Psychology Department of the Danish Defence. Results: All hypotheses were supported. Latent profile analysis (LPA) revealed separate classes representing PTSD and CPTSD. In comparison to the PTSD-class, membership of the CPTSD-class was predicted by more childhood traumatic experiences, and members of this class were more likely being single/divorced/widowed and more likely to use psychotropic medication. Besides a PTSD-class and a CPTSD-class, LPA revealed a Low Symptoms-class, a Moderate DSO-class, a Hyperarousal-class, and a High DSO-class, with clear differences in functional outcomes between classes. Conclusion: Findings replicate previous studies supporting the distinction between ICD-11 PTSD and CPTSD. In addition, there seem to be groups of treatment-seeking military veterans that do not fulfil full criteria for a trauma-related disorder. Further research should explore subsyndromal PTSD and CPTSD profiles in veterans and other populations. * The present study evaluated the ICD-11 model of PTSD and CPTSD in a sample of treatment-seeking military veterans. * Latent profile analysis revealed a CPTSD-class, a PTSD-class, a High DSO-class, a Hyperarousal-class, a Moderate DSO-class, and a Low Symptoms-class. * CPTSD is a more debilitating condition than PTSD. * Compared to the PTSD-class, membership of the CPTSD-class was predicted by increased exposure to childhood traumatic experiences.

Background Due to an increase in PTSD patients seeking help in the Danish mental health sector and the addition of Complex PTSD to the ICD-11, there is a need to increase efficiency of existing treatments for PTSD. mHealth interventions have been shown to reduce PTSD symptoms. Therefore, the implementation of a mHealth intervention designed for psychiatric PTSD patients as a therapy add-on may improve treatment outcome. No study to date has explored the effects of mHealth interventions for PTSD in the Danish mental health sector, the feasibility and effect of this type of intervention needs testing. Methods The study is an investigator-initiated randomized controlled feasibility trial investigating the clinical mHealth tool PTSD help combined with care as usual (CAU) compared to CAU for adults with PTSD. Seventy patients will be recruited and receive either the mHealth intervention combined with CAU or CAU alone. The primary feasibility outcome is the proportion of eligible patients that participate in the study until the end assessment. Secondary outcome data consists of the fraction of compliant patients in the experimental group and exploratory data on PTSD help on PTSD symptom severity, level of psychological distress, sleep quality, dissociation symptoms, therapy readiness, quality of life, disability levels, and recovery. Discussion This study may help increase our knowledge of possible benefits of, as well as potential barriers to, the implementation of mHealth tools in the psychiatric sector. It may also provide a cost-efficient means to increase therapy outcomes and decrease the duration of suffering for PTSD patients in the psychiatric sector. Trial registration The trial is registered at ClinicalTrials.gov (ID: NCT03862703) https://clinicaltrials.gov/ct2/show/NCT03862703 on the 27 of February 2019 and has been approved by the Danish Data Protection Agency (journal number: VD-2018-200 ISuite number 6443). Referring to the committee law §2, the National Committee on Health Research Ethics (DNVK) [H-18024180] decided that the study could proceed without approval as the use of PTSD help did not constitute a health science intervention according to Danish health science legislation.

ObjectiveTo explore the experiences of volunteer responders attending a paediatric out-of-hospital cardiac arrests (POHCAs) in Denmark.DesignThis qualitative study used the Reflective Lifeworld Research theoretical framework. Data were generated through nine in-depth, in-person or virtual semistructured interviews conducted with volunteer responders.SettingThe study was conducted in Denmark. We recruited volunteer responders from all of Denmark enrolled in the nationwide volunteer responder programme.ParticipantsNine volunteer responders who were dispatched in response to a POHCA from 2020 to 2023 were included in the study.ResultsThe experiences of attending a POHCA were categorised into three key themes: the mission, the situation and the aftermath. The mission refers to the altruistic drive of volunteer responders to contribute to life-saving efforts. The situation reflects the profound shock experienced when volunteer responders realise that the patient is a child, alongside their ability to act decisively and initiate cardiopulmonary resuscitation in the situation. The aftermath reveals the deep sense of fulfilment derived from being present and actively involved in attempting to save a child’s life, as well as the various emotions and reactions that the volunteer responders process after the event.ConclusionAttending a POHCA is a profoundly intense experience that can leave an emotional impact on the volunteer responders. On arriving at the location, despite the initial shock upon realising that the patient is a child, the volunteer responders engage in the resuscitation attempt and offer support to the child’s family. However, alerting the volunteer responders beforehand that the patient is a child may help mitigate the initial shock. Volunteer responders find significant meaning in their roles and express a strong commitment to saving lives, irrespective of the age of those in need.