3039 — Is PTSD Always PTSD?: Factor Structure Variability for Multiple Methods of PTSD Assessments across African American, Hispanic, and White Veterans

Weaver CM (VA Palo Alto), Kimerling RE (VA Palo Alto)

Objectives:
For researchers and treatment providers of veterans with PTSD, a key element of equitable evidence-based service provision is cross-validation of PTSD measurement across ethnic groups. A critical component of such cross-validation that has yet to receive thorough empirical emphasis in the PTSD literature is factor structure variability across diverse groups (L. King, et al., 2006). Were the factor structure to vary across groups, it may indicate disparate assessment and treatment needs for veterans returning with PTSD symptoms, depending on their ethnicity. In contrast, demonstration of invariance would validate existing assessment practices. Preliminary evidence supporting self-report factor invariance between Hispanic and non-Hispanic groups exists in non-veteran samples (Norris, Perilla, & Murphy, 2001; Marshall, 2004). However, the issue has yet to be addressed with gold-standard clinician-administered assessments, or with African American veterans. The current study sought to alleviate these gaps by determining factor structure variability across veterans of different ethnic groups.

Methods:
2,113 [White (n=1,451), African American (330), or Hispanic (332)] veterans were administered either the Clinician Administered PTSD Scale (CAPS; n=1,291), or the PTSD Checklist (PCL; n=857) at intake to inpatient PTSD treatment. We subjected one 3-factor, and two 4-factor models to group factor analyses as described by Byrne (2001).

Results:
The factor structure of the CAPS was invariant across all ethnicity pairs for all three factor models. Minor, but significant differences (chi square = 43.46 (23), p < .01) were observed between White and Hispanic groups with one of the 4-factor models due specifically to a higher covariance between the Re-experiencing and Avoidance factors in Hispanic (weight of .86 with all other parameters constrained) versus White (comparatively .62) veterans.

Implications:
These results provide a key validity component to the use of the CAPS with African American and Hispanic veterans. The small differences in PCL factor structures between White and Hispanic veterans are of research interest, but do not warrant immediate and drastic changes in the use of the measure with veterans of Hispanic origin.

Impacts:
The factor structure of the CAPS is invariant across White, Hispanic, and African American groups. Small differences in the self-report PCL factor structure exist between White and Hispanic veterans.