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Prolonged Grief Disorder (PGD) is a new stress-related disorder included in both the ICD-11 and DSM-5-TR. It is characterised by persistent longing for and preoccupation with the deceased, accompanied by associated emotional symptoms. The Aarhus Prolonged Grief Disorder scale (A-PGDs) is a self-report measure based on these diagnostic criteria. A clinically validated straightforward scoring method may increase its clinical utility. This study aimed to establish a scoring procedure for identifying probable ICD-11 and DSM-5-TR PGD cases using the A-PGDs. Specifically, we sought to develop a two-step approach requiring endorsement of core symptoms and exceeding a cut-off score on associated symptoms. Participants included bereaved adults (  = 122; 89.9% female) experiencing grief-related difficulties more than six months post loss. Optimal item thresholds for core symptoms were identified, and receiver operator characteristic (ROC) curve analyses determined the optimal cut-off score for associated symptoms. The Aarhus Structured Clinical Interview (A-PGDi) served as the gold standard. Endorsing core symptoms at a threshold of ≥3 identified 81.1% (  = 99) of participants. For these individuals, a cut-off score of ≥27 on the associated symptom items produced sensitivity and specificity of 80% and 61%, respectively, for ICD-11 PGD, and a cut-off score of ≥29 produced sensitivity and specificity of 81% and 66%, respectively, for DSM-5-TR PGD. Using the full two-step method, sensitivity and specificity were 80% and 70% for ICD-11 PGD, and 78% and 74% for DSM-5-TR PGD. Prevalence estimates were 34.4% for probable ICD-11 PGD and 36.0% for DSM-5-TR PGD. This two-step scoring method provides a simple, easy-to-use approach for clinicians to identify probable PGD cases.

Background: International research has established that children and adolescents are at risk for posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as defined by the WHO ICD-11. There is a need for a Danish language version of the International Trauma Questionnaire - Child and Adolescent (ITQ-CA) to assess symptoms of PTSD and CPTSD. Objective: To test the ICD-11 formulations of PTSD and DSO (Disturbances of Self-Organization) using the ITQ-CA version in a sample of children exposed to abuse. Additionally, to study the distribution of symptoms and probable prevalence of ICD-11 PTSD and CPTSD among the population of children exposed to violence or sexual abuse. Method: Confirmatory factor analysis of competing models of the dimensionality of the ITQ-CA was tested among a sample of 119 children and adolescents that were referred to the Danish Children Centres on suspicion of physical or sexual abuse or both. Latent class analysis (LCA) was used to study the distribution of symptoms and consequences of different operationalisations of functional impairment were explored. Results: Findings supported a two-factor second-order model corresponding to the operationalisation of CPTSD in ICD-11 as the best representation of the data. Findings from the LCA suggested that symptoms were distributed in a pattern consistent with the ICD-11 proposal for CPTSD. CPTSD was more prevalent than PTSD regardless of the operationalisation of functional impairment. Conclusion: ITQ-CA is a valid tool for identifying symptoms of ICD-11 PTSD and CPTSD among Danish children exposed to physical or sexual abuse. Further research is needed to study the relationship between ICD-11 C/PTSD symptomatology and anxiety and depression in this population. The International Trauma Questionnaire - Child and Adolescent version (ITQ-CA) is a valid measure of symptoms of ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD among Danish children exposed to physical or sexual violence. The structure of the ITQ-CA in the Danish sample reflects the ICD-11 diagnostic algorithm. CPTSD is a more prevalent disorder among children recently exposed to violence than PTSD.

Background: The 11 th version of the International Classification of Diseases (ICD-11) revised the diagnosis of Posttraumatic Stress Disorder (PTSD) and introduced Complex PTSD as a sibling disorder to PTSD. As the Danish Health Authorities will implement the ICD-11 in 2022, it is more relevant than ever to introduce a measure that enables the identification of ICD-11 PTSD and CPTSD. Objective: The primary aim of the present study was to test the construct validity of the ICD-11 conceptualization of PTSD and DSO in five clinical samples using translated versions of the International Trauma Questionnaire (ITQ). Method: Data from existing studies of adult survivors of sexual abuse (n = 385), women in shelters (n = 147), psychiatric outpatients endorsing an ICD-10 diagnosis of PTSD (n = 111), a heterogenous sample of psychiatric outpatients (n = 178) and refugees and torture survivors (n = 385) was used for the current study. Confirmatory factor analyses were conducted to test the internal structure of the ITQ, and regression models were conducted to test the convergent and discriminant validity of the factor solutions for each sample. Results: Findings supported the ICD-11 formulation of PTSD and disorders in self-organization (DSO) as a representation of the latent structure of the ITQ across five Danish clinical samples. Uniquely for women in shelters, however, the model displayed an unacceptable fit. A revised operationalization of re-experiencing proved a better fit when 'recurrent nightmares' was exchanged with symptoms of intense emotional reactions to reminders of the trauma for women in shelter as well as ICD-10 PTSD psychiatric outpatients. Conclusion: This study supports the use of a Danish translated version of the ITQ to assess symptoms of ICD-11 PTSD and DSO for the introduction of ICD-11 in 2022. Future research is needed to further explore the operationalization of re-experiencing across different trauma exposed populations. Scores from the ITQ validly represent ICD-11 PTSD and DSO across five trauma-exposed populations recruited in Denmark (n = 1197). Results suggest that symptoms of trauma-related re-experiencing might differ depending on population or recency of the trauma.

Background Social support is a key protective factor against mental illness. Yet, qualitative studies have suggested that emergency medical service (EMS) personnel working in ambulance contexts underutilise workplace-provided social support. Although a possible barrier to seeking support, no previous quantitative study has examined workload’s association with support utilisation in high-strain emergency settings. This study assesses the longitudinal association between EMS personnel’s workload and utilisation of workplace-provided formal support in an ambulance context. Methods 703 personnel from a Danish EMS organisation were invited to participate in the study. The survey data were collected from 2022 to 2023 over five survey rounds. Survey data were combined with organisational records of emergency responses from the same period, providing a measure of workload at a station level. Logistic mixed models were performed to assess associations between workload, measured by number of emergency responses, and formal support utilisation. Main analyses were performed using R-Studio (version 4.4.2). Results Of the 703 invited personnel, 341 participated in repeated survey rounds. At the final wave, 642 employees were eligible, corresponding to a response rate of 53.2% of possible participants at final wave. 82.1% of the participants were male, and 17.8% were female. The mean age of the participants was 42.13 years. EMS personnel at higher-workload stations were more likely to use support than those at lower-workload stations (OR = 2.03, CI = 1.26; 3.35). This effect persisted after adjusting for age, gender, workplace social capital, posttraumatic stress symptoms, and time effect (OR = 1.93, CI = 1.12; 3.35). Conclusion This is the first study examining EMS personnel’s workload and social support utilisation in a longitudinal design. Contrasting qualitative findings, this study presents evidence of greater support utilisation under higher workload. With reference to the Conservation of Resources Theory, the results could reflect a need to conserve resources under pressure, and underline the importance of accessible support in high-risk occupations.

The introduction of the WHO ICD-11 created a need for reliable and valid measures of Post-Traumatic Stress Disorder (PTSD) and complex PTSD (CPTSD). The International Trauma Questionnaire (ITQ) has been applied to different samples and cultures. Previous research using the original ordinal polytomous items supported the construct validity of the ITQ across different language versions in a sample of refugees in treatment and found evidence of locally dependent items and differential item functioning (DIF) relative to gender and time since trauma in the PTSD subscale. Another strand of research on the measurement properties of the ITQ has used dichotomized items and focused on discovering the model that best described the data found no evidence of DIF. To investigate the consequences of using dichotomized ITQ PTSD items for detecting DIF, other departures from the Rasch model as well as implications for measurement precision. We used Rasch and graphical log-linear Rasch models for the analysis, as these models have previously been employed in the only psychometric study using the original polytomous ITQ PTSD items. The use of dichotomized PTSD items lead to detection of less DIF than previous research with the polytomous items, and it accentuated local dependence between items and DIF relative to gender. Measurement by scores over dichotomized items increased the standard error of measurement and reduced the reliability to a level, where psychometric theory would conclude that the measure of PTSD was inapplicable. In contrast, previous research has shown measurement by the polytomous ITQ PTSD items to have precision and reliability sufficient for screening for PTSD. The original polytomous ITQ PTSD items are recommended for purposes of studying measurement properties of the ITQ and treatment effects.

Prolonged Grief Disorder (PGD) is a new disorder. A structured clinical interview for ICD-11 and DSM-5-TR PGD is a necessary tool in diagnosing PGD needed as PGD is implemented as a mental disorder in health services across the world. This study developed and validated The Aarhus PGD Interview (A-PGDi) to provide clinicians with free access to a valid method to diagnose PGD in alignment with recent diagnostic requirements in ICD-11 and DSM-5-TR and to training materials. The A-PGDi was developed in close collaboration between scientists, clinicians, and bereaved individuals. First, all PGD-symptoms underwent two rounds of item-formulations by clinicians and researchers. Then, a first version of the A-PGDi was tested in a group of bereaved adults with PGD symptoms, who were interviewed about the A-PGDi. The A-PGDi was refined according to their responses, piloted in 13 bereaved adults and further refined to its final version. The validity of A-PGDi was then tested with clinical interviews for PGD, PTSD, depression, and anxiety performed by carefully trained clinical interviewers in a sample of 124 bereaved adults (mean age 47 years (range 19-83 years); 85% female). Benchmarked against a self-report measure of PGD and moderate to substantial inter-diagnostic agreement between ICD-11 and DSM-5-TR diagnoses the A-PGDi had sufficient content validity. Significant relations between PGD-diagnosis and other mental disorders estimated with clinical interviews and self-report scales and moderate to substantial inter-diagnostic and test-retest agreement indicated sufficient criterion validity and reliability. small non-probability sample with PGD symptoms; self-identified for participation; mostly female. The results indicate that A-PGDi with some limitations is a valid structured clinical interview for diagnosing both ICD-11 and DSM-5-TR PGD that is relevant to administer in mental health settings to ensure correct diagnostics and the most helpful treatment plan for people with PGD.

Little peer-reviewed research has been done on trauma exposure, Post-Traumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD) prevalence among Greenlandic children and adolescents. There is a need for a validated Greenlandic version of the International Trauma Questionnaire - Child and Adolescent version (ITQ-CA) to assess symptoms of ICD-11 PTSD and CPTSD, as well as investigations of the prevalence of these disorders. This information is imperative in a Greenlandic context, where general epidemiological knowledge on traumatic exposure and reactions is lacking. The present study examined the factor structure of the Greenlandic ITQ-CA, estimated the prevalence of trauma exposure, ICD-11 PTSD and CPTSD, and examined the relationship between potentially traumatic events (PTEs), PTSD, CPTSD, and demographic variables in a Greenlandic adolescent population. Confirmatory factor analysis of competing models of the dimensionality of the ITQ-CA was tested among Greenlandic adolescents (  = 704) aged 11-17 years (  = 13.4, SD = 1.77). Using the ITQ-CA, PTSD and CPTSD was assessed. Findings supported the factorial validity of the Greenlandic ITQ-CA although factor structure differed across boys and girls. A total of 82.8% of the adolescents had been directly exposed to at least 1 PTE (  = 3.2), and 57.0% had been indirectly exposed (  = 3.1). The estimated prevalence of PTSD and CPTSD was 7.8% and 8.5%, while an additional 13.9% and 7% reached subclinical levels. Older age, female gender, several different and cumulative PTEs significantly elevated the risk of PTSD and CPTSD. ITQ-CA is a valid tool for identifying symptoms of ICD-11 PTSD and CPTSD. Results indicate that type and quantity of direct traumatic exposure are important predictors of PTSD and CPTSD. Events not normally considered traumatic as well as non-interpersonal events are significantly associated with CPTSD symptoms.

Background: The ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD diagnoses have been examined in several studies using the International Trauma Questionnaire (ITQ). The cross-cultural validity of the ITQ has not previously been studied using item responses theory methods focused on the issue of equal item functioning and thus comparability of scores across language groups. Objective: To investigate the cross-cultural validity of the ITQ scales considering specifically local independence of items and differential item functioning (DIF) in a cross-cultural sample of refugees. Method: Data from 490 treatment-seeking refugees were included, covering Danish, Arabic, and Bosnian languages and different levels of interpreter-assisted administration. Rasch and graphical log-linear Rasch models were used. Results: There was strong local dependence among items from the same symptom clusters in the PTSD and disorders in self-organization (DSO) scales, except between affective dysregulation items. Weak local dependence was discovered between an item from the affective dysregulation cluster and an item from the disturbed relationship cluster. There was no evidence of DIF related to language or interpreter assistance. There was evidence of DIF for two PTSD items relative to gender and time since the traumatic event. The targeting of the scales to the study population was not optimal. Reliability varied from 0.55 to 0.78 for subgroups. Conclusions: The PTSD and the DSO scales have stable psychometric properties across the Danish, Arabic, and Bosnian language versions and different levels of assisted administration. Scores are comparable across these groups. However, DIF relative to gender and time since trauma introduces considerable measurement bias. DIF-adjusted summed scale scores or estimated person parameters should be used to avoid measurement bias. Future research should investigate whether scales including more and/or alternative items that require higher levels of PTSD and DSO to be endorsed will improve targeting and measurement precision for refugee populations. A first cross-cultural validity study of the ITQ using IRT. PTSD and DSO subscales functioned invariantly across Danish, Arabic, and Bosnian, and also across degrees of interpreter assistance. Two PTSD items did not function invariantly across gender and time since trauma. The Danish, Arabic, and Bosnian ITQ can be used for screening treatment-seeking refugees, taking into account the item bias in the PTSD subscale, and suboptimal targeting and reliability, which require extensions or modification of items.

Abstract Objective The fear avoidance model has served as a popular, heuristic model in explaining the transition from acute to chronic pain. In addition, the significance of pain-related acceptance in chronic pain development and adjustment is underlined in a vast number of empirical studies. The objective of the current preliminary study was to investigate pain-related acceptance as a mediator within the key cognitive relationships proposed by the fear avoidance model of chronic pain. Materials and Methods. In a cross-sectional design, bodily pain, pain catastrophizing, fear avoidance beliefs, and pain-related acceptance were assessed by questionnaires in 125 chronic pain patients in a Danish multidisciplinary pain center. Mediation analyses were performed to test the effect of pain-related acceptance on bodily pain, pain catastrophizing, and fear avoidance beliefs. Results Medium-sized correlations were found between all outcomes. Mediation analyses revealed that pain-related acceptance was a significant mediator between 1) bodily pain and pain catastrophizing and 2) pain catastrophizing and fear avoidance beliefs after controlling for bodily pain. Furthermore, pain-related acceptance accounted for a large proportion in both associations (82.2% and 56.1%). Conclusions The results suggest that pain-related acceptance is a prominent psychological mechanism within the key cognitive associations of the fear avoidance model, which predicts a certain path of cognitive, emotional, and behavioral factors in the development and maintenance of chronic pain. This proposes pain-related acceptance to be an important mechanism that possibly counteracts the negative reactions of pain catastrophizing and fear avoidance beliefs. These findings should be investigated further and could potentially be an important place to intervene clinically in order to counteract the development and/or maintenance of chronic pain.