Reappraising the dimensional structure of the PTSD Checklist: lessons from the DSM-IV-based PCL-C

Objective: The dimensional structure of posttraumatic stress disorder (PTSD) has been extensively debated, but the literature is still inconclusive and contains gaps that require attention. This article sheds light on hitherto unvisited methodological issues, reappraising several key models advanced for the DSM-IV-based civilian version of the PTSD Checklist (PCL-C) as to their configural and metric structures. Methods: The sample comprised 456 women, interviewed at 6-8 weeks postpartum, who attended a high-complexity facility in Rio de Janeiro, Brazil. Confirmatory factor analysis (CFA) and exploratory structural equation models (ESEM) were used to evaluate the dimensional structure of the PCL-C. Results: The original three-factor solution was rejected, along with the four-factor structures most widely endorsed in the literature (PTSD-dysphoria and PTSD-numbing models). Further exploration supported a model comprised of two factors (re-experience/avoidance and numbing/hyperarousal). Conclusion: These findings are at odds with the dimensional structure proposed in both DSM-IV and DSM-5. This also entails a different presumption regarding the latent structure of PTSD and how the PCL should be operationalized.

Magnitude da depressão pós-parto no Brasil: uma revisão sistemática / The extent of post-partum depression in Brazil: a systematic review

OBJETIVOS: realizar uma revisão sistemática dos estudos sobre a magnitude da depressão pós-parto (DPP) no Brasil. MÉTODOS: a busca e seleção da literatura baseouse em artigos publicados em periódicos nacionais e internacionais, nas bases de dados eletrônicas Lilacs, SciELO e Medline. RESULTADOS: foram selecionados 14 estudos, sendo que 13 deles reportavam a prevalência de DPP e apenas um estudo de seguimento com limitada casuística (n=21) trazia estimativa da incidência do agravo (42,8 por cento). A grande heterogeneidade em relação à população de estudo, método diagnóstico utilizado e período pós-parto focalizado dificultou a obtenção de uma estimativa agregada da prevalência de DPP no Brasil. Contudo, estudos conduzidos em unidades básicas de saúde, no âmbito da Estratégia de Saúde da Família ou em populações carentes apontaram uma prevalência entre 30 e 40 por cento de DPP, enquanto pesquisas que incluíram amostras de base populacional e populações de unidades hospitalares terciárias revelaram uma prevalência de cerca de 20 por cento. CONCLUSÕES: embora novos estudos sejam necessários para melhor caracterizar as peculiaridades que envolvem a magnitude da DPP no Brasil, as evidências disponíveis justificam uma atenção prioritária para os agravos à saúde mental materna no âmbito da saúde pública no país.

OBJECTIVES: to carry out a systematic review of studies of the extent of post-partum depression (PPD) in Brazil. METHODS: articles were searched for and selected from national and international periodicals included in the Lilacs, SciELO and Medline electronic databases. RESULTS: fourteen studies were selected, thirteen of which reported the prevalence of PPD and one, which followed up a limited number of cases (n=21) estimated the incidence of the disorder at 42.8 percent. The wide range of different populations studied, diagnostic methods used, and post-partum period monitored made it difficult to obtain an aggregate estimate for the prevalence of PPD in Brazil. Nevertheless, studies conducted at Family Health Program basic health units and among underprivileged populations suggest a prevalence of around 30 to 40 percent, although studies that are based on population-wide samples and tertiary hospital units reveal a prevalence of around 20 percent. CONCLUSIONS: although further studies are needed to characterize the specific features of the extent of PPD in Brazil, the available evidence provides sufficient justification for prioritizing treatment of mental health disorders in mothers attending the public health services.