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. 2019 May 28;10(1):1616488.
doi: 10.1080/20008198.2019.1616488. eCollection 2019.

Complex posttraumatic stress disorder (CPTSD) following captivity: a 24-year longitudinal study

Gadi Zerach  1 , Mark Shevlin  2 , Marylene Cloitre  3   4 , Zahava Solomon  5
Affiliations

Complex posttraumatic stress disorder (CPTSD) following captivity: a 24-year longitudinal study

Gadi Zerach et al. Eur J Psychotraumatol. .

Abstract
in English, Spanish, Chinese

Background: The World Health Organization(WHO) International Classification of Diseases, 11th version (ICD-11), has proposed a new trauma-related diagnosis of complex posttraumatic stress disorder (CPTSD), separate and distinct from posttraumatic stress disorder (PTSD). However, to date, no study has examined CPTSD over time. Objectives: This prospective study aimed to examine predictors and outcomes of latent classes of PTSD and CPTSD following war captivity. Method: A sample of 183 Israeli former prisoners of the 1973 Yom Kippur War (ex-POWs) participated in a 24-year longitudinal study with three waves of measurements (T1: 1991, T2: 2008, and T3: 2015). Participants completed validated self-report measures, and their cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA). Results: Estimated rates of PTSD and CPTSD were high at all waves, with PTSD rates higher than CPTSD. A Latent Class Analysis (LCA) identified three main classes at T2: (1) a small class with low probability to meet PTSD and CPTSD clusters criteria (15.26%); (2) a class high only in PTSD symptoms (42.37%) and (3) a class high only in CPTSD symptoms (42.37%). Importantly, higher levels of psychological suffering in captivity at T1 were associated with higher odds of being in the CPTSD class at T2. In addition, CPTSD at T2 was more strongly associated with low self-rated health, functional impairment, and cognitive performance at T3, compared to the PTSD only class. Conclusions: Adulthood prolonged trauma of severe interpersonal intensity such as war captivity is related to CPTSD, years after the end of the war. Exposure to psychological suffering in captivity is a risk factor for future endorsement of CPTSD symptoms. CPTSD among ex-POWs is a marker for future dire mental health and functional consequences.

Antecedentes: La Clasificación Internacional de Enfermedades de la Organización Mundial de la Salud (OMS), 11ª versión (CIE-11), ha propuesto un nuevo diagnóstico relacionado con el trauma del trastorno de estrés postraumático complejo (TEPTC), separado y distinto del trastorno de estrés postraumático (TEPT). Sin embargo, hasta la fecha, ningún estudio ha examinado el TEPTC a lo largo del tiempo.Objetivos: Este estudio prospectivo tuvo como objetivo examinar los factores predictivos y los resultados de las clases latentes del TEPT y el TEPTC después del cautiverio de la guerra.Método: Una muestra de 183 prisioneros israelíes de la Guerra de Yom Kippur de 1973 (ex-prisioneros de guerra) participó en un estudio longitudinal de 24 años con tres momentos de mediciones (T1: 1991, T2: 2008, y T3: 2015). Los participantes completaron medidas validadas de autoinforme y su rendimiento cognitivo se evaluó mediante la Evaluación Cognitiva de Montreal (MoCA en sus siglas en inglés).Resultados: Las tasas estimadas del TEPT y TEPTC fueron altas en todos los momentos evaluados, con las tasas del TEPT más altas que del TEPTC. Un Análisis de Clase Latente (LCA en sus siglas en inglés) identificó tres clases principales en T2: (1) un grupo pequeño con baja probabilidad de cumplir con los criterios sintomáticos del TEPT y TEPTC (15.26%); (2) un grupo alto solo en los síntomas del TEPT (42.37%), y (3) un grupo alto solo en los síntomas del TEPTC (42.37%). Es importante destacar que los niveles más altos de sufrimiento psicológico en cautiverio en T1 se asociaron con mayores probabilidades de estar en el grupo del TEPTC en T2. Además, el TEPTC en T2 se asoció más fuertemente con una baja autoevaluación de salud, deterioro funcional, y rendimiento cognitivo en T3, en comparación con el grupo del TEPT solamente.Conclusiones: El trauma prolongado en la edad adulta de intensidad interpersonal severa, como el cautiverio de guerra, está relacionado con el TEPTC, años después de término de la guerra. La exposición al sufrimiento psicológico en cautiverio es un factor de riesgo para confirmación futura de los síntomas de TEPTC. El TEPTC entre los ex prisioneros de guerra es un marcador para la salud mental y las consecuencias funcionales futuras.

背景：世界卫生组织（WHO）国际疾病分类第11版（ICD-11），提出了一种新的创伤相关的复杂性创伤后应激障碍（CPTSD）诊断，与创伤后应激障碍（PTSD）区分。然而，到目前为止，还没有研究对CPTSD进行追踪考察。目标：这项前瞻性研究旨在研究战争囚禁后PTSD和CPTSD潜在类别的预测因素和结果。方法：1973年赎罪日战争的183名以色列前囚犯（ex-POWs, 前战俘）参加了一项为期24年的纵向研究，其中有三次测量（T1：1991年，T2：2008年和T3：2015年）。参与者完成了自评问卷，并使用蒙特利尔认知评估工具（MoCA）评估了他们的认知表现。结果：在所有测量时间点PTSD和CPTSD的估计发病率都很高，PTSD高于CPTSD。潜类分析（LCA）确定了T2的三个主要类别：（1）符合PTSD和CPTSD症状簇标准的概率较低的小类（15.26％）; （2）仅有高PTSD症状（42.37％）和（3）仅有高CPTSD症状的大类（42.37％）。重要的是，在T1时被囚禁时更多的心理痛苦和出现在T2的CPTSD类别的更高的几率相关。此外，与PTSD类相比，T2的CPTSD类与T3的低自评健康、功能障碍和认知表现更强烈相关。结论：成年后长期严重的人际剧烈创伤，如战争囚禁，与战争结束数年后的CPTSD有关。囚禁过程中遭受心理痛苦是未来出现CPTSD症状的风险因素。前战俘中的CPTSD是以后的心理健康和功能恶化的提示。.

Keywords: Complex PTSD; ICD-11; PTSD; ex-POWs; prolonged trauma; war; • We examined predictors and outcomes of latent classes of PTSD and CPTSD among ex-POWs.• A Latent Class Analysis (LCA) identified three main classes.• Psychological suffering in captivity was associated with higher odds of being in the CPTSD.• CPTSD was more strongly associated with low self-rated health, functional and cognitive impairment..

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Conflict of interest statement

No potential conflict of interest was reported by the authors.

Figures

Figure 1.
Figure 1.
Latent class model for PTSD and CPTSD in 2008 with predictors (1991) and distal outcomes (2015).
Figure 2.
Figure 2.
Three-class LCA profile plot.
See this image and copyright information in PMC

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