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. 2024;15(1):2353530.
doi: 10.1080/20008066.2024.2353530. Epub 2024 Jun 5.

The significant others' responses to trauma scale (SORTS): applying factor analysis and item response theory to a measure of PTSD symptom accommodation

Johanna Thompson-Hollands  1   2 , Daniel J Lee  1   2 , Elizabeth S Allen  3 , Nicole D Pukay-Martin  4 , Sarah B Campbell  5   6 , Kathleen M Chard  4   7 , Keith D Renshaw  8 , Joel G Sprunger  7 , Erica Birkley  7 , Katherine A Dondanville  9 , Brett T Litz  2   10   11 , David S Riggs  12 , Richard P Schobitz  13   14 , Jeffrey S Yarvis  15   16 , Stacey Young-McCaughan  9   17 , Terence M Keane  1   2 , Alan L Peterson  9   17   18 , Candice M Monson  19 , Steffany J Fredman  20
Affiliations

The significant others' responses to trauma scale (SORTS): applying factor analysis and item response theory to a measure of PTSD symptom accommodation

Johanna Thompson-Hollands et al. Eur J Psychotraumatol. 2024.

Abstract
in English, Spanish

Background: Symptom accommodation by family members (FMs) of individuals with posttraumatic stress disorder (PTSD) includes FMs' participation in patients' avoidance/safety behaviours and constraining self-expression to minimise conflict, potentially maintaining patients' symptoms. The Significant Others' Responses to Trauma Scale (SORTS) is the only existing measure of accommodation in PTSD but has not been rigorously psychometrically tested.Objective: We aimed to conduct further psychometric analyses to determine the factor structure and overall performance of the SORTS. Method: We conducted exploratory and confirmatory factor analyses using a sample of N = 715 FMs (85.7% female, 62.1% White, 86.7% romantic partners of individuals with elevated PTSD symptoms).Results: After dropping cross-loading items, results indicated good fit for a higher-order model of accommodation with two factors: an anger-related accommodation factor encompassed items related largely to minimising conflict, and an anxiety-related accommodation factor encompassed items related primarily to changes to the FM's activities. Accommodation was positively related to PTSD severity and negatively related to relationship satisfaction, although the factors showed somewhat distinct associations. Item Response Theory analyses indicated that the scale provided good information and robust coverage of different accommodation levels.Conclusions: SORTS data should be analysed as both a single score as well as two factors to explore the factors' potential differential performance across treatment and relationship outcomes.

Antecedentes: La acomodación de los síntomas por miembros de la familia (MFs) de las personas con trastorno de estrés postraumático (TEPT) incluye a la participación de los MFs en las conductas de evitación/seguridad y la contención de las propias expresiones para minimizar el conflicto, lo que potencialmente promueve la continuidad de los síntomas del paciente. La escala para la respuesta de las personas significativas (SORTS por sus siglas en inglés) es la única escala desarrollada para medir la acomodación de los síntomas en el TEPT, pero no ha sido evaluada psicométricamente de forma rigurosa.

Objetivo: Conducir análisis psicométricos adicionales para determinar la estructura factorial y el desempeño general de la SORTS.

Métodos: Se realizó un análisis factorial exploratorio y confirmatorio a partir de una muestra de n = 715 MFs (85,7 % mujeres, 62,1 % de raza blanca, 86,7 % parejas románticas de personas con elevados síntomas del TEPT).

Resultados: Luego de retirar ítems con cargas cruzadas, los resultados indicaron un adecuado ajuste para un modelo de acomodación de orden alto con dos factores: un factor de acomodación asociado con la ira que incluía ítems ampliamente relacionados a la minimización de conflicto y un factor de acomodación asociado a la ansiedad que incluía ítems asociados principalmente en cambios en las actividades de los MFs. La acomodación estaba asociada de forma directa a la severidad de los síntomas del TEPT y de forma inversa a la satisfacción con la relación; no obstante, los factores mostraron algunas asociaciones distintas. Los análisis basados en la teoría de respuesta a ítems mostraron que la escala brindaba buena información y una cobertura robusta sobre los diferentes niveles de acomodación.

Conclusión: Los datos de la SORTS deben ser analizados tanto como un puntaje único como en dos puntajes para cada uno de sus factores de forma que se explore el desempeño potencial de cada factor durante el tratamiento y en los resultados en las relaciones interpersonales.

Keywords: PTSD; TEPT; accommodation; acomodación; anger; couple; ira; pareja; pareja sentimental; partner.

Plain language summary

We examined the Significant Others’ Responses to Trauma Scale (SORTS), a measure of symptom accommodation in PTSD, among a large sample of family members.As measured by the SORTS, accommodation in PTSD could be broken down into two aspects: anger-related accommodation and anxiety-related accommodation.Accommodation was positively related to PTSD severity and negatively related to relationship satisfaction.

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Conflict of interest statement

No potential conflict of interest were reported by the author(s).

Figures

Figure 1.
Figure 1.
Higher-order measurement model of the significant others’ Responses to Trauma Scale with items identified through exploratory factor analysis.
Figure 2.
Figure 2.
Item information curves (IICs) for individual frequency items from the Significant other’s Responses to Trauma Scale (SORTS) loading onto Factor 1 (anger-related accommodation) and factor (anxiety-related accommodation).
See this image and copyright information in PMC

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