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Citation
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Feizi S, Elgar F, Lonergan M, Eisenberg K, Rahmouni N, Brunet A. Front. Psychiatry 2022; 13: e1006330. |
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Abstract
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We read with interest the recent study by Zhen et al. (1), titled "Pandemic Exposure, Post-traumatic Stress Disorder, Conflict Behaviors, and Online Aggressive Behaviors Among College Students During the COVID-19 Pandemic: Examining the Moderating Role of Gender." Their online survey of 1,153 college students found that pandemic exposure relates to conflict behaviors and online aggressive behaviors through posttraumatic stress disorder (PTSD) symptoms. The authors' efforts to contribute to a growing body of knowledge about the psychological consequences of the pandemic are laudable. However, conceptual and measurement issues cast uncertainty on their main findings. This letter describes some of our concerns.
PTSD is defined as a "pathological response to the experience of a life-threatening event" [(2); p. 97]. Given this definition, the measure of pandemic exposure used in this research may not have adequately measured "trauma" exposure given that the items did not necessarily capture the "life-threatening" criterion. The weak correlations found between pandemic exposure and symptoms (rs = −0.08 to 0.05) suggest that any PTSD in this sample of college students was unrelated to COVID-19. In fact, it appears that participants in this study had mean PTSD scores comparable to those of military veterans (3); but it is unclear what "trauma" was experienced. This is important because when participants in a recent study were asked whether they had experienced trauma as a consequence of COVID-19, only 7% responded affirmatively (4). During the COVID-19 pandemic, it was mostly front-line health care workers and individuals who witnessed a death or had a near-death experience due to COVID-19 who were at risk of developing PTSD (5). Therefore, the theoretical model presented by the authors is inconsistent with the known epidemiology of PTSD (6). A causal model of PTSD would naturally describe its symptoms as the outcome, not as mediators on a causal chain to something else.
In addition to this conceptual issue, certain methodological aspects led us to question the robustness of the findings. The authors measured symptoms using the well-known PTSD Checklist (i.e., PCL-5). There are two concerns with how this measure was used by the authors that challenge its construct validity. First, the PCL-5 is a 20-item self-report measure of PTSD symptom severity in the past month, and items are rated on a 5-point Likert scale ranging from 0 (not at all) to four [extremely; (7)]. However, the authors asked participants about symptoms in the preceding 2 weeks with the modified range of 0 (not at all/only once) to four (almost every day) on each item. It is possible their unvalidated version of the PCL-5 measured some aspects of PTSD but did not correspond to DSM-5 criteria.
The second concern involves PTSD inclusion criteria. One way to calculate PTSD severity is by the sum of items on the PCL-5. However, the PCL-5 can also be used to obtain a provisional PTSD diagnosis according to DSM-5 criteria, which requires individuals to endorse at least one intrusive symptom (questions 1-5), one avoidance symptom (questions 6-7), two arousal cognition and mood symptoms (questions 8-14), and two arousal and reactivity symptoms (questions 15-20; 7). It is unclear how many participants in the study met these criteria...
Language: en |