Psychometric Properties of the Child PTSD Symptom Scale for DSM-5 Interview and Self- Report Forms: Validation in a Clinical Sample

Psychometric Properties of the Child PTSD Symptom Scale for DSM-5 Interview and Self- Report Forms: Validation in a Clinical Sample | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Psychometric Properties of the Child PTSD Symptom Scale for DSM-5 Interview and Self- Report Forms: Validation in a Clinical Sample Fatma Zehra Bıçakcı, Alperen Bıkmazer, Ayşe Beyza Bıçakcı, Vahdet Görmez This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9327295/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Post-traumatic stress disorder (PTSD) affects a substantial proportion of trauma-exposed children and adolescents, yet validated DSM-5 PTSD assessment tools for Turkish-speaking youth remain limited, particularly measures offering both clinician-administered and self-report formats. This study aimed to evaluate the psychometric properties of the Turkish versions of the Child PTSD Symptom Scale for DSM-5 (CPSS-5) interview (CPSS-5-I) and self-report (CPSS-5-SR) forms in a clinical sample. Participants were 102 trauma-exposed children and adolescents (67.6% female; M age = 14.8 years, SD = 2.75) recruited from outpatient and inpatient child and adolescent psychiatry services. Psychometric properties were evaluated using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), internal consistency (Cronbach's α), test-retest reliability (ICC), convergent and discriminant validity (Spearman's ρ), and diagnostic accuracy (ROC analysis with K-SADS-based DSM-5 PTSD diagnosis as the reference standard). Both forms demonstrated excellent internal consistency (CPSS-5-SR: α = .936; CPSS-5-I: α = .904). EFA and CFA supported a four-factor structure consistent with DSM-5 PTSD symptom clusters (CPSS-5-SR: RMSEA = .045, CFI = .969; CPSS-5-I: RMSEA = .046, CFI = .951). Test-retest reliability was excellent for both forms (CPSS-5-I: ICC = .896; CPSS-5-SR: ICC = .871). Convergent validity was strong (ρ = .900, p < .001). Discriminant validity was supported by moderate correlations with anxiety (ρ = .326–.461) and depression (ρ = .437–.583; n = 37), substantially lower than the inter-form coefficient. ROC analysis revealed excellent diagnostic accuracy (CPSS-5-I: AUC = .927; CPSS-5-SR: AUC = .928), with optimal cutoffs of 33.5 (sensitivity 91.5%, specificity 85.2%) and 44 (sensitivity 83.0%, specificity 90.7%), respectively. The Turkish CPSS-5-I and CPSS-5-SR demonstrated strong psychometric properties and excellent diagnostic accuracy, supporting their use for PTSD screening, diagnosis, and treatment monitoring in clinical settings. PTSD CPSS-5 psychometric validation Turkish children DSM-5 Figures Figure 1 Introduction Traumatic life events represent a major public health concern across all age groups. A large-scale World Health Organization study reported that 70.4% of respondents worldwide had experienced at least one traumatic event, with an average of 3.2 events per person (Kessler et al., 2017 ). Among children and adolescents, approximately 40% have been exposed to at least one traumatic event (Costello et al., 2002 ). Of those exposed, approximately 15.9% develop post-traumatic stress disorder (PTSD), with rates varying considerably by trauma type and sex — ranging from 8.4% in boys exposed to non-interpersonal trauma to 32.9% in girls exposed to interpersonal trauma (Alisic et al., 2014 ). In Turkey, similar patterns have been observed, with the country's geographic vulnerability to earthquakes, ongoing urbanization challenges, and rising rates of violence against children contributing to substantial trauma exposure among youth (Yildiz et al., 2024 ). The psychological sequelae of trauma are diverse, ranging from full recovery to the development of PTSD and comorbid conditions including anxiety and depressive disorders (Kessler et al., 1995 ; Lewis et al., 2021 ). Between 60% and 80% of individuals who develop PTSD also meet criteria for at least one additional psychiatric disorder (Brady et al., 2000 ). Adverse childhood experiences are particularly consequential, as the neurobiological effects of early trauma are increasingly recognized as critical risk factors for adult psychopathology (Cross et al., 2017 ; Orellana et al., 2024 ; Teicher et al., 2006 ). Clinical assessment of trauma and PTSD in children poses specific challenges: traumatic events are often difficult to disclose, PTSD presentations are influenced by developmental, cultural, and interpersonal factors, and the clinical interview itself may require sensitive navigation — particularly when intrafamilial violence or abuse is involved. The publication of DSM-5 in 2013 brought significant revisions to the PTSD diagnostic criteria (APA, 2013 ). Key changes included the introduction of a separate PTSD subtype for children aged six years and under, the removal of the subjective fear response from Criterion A, the explicit inclusion of sexual violence in the trauma definition, and the expansion from three to four symptom clusters by separating negative alterations in cognition and mood (Cluster D) from hyperarousal (Cluster E). Collectively, these revisions broadened the diagnostic framework beyond the fear-based conceptualization of DSM-IV, reconceptualizing PTSD as a heterogeneous syndrome that may also encompass anhedonic and dysphoric presentations. As a result, previously validated assessment tools required updating to reflect the revised criteria. The DSM-5-TR (2022) retained the PTSD diagnostic criteria without substantive modification (APA, 2022 ). Several measures have been developed or revised to assess DSM-5 PTSD in children and adolescents, including the Kiddie Schedule for Affective Disorders and Schizophrenia – Present and Lifetime Version (K-SADS-PL; (Kaufman et al., 1997 )), the Clinician-Administered PTSD Scale for DSM-5 Child/Adolescent version (CAPS-CA-5; (Pynoos et al., 2015 )), the UCLA PTSD Reaction Index for DSM-5 (UCLA PTSD-RI-5; (Kaplow et al., 2020 ) ), the Child and Adolescent Trauma Screen 2 (CATS-2; (Sachser et al., 2022 )), and the Child PTSD Symptom Scale for DSM-5 (CPSS-5; (Foa et al., 2018 )). In Turkey, the psychometric properties of the DSM-IV version of the CPSS were previously examined in an earthquake-affected sample (Kadak et al., 2014 ); however, the subsequent revision of diagnostic criteria in DSM-5 necessitated an updated validation study. At the time, this study was designed and conducted, the only DSM-5 PTSD measure with a validated Turkish adaptation for use with children and adolescents was the K-SADS-PL (Ünal et al., 2019 ). Since then, a Turkish adaptation of the UCLA PTSD-RI-5 has been published (Kucukardali et al., 2025 ); however, a comprehensive Turkish validation of the CPSS-5 — incorporating both its interview and self-report forms — has not yet been reported. The CPSS-5 (Foa et al., 2018 ) is a widely used measure that offers both a clinician-administered interview (CPSS-5-I) and a self-report version (CPSS-5-SR), providing flexibility for different clinical contexts. The scale comprises 20 symptom items aligned with DSM-5 PTSD criteria and 7 functional impairment items assessed separately. The original development study demonstrated excellent internal consistency (α = .92 for both forms), good to excellent test-retest reliability, high convergent validity between the interview and self-report versions, and adequate diagnostic accuracy in trauma-exposed youth (Foa et al., 2018 ). The availability of parallel interview and self-report versions makes the CPSS-5 particularly suited to routine clinical use, enabling efficient screening and structured diagnostic evaluation within the same clinical encounter. The present study aimed to evaluate the psychometric properties of the Turkish CPSS-5-I and CPSS-5-SR in a clinical sample of trauma-exposed children and adolescents. Specifically, the study objectives were: (1) to examine the factor structure of both forms using EFA and CFA; (2) to evaluate internal consistency and test-retest reliability; (3) to assess convergent and discriminant validity; and (4) to determine optimal diagnostic cutoff scores using ROC analysis. Methods Participants Participants were 102 Turkish children and adolescents (69 girls, 67.6%; 33 boys, 32.4%) between 8 and 18 years of age ( M = 14.8, SD = 2.75). All participants had experienced at least one traumatic event meeting the DSM-5 PTSD Criterion A definition. The sample was recruited from both outpatient ( n = 79, 77.5%) and inpatient ( n = 23, 22.5%) child and adolescent psychiatry services at a tertiary hospital in Istanbul, Turkey. Data were collected between August 2024 and March 2025. Index trauma types were assessed using the Life Events Checklist for DSM-5 (LEC-5) and covered a broad spectrum of traumatic experiences. The most frequently reported index trauma was sexual assault (n = 32, 31.4%), followed by sudden violent death (n = 15, 14.7%), physical assault (n = 15, 14.7%), other unwanted or uncomfortable sexual experience (n = 13, 12.7%), and sudden accidental death (n = 5, 4.9%). Less frequently reported trauma types included natural disaster (n = 5, 4.9%), assault with a weapon (n = 6, 5.9%), life-threatening illness or injury (n = 6, 5.9%), transportation accident (n = 3, 2.9%), fire or explosion (n = 1, 1.0%), and serious accident (n = 1, 1.0%). Collectively, interpersonal trauma — including sexual and physical assault — constituted the majority of index trauma types (n = 66, 64.7%). Inclusion criteria were: (1) age 8–18 years; (2) exposure to a DSM-5 Criterion A traumatic event; (3) literacy in Turkish; and (4) voluntary participation with written informed consent from a parent or legal guardian and written assent from the participants. Exclusion criteria included intellectual disability, active psychotic illness, sensory impairment precluding participation, and neurological disorder affecting perception. A total of 157 children and adolescents who had disclosed a history of at least one traumatic event during routine clinical interviews were contacted and assessed for eligibility. Of these, 46 were contacted by telephone but declined to participate before the formal assessment. The remaining 111 attended the assessment; of these, a further 9 were excluded: 6 declined to complete the scales after attending, 2 were identified as having intellectual impairment based on clinical assessment, and 1 was excluded due to active psychotic symptoms. The final sample comprised 102 participants. Procedure This study was conducted in accordance with the Declaration of Helsinki and was approved by the local Clinical Research Ethics Committee (approval number: 2024.08.150). Written informed consent and assent were obtained from all parents and participants prior to data collection. All participants were individually assessed by the same child and adolescent psychiatrist. The CPSS-5-I was administered first, followed by the CPSS-5-SR, in a single session. Test-retest reliability was assessed in clinically stable subsamples re-evaluated after a 2–3 weeks interval ( n = 16 for CPSS-5-I; n = 23 for CPSS-5-SR). Measures Child PTSD Symptom Scale - Interview Version for DSM-5 (CPSS-5-I) The CPSS-5-I is a 27-item semi-structured clinician-administered interview assessing the presence and severity of DSM-5 PTSD symptoms over the past month (Foa et al., 2018 ). The first 20 items correspond to the DSM-5 PTSD symptom clusters: intrusion (items 1–5), avoidance (items 6–7), negative alterations in cognition and mood (items 8–14), and alterations in arousal and reactivity (items 15–20). Each item is rated on a 5-point frequency scale (0 = never to 4 = 6 or more times a week), yielding a total severity score ranging from 0 to 80. The remaining 7 items assess functional impairment across home, school, peer, and leisure domains; these are rated by frequency during the interview but are not included in the total symptom severity score. Prior to symptom assessment, the clinician identifies the most distressing traumatic event as the index trauma. Administration takes approximately 30 minutes. Child PTSD Symptom Scale – Self-Report Version for DSM-5 (CPSS-5-SR) The CPSS-5-SR is the self-report counterpart of the CPSS-5-I, comprising 27 items with identical symptom content and the same 5-point frequency rating scale (0–80 total score range). The 7 functional impairment items differ from the interview version in that they are presented in a binary yes/no format and are similarly excluded from the total score. Completion takes approximately 5–10 minutes. Life Events Checklist for DSM-5 (LEC-5) This is a self-report questionnaire consisting of 17 items designed to determine the type of event (such as traffic accidents, natural disasters like earthquakes, gunshot injuries, sexual abuse, etc.) and the manner of experiencing it (e.g., directly experienced, witnessed, learned about, or job-related) according to the DSM-5 PTSD criterion A. In addition to 16 defined events, it includes an extra item for any other stressful events not listed. There are different scoring methods based on calculating the number of events or including multiple types of events experienced in various ways (Weathers et al., 2013 ). Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) This is a semi-structured interview form developed to assess the past and current psychopathologies of children and adolescents aged 6–18 years (Kaufman et al., 1997 ). A diagnostic evaluation is conducted based on all the information gathered from interviews with parents and the child. The Turkish validity and reliability study of the DSM-5 revised version of the form has been conducted (Ünal et al., 2019 ). Revised Child Anxiety and Depression Scale (RCADS) The RCADS is a 47-item self-report questionnaire assessing anxiety disorders and depression in children and adolescents based on DSM criteria (Chorpita et al., 2005 ). It comprises six subscales: generalized anxiety disorder, separation anxiety disorder, social anxiety disorder, panic disorder, obsessive-compulsive disorder, and major depressive disorder. Items are rated on a 4-point scale (0 = never to 3 = always). In the present study, the total anxiety score (sum of all subscales excluding depression) and the depression subscale score were used to examine discriminant validity. The Turkish validity and reliability study of the RCADS demonstrated good internal consistency across all subscales (Cronbach's α > .70) (Gormez et al., 2017 ). Translation Procedure The Turkish adaptation of the CPSS-5 followed the translation protocol specified by the scale developers, as communicated directly by Dr. Foa's research team. First, the original English versions of the CPSS-5-I and CPSS-5-SR were translated into Turkish by the first author. An independent bilingual translator then back-translated the Turkish versions into English. The back-translations were submitted to Dr. Edna Foa and her research team at the University of Pennsylvania for review and feedback. Necessary revisions were incorporated into the Turkish versions, after which a second independent back-translation was conducted and resubmitted for review and approval. The final Turkish versions received formal approval from Dr. Foa prior to use in the study. Statistical Analysis All analyses were conducted using IBM SPSS Statistics Version 26 (IBM Corp., Armonk, NY, USA) and IBM SPSS AMOS. Data suitability for factor analysis was assessed using the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and Bartlett's test of sphericity. Exploratory factor analysis (EFA) was conducted using principal component extraction with varimax rotation; the number of factors was fixed at four, consistent with the DSM-5 PTSD symptom clusters. Confirmatory factor analysis (CFA) model fit was evaluated using multiple indices: the chi-square to degrees of freedom ratio (χ²/df; acceptable ≤ 3.0), the Root Mean Square Error of Approximation (RMSEA; good fit ≤ .05), the Comparative Fit Index (CFI; good ≥ .97, acceptable ≥ .95), the Tucker-Lewis Index (TLI; acceptable ≥ .95), the Incremental Fit Index (IFI; acceptable ≥ .95), and the Goodness-of-Fit Index (GFI; interpreted cautiously due to its known sensitivity to sample size). Internal consistency was assessed using Cronbach's alpha (α). Test-retest reliability was evaluated using the intraclass correlation coefficient (ICC; two-way mixed effects model, absolute agreement, single measures) with 95% confidence intervals. Convergent validity was examined using Spearman rank correlation coefficients (ρ) between the two CPSS-5 forms. Discriminant validity was assessed using Spearman correlations between CPSS-5 total scores and RCADS total anxiety and depression scores in a subsample with available concurrent data (n = 37). Diagnostic accuracy was evaluated using receiver operating characteristic (ROC) analysis with K-SADS-based DSM-5 PTSD diagnosis as the reference standard; optimal cutoff scores were determined using the Youden Index (sensitivity + specificity − 1). Statistical significance was set at p < .05. Results Descriptive Statistics The sample included 102 participants (mean age 14.8 years, SD = 2.75). K-SADS-based PTSD diagnosis was present in 48 participants (47.1%) and absent in 54 (52.9%). Index trauma types were assessed using the Life Events Checklist for DSM-5 (LEC-5) and are presented in Table 1 . Sexual assault was the most common index trauma, reported by approximately one third of the sample (n = 32, 31.4%), followed by sudden violent death and physical assault (both n = 15, 14.7%). Other unwanted or uncomfortable sexual experience was reported by 12.7% of participants (n = 13). Table 1 Demographic and Clinical Characteristics of the Sample (N = 102) Characteristic n % Sex Female 69 67.6 Male 33 32.4 Clinical setting Outpatient 79 77.5 Inpatient 23 22.5 Index trauma type Sexual assault 32 31.4 Physical assault 15 14.7 Sudden violent death 15 14.7 Unwanted sexual experience 13 12.7 Assault with a weapon 6 5.9 Life-threatening illness/injury 6 5.9 Sudden accidental death 5 4.9 Natural disaster 5 4.9 Transportation accident 3 2.9 Fire or explosion 1 1 Serious accident 1 1 PTSD diagnosis PTSD positive 48 47.1 PTSD negative 54 52.9 Note. PTSD = post-traumatic stress disorder. The remaining trauma types were less frequently endorsed, each representing fewer than 6% of the sample. Notably, interpersonal trauma types collectively accounted for the majority of index traumas (n = 66, 64.7%), a distribution with potential implications for the interpretation of symptom profiles and factor loadings observed in the present study. Socioeconomic status was assessed and the majority reported low-to-middle income levels, with 82.5% falling within the very low, low, or middle categories. Sample characteristics are presented in Table 1 . Factor Analyses Exploratory Factor Analysis KMO values indicated excellent (CPSS-5-SR: .901) and good (CPSS-5-I: .843) sampling adequacy. Bartlett's tests were significant for both forms ( p < .001). The four-factor EFA solution explained 63.27% (SR) and 60.99% (I) of total variance. Factor loadings ranged from .37 to .83 (SR) and .43 to .81 (I), with items loading onto theoretically expected DSM-5 clusters. Two items in the self-report form (items 4 and 5) yielded loadings below .40 (.39 and .37, respectively). Factor loadings are presented in Table 2 . Table 2 Exploratory Factor Analysis: Factor Loadings for CPSS-5-SR and CPSS-5-I (N = 102) Item DSM-5 Cluster Self-Report Form Interview Form F1 F2 F3 F4 F1 F2 F3 F4 1 Intrusion .43 .67 2 Intrusion .52 .62 3 Intrusion .53 .50 4 Intrusion .39† .73 5 Intrusion .37† .64 6 Avoidance .83 .77 7 Avoidance .63 .69 8 Changes in Cognition/Mood .69 .58 9 Changes in Cognition/Mood .71 .62 10 Changes in Cognition/Mood .60 .59 11 Changes in Cognition/Mood .73 .48 12 Changes in Cognition/Mood .65 .62 13 Changes in Cognition/Mood .63 .43 14 Changes in Cognition/Mood .56 .76 15 Arousal and Hyperreactivity .68 .60 16 Arousal and Hyperreactivity .72 .78 17 Arousal and Hyperreactivity .61 .56 18 Arousal and Hyperreactivity .63 .81 19 Arousal and Hyperreactivity .58 .63 20 Arousal and Hyperreactivity .70 .53 Variance explained (%) 63.27% 60.99% Note. F1 = Intrusion; F2 = Avoidance; F3 = Changes in Cognition and Mood; F4 = Arousal and Hyperreactivity. † Factor loading below .40. Confirmatory Factor Analysis CFA demonstrated good model fit for the CPSS-5-SR (χ²/ df = 1.207, RMSEA = .045, CFI = .969, TLI = .962, IFI = .970, GFI = .852) and acceptable fit for the CPSS-5-I (χ²/ df = 1.245, RMSEA = .046, CFI = .951, TLI = .941, IFI = .953, GFI = .857). The TLI for the interview form was marginally below .95, though all other indices were within acceptable ranges. Fit statistics are presented in Table 3 . Table 3 Confirmatory Factor Analysis Model Fit Indices Index Good Fit Acceptable CPSS-5-SR CPSS-5-I χ²/df ≤ 2.0 ≤ 3.0 1.207** 1.245** RMSEA ≤ .05 .05–.08 .045** .046** CFI ≥ .97 ≥ .95 .969** .951** TLI ≥ .95 .90–.95 .962** .941* IFI ≥ .95 .90–.95 .970** .953** GFI ≥ .90 .85–.89 .852* .857* Note. * Acceptable fit. ** Good fit. RMSEA = Root Mean Square Error of Approximation; CFI = Comparative Fit Index; TLI = Tucker-Lewis Index; IFI = Incremental Fit Index; GFI = Goodness-of-Fit Index. Internal Consistency and Test-Retest Reliability Cronbach's alpha was .936 for the CPSS-5-SR and .904 for the CPSS-5-I, indicating excellent internal consistency for both forms. Test-retest reliability over 2–3 weeks was excellent for the CPSS-5-I (ICC = .896, 95% CI: .725–.963, p < .001; n = 16) and good-to-excellent for the CPSS-5-SR (ICC = .871, 95% CI: .663–.949, p < .001; n = 23). Wide confidence intervals reflect the small retest subsamples and should be interpreted cautiously. Convergent and Discriminant Validity Total score correlation between forms was ρ = .900 ( p < .001). Subscale correlations ranged from ρ = .644 (avoidance) to ρ = .869 (intrusion; all p < .001). Full correlations are presented in Table 4 . Discriminant validity was examined in a subsample of 37 participants with available RCADS data. Both CPSS-5 forms showed moderate correlations with RCADS total anxiety scores (CPSS-5-I: ρ = .326, p = .049; CPSS-5-SR: ρ = .461, p = .004) and depression scores (CPSS-5-I: ρ = .437, p = .007; CPSS-5-SR: ρ = .583, p < .001). These correlations were substantially lower than the inter-form convergent validity correlation (ρ = .900), supporting the discriminant validity of both Turkish CPSS-5 forms. Table 4 Spearman Correlations Between CPSS-5-I and CPSS-5-SR Total and Subscale Scores CPSS-5-SR Total CPSS-5-I Total Intrusion (I) Avoidance (I) Changes in Cognition and Mood (I) Arousal and Hyperreactivity (I) .900** .813** .598** .782** .766** Intrusion (SR) .855** .869** .602** .689** .691** Avoidance (SR) .594** .591** .644** .462** .419** Changes in Cognition and Mood (SR) .839** .715** .479** .823** .671** Arousal and Hyperreactivity (SR) .829** .691** .506** .694** .821** Note. (I)= Interview version; (SR)= Self-report version; ** p < .001. Table 5 Spearman Correlations Between CPSS-5 Total Scores and RCADS Anxiety and Depression Scores (n = 37) CPSS-5-I Total RCADS Anxiety RCADS Depression .326* .437** CPSS-5-SR Total .461** .583** Note. RCADS = Revised Child Anxiety and Depression Scale; CPSS-5-I = Child PTSD Symptom Scale Interview Version for DSM-5; CPSS-5-SR = Child PTSD Symptom Scale Self-Report Version for DSM-5. Analyses conducted in a subsample of participants with available concurrent data ( n = 37). * p < .05. ** p < .001. Diagnostic Accuracy ROC analysis yielded excellent AUC values for both the CPSS-5-I (.927, 95% CI: .875–.978) and CPSS-5-SR (.928, 95% CI: .879–.977; both p < .001). The optimal cutoff for the CPSS-5-I was 33.5 (sensitivity 91.5%, specificity 85.2%, Youden Index = .767); for the CPSS-5-SR, the cutoff was 44 (sensitivity 83.0%, specificity 90.7%, Youden Index = .737). Full results are in Table 6 . Table 6 ROC Analysis: Diagnostic Accuracy of CPSS-5-I and CPSS-5-SR Parameter CPSS-5-I CPSS-5-SR AUC .927 .928 95% CI .875–.978 .879–.977 p value < .001 < .001 Optimal cutoff 33.5 44 Sensitivity (%) 91.5 83.0 Specificity (%) 85.2 90.7 Youden Index .767 .737 Note. AUC = Area Under the Curve; CI = Confidence Interval. Optimal cutoff by maximum Youden Index. Discussion The present study examined the psychometric properties of the Turkish CPSS-5-I and CPSS-5-SR in a clinical sample of trauma-exposed children and adolescents. Both forms demonstrated strong and consistent psychometric properties across multiple indices, supporting their reliability and validity for DSM-5 PTSD assessment in Turkish-speaking youth. Factor Structure EFA supported a four-factor structure for both forms, consistent with DSM-5 PTSD symptom clusters and accounting for 63.27% (SR) and 60.99% (I) of total variance. CFA confirmed adequate-to-good model fit (CPSS-5-SR: RMSEA = .045, CFI = .969; CPSS-5-I: RMSEA = .046, CFI = .951). The marginal TLI for the interview form (.941) may reflect variability inherent to clinician-administered interviews and the modest sample size, and should be considered alongside the other uniformly acceptable fit indices. The relatively lower factor loadings observed for items 4 and 5 in self-report form may reflect several overlapping factors. First, children and adolescents with prominent avoidance symptoms may have difficulty engaging with these items — not because of content overlap, but because confronting trauma-related internal cues is itself an avoidance-driven response, leading to inconsistent or attenuated endorsement. Second, for the younger children in the sample — approximately one quarter of participants were aged 8–12 — concrete-operational thinking may have contributed to differential interpretation of these items, which require introspective awareness of internal distress states. Third, in samples with high rates of sexual assault survivors, as in the present study (44.1%, both sexual assault and unwanted sexual experiences), intrusion symptoms may manifest atypically, with dissociative responses partially replacing or masking classic re-experiencing presentations – potentially reducing the salience of these items. These findings warrant attention in future research, particularly in age-stratified analyses and in samples with varying trauma profiles. The confirmation of a four-factor structure is also noteworthy in the context of the Turkish literature: whereas the earlier Turkish adaptation of the DSM-IV version of the CPSS reported a three-factor structure (Kadak et al., 2014 ), the present findings support a successful transition to the DSM-5 four-factor model, consistent with the revised diagnostic framework and suggesting that the expanded symptom structure introduced in DSM-5 is similarly applicable in Turkish clinical populations. Reliability Both forms showed excellent internal consistency (α = .936 and .904, respectively), comparable to or exceeding values reported in the original development sample (n = 64; α = .92 for both forms) (Foa et al., 2018 ). The higher alpha value observed for the self-report form may reflect greater symptom heterogeneity arising from the diversity of trauma types in the present sample. Test-retest reliability was excellent (CPSS-5-I: ICC = .896) and good-to-excellent (CPSS-5-SR: ICC = .871), supporting temporal stability of both instruments. Wide confidence intervals are attributable to small retest subsample sizes (see Limitations). Convergent and Discriminant Validity The two forms showed strong convergent validity (total score ρ = .900). The comparatively lower avoidance subscale correlation (ρ = .644) may reflect format-related differences in avoidance endorsement: clinician-administered interviews may elicit avoidance disclosures more effectively than self-report formats, where avoidant response tendencies may lead to underreporting. This pattern has been noted in prior cross-format comparisons (Foa et al., 2018 ) and underscores the complementary value of using both forms in clinical practice. Evidence for discriminant validity was provided by moderate correlations between CPSS-5 total scores and concurrent measures of anxiety (ρ = .326–.461) and depression (ρ = .437–.583), which were substantially lower than the inter-form convergent validity coefficient (ρ = .900). The somewhat higher correlations with depression than anxiety scores are consistent with the well-documented comorbidity between PTSD and depressive disorders (Brady et al., 2000 ; Foa et al., 2018 ; Kessler et al., 1995 ) and do not compromise the discriminant validity of the measure. These findings are broadly consistent with those reported in the original CPSS-5 validation study (Foa et al., 2018 ), which similarly observed moderate associations between CPSS-5 scores and concurrent measures of anxiety and depression, supporting the construct specificity of the scale. Diagnostic Accuracy Both forms demonstrated excellent diagnostic accuracy (AUC = .927 and .928), among the highest reported for child PTSD measures. The elevated AUC values should be interpreted in light of sample characteristics: the inclusion of inpatients with severe symptom profiles likely enhanced discrimination between PTSD-positive and PTSD-negative cases. The interview form showed higher sensitivity (91.5% vs. 83.0%), supporting its utility for screening contexts, while the self-report form showed higher specificity (90.7% vs. 85.2%), supporting its use for confirmation. These complementary profiles suggest that using both forms in sequence represents optimal clinical practice. A particular strength of the present study is the administration of the K-SADS to the full sample (n = 102), providing a comprehensive criterion validity framework for the ROC analyses. Turkish Context and Generalizability A key strength of this study is the breadth of trauma types represented, contrasting with prior Turkish PTSD measurement studies conducted predominantly with earthquake-affected samples. This diversity enhances ecological validity and supports the applicability of the Turkish CPSS-5 across the range of trauma presentations encountered in routine clinical practice in Turkey. The low-to-middle socioeconomic profile of the majority of participants (82.5%) reflects the demographic reality of public psychiatric services and adds to the representativeness of findings for this population. In this regard, the present study directly addresses gaps identified in the sole previously published Turkish validation of a CPSS version, using the DSM-IV iteration of the scale in a community sample of earthquake survivors (n = 479) (Kadak et al., 2014 ). While that study demonstrated sound psychometric properties, the sample was restricted to a single trauma type and did not include a clinician-administered interview version or diagnostic accuracy analysis — limitations the authors themselves acknowledged. By validating both the interview and self-report forms of the DSM-5 updated CPSS-5 in a clinical sample spanning a broad range of trauma types, including interpersonal violence, the current findings extend the evidence base for PTSD assessment in Turkish-speaking youth beyond earthquake-affected populations. Clinical Implications The complementary psychometric profiles of the two forms have direct implications for clinical practice. Trauma-related clinical interviews present unique challenges for both clinicians and patients; the re-emergence of traumatic material, the patient's avoidance tendencies, and the risk of secondary traumatization in the clinician are among the foremost of these difficulties (Figley, 2004 ; Pearlman & Saakvitne, 1995 ). The provision of a structured interview format enables clinicians to work with traumatic material in a systematic and comprehensive manner within a therapeutic framework; by reducing inter-clinician variability in questioning and interpretation, it safeguards the breadth of assessment and facilitates more reliable clinical judgements (Rogers, 2001 ). The brevity of the CPSS-5-SR (5–10 minutes) makes it particularly suited for routine screening in busy outpatient settings, enabling rapid identification of at-risk individuals. The CPSS-5-I, with its structured clinical interview format and higher sensitivity (91.5%), is better suited for formal diagnostic evaluation — ensuring that PTSD diagnoses are not missed in high-risk contexts such as emergency psychiatric assessments, child protection evaluations, or post-acute trauma presentations. The higher specificity of the CPSS-5-SR (90.7%) further supports its utility in research settings and treatment monitoring, where minimizing false positives is a priority. Used sequentially — the self-report form for initial screening, followed by the interview for confirmation in screen-positive cases — the two forms offer a clinically efficient and psychometrically robust assessment pathway for PTSD in children and adolescents. Limitations Several limitations warrant consideration. First, the sample size (n = 102) is at the lower boundary for factor-analytic studies. The requirement for a verified DSM-5 Criterion A traumatic event as an inclusion criterion — while methodologically rigorous — necessarily restricted the eligible sample, as individuals presenting with distressing life experiences that did not meet the formal Criterion A definition were not enrolled; this may partially account for the relatively modest sample size. Second, test-retest subsamples were small, reflecting the practical challenges of re-assessing children in active psychiatric treatment — including fluctuating motivation, irregular attendance, and early discharge. Third, EFA and CFA were conducted on the same sample. While this is a recognized methodological limitation, it is important to note that the factor solution was not empirically derived but theoretically constrained a priori to four factors, consistent with the DSM-5 PTSD symptom clusters. The EFA in the present study thus served a confirmatory rather than exploratory purpose — examining whether items loaded onto their theoretically expected clusters rather than identifying an unknown factor structure. This approach is consistent with practice in cross-cultural validation studies where sample size precludes split-sample designs, and where the theoretical structure of the construct is well-established (Floyd & Widaman, 1995 ; Worthington & Whittaker, 2006 ). Nevertheless, future studies with larger samples should employ independent EFA and CFA samples to provide more rigorous factorial evidence. Fourth, the clinical sample limits generalizability to community populations, and asymptomatic trauma-exposed individuals were not included. Future Directions Future research should investigate the psychometric properties of the Turkish CPSS-5 in community and school-based samples to establish normative data and examine whether cutoff scores require adjustment for non-clinical populations. Trauma type-specific analyses and age-stratified investigations in larger samples would address developmental and contextual variability. Longitudinal studies examining treatment sensitivity would establish the CPSS-5's utility as an outcome measure in clinical trials. Conclusions This study provides the first comprehensive psychometric evaluation of the Turkish CPSS-5-I and CPSS-5-SR in a clinical pediatric sample. Both forms demonstrated strong reliability, good factorial validity, robust convergent and discriminant validity, and excellent diagnostic accuracy. The Turkish CPSS-5 represents a valid and clinically useful instrument for DSM-5 PTSD assessment in Turkish-speaking children and adolescents, filling a significant gap in the available evidence-based measurement tools for this population. Statements and Declarations Author Contributions F.Z.B. conceptualized the study, collected and curated the data, conducted the formal analyses, and wrote the main manuscript text. A.B. contributed to conceptualization, methodology, and supervision. A.B.B. contributed to formal analysis and methodology. V.G. contributed to conceptualization, methodology, and supervision. All authors reviewed the manuscript. Ethics Approval and Consent to Participate This study was performed in line with the principles of the Declaration of Helsinki. The research was approved by the Clinical Research Ethics Committee of Istanbul Kanuni Sultan Süleyman Training and Research Hospital on August 29th, 2024, under the number 2024.08.150. Consent to Publish Informed consent for publication was obtained from all participants and their legal guardians. Competing Interests The authors have no relevant financial or non-financial interests to disclose. Funding No funding was received for conducting this study. Data Availability Statement The data that support the findings of this study are not publicly available due to their containing information that could compromise the privacy of research participants. References Alisic E, Zalta A, Wesel F, Larsen S, Hafstad G, Hassanpour K, & Smid G. (2014). Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: meta-analysis. British Journal of Psychiatry , 204 (5), 335–340. https://doi.org/10.1192/bjp.bp.113.131227 APA. (2013). Diagnostic and Statistical Manual of Mental Disorders. Diagnostic and Statistical Manual of Mental Disorders . https://doi.org/10.1176/APPI.BOOKS.9780890425596 APA. (2022). Diagnostic and statistical manual of mental disorder : DSM-5-TR. In America Psychiatric Association, 6(11), 951–952. Brady, K., Killeen, T., & Brewerton, T. (2000). Comorbidity of psychiatric disorders and posttraumatic stress disorder. Journal of Clinical Psychiatry , 61 Suppl 7 , 22–32. Chorpita, B. F., Moffitt, C. E., & Gray, J. (2005). Psychometric properties of the Revised Child Anxiety and Depression Scale in a clinical sample. Behaviour Research and Therapy , 43 (3), 309–322. https://doi.org/10.1016/J.BRAT.2004.02.004 Costello, E. J., Erkanli, A., Fairbank, J. A., & Angold, A. (2002). The prevalence of potentially traumatic events in childhood and adolescence. Journal of Traumatic Stress , 15 (2), 99–112. https://doi.org/10.1023/A:1014851823163 Cross, D., Fani, N., Powers, A., & Bradley, B. (2017). Neurobiological Development in the Context of Childhood Trauma. 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C., Ebesutani, C., Kaya, I., Ceri, V., Nasıroglu, S., Filiz, M., & Chorpita, B. (2017). Psychometric properties of the Turkish version of the Revised Child Anxiety and Depression Scale – Child Version in a clinical sample. Psychiatry and Clinical Psychopharmacology , 27 (1), 84–92. https://doi.org/10.1080/24750573.2017.1297494 Kadak, M. T., Boysan, M., Ceylan, N., & Çeri, V. (2014). Psychometric properties of the Turkish version of the Child PTSD Symptom Scale. Comprehensive Psychiatry , 55 (6), 1435–1441. https://doi.org/10.1016/J.COMPPSYCH.2014.05.001 Kaplow, J. B., Rolon-Arroyo, B., Layne, C. M., Rooney, E., Oosterhoff, B., Hill, R., Steinberg, A. M., Lotterman, J., Gallagher, K. A. S., & Pynoos, R. S. (2020). Validation of the UCLA PTSD Reaction Index for DSM-5: A Developmentally Informed Assessment Tool for Youth. Journal of the American Academy of Child & Adolescent Psychiatry , 59 (1), 186–194. https://doi.org/10.1016/J.JAAC.2018.10.019 Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., Williamson, D., & Ryan, N. (1997). Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): Initial Reliability and Validity Data. Journal of the American Academy of Child & Adolescent Psychiatry , 36 (7), 980–988. https://doi.org/10.1097/00004583-199707000-00021 Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Benjet, C., Bromet, E. J., Cardoso, G., Degenhardt, L., de Girolamo, G., Dinolova, R. V., Ferry, F., Florescu, S., Gureje, O., Haro, J. M., Huang, Y., Karam, E. G., Kawakami, N., Lee, S., Lepine, J. P., Levinson, D., … Koenen, K. C. (2017). Trauma and PTSD in the WHO World Mental Health Surveys. European Journal of Psychotraumatology , 8 . https://doi.org/10.1080/20008198.2017.1353383 Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic Stress Disorder in the National Comorbidity Survey. Archives of General Psychiatry , 52 (12), 1048–1060. https://doi.org/10.1001/ARCHPSYC.1995.03950240066012 Kucukardali, R. S., Karal, B. N., Steinberg, A. M., & Orengul, A. C. (2025). Psychometric evaluation of the UCLA PTSD Reaction Index (PTSD RI-5) in a Turkish Clinical sample of trauma-exposed children. European Journal of Psychotraumatology , 16 (1), 2465082. https://doi.org/10.1080/20008066.2025.2465082 Lewis, S. J., Koenen, K. C., Ambler, A., Arseneault, L., Caspi, A., Fisher, H. L., Moffitt, T. E., & Danese, A. (2021). Unravelling the contribution of complex trauma to psychopathology and cognitive deficits: a cohort study. The British Journal of Psychiatry , 219 (2), 448–455. https://doi.org/10.1192/BJP.2021.57 Orellana, S. C., Bethlehem, R. A. I., Simpson-Kent, I. L., van Harmelen, A. L., Vértes, P. E., & Bullmore, E. T. (2024). Childhood maltreatment influences adult brain structure through its effects on immune, metabolic, and psychosocial factors. Proceedings of the National Academy of Sciences of the United States of America , 121 (16). https://doi.org/10.1073/PNAS.2304704121 Pearlman, L. A., & Saakvitne, K. W. (1995). Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. . W. W. Norton & Company. Pynoos, R. S., Weathers F. W., Steinberg, A. M. , Marx, B. P., Layne, C. M., Kaloupek, D. G., Schnurr, P. P., Keane, T. M., Blake, D. D., Newman, E., Nader, K. O., & & Kriegler, J. A. (2015). Clinician-Administered PTSD Scale for DSM-5 - Child/Adolescent Version. [Assessment] Available from the National Center for PTSD at www.ptsd.va.gov. Rogers, R. (2001). Handbook of diagnostic and structured interviewing . Guilford Press. Sachser, C., Berliner, L., Risch, E., Rosner, R., Birkeland, M. S., Eilers, R., Hafstad, G. S., Pfeiffer, E., Plener, P. L., & Jensen, T. K. (2022). The child and Adolescent Trauma Screen 2 (CATS-2) – validation of an instrument to measure DSM-5 and ICD-11 PTSD and complex PTSD in children and adolescents. European Journal of Psychotraumatology , 13 (2). https://doi.org/10.1080/20008066.2022.2105580 Teicher, M. H., Tomoda, A., & Andersen, S. E. (2006). Neurobiological consequences of early stress and childhood maltreatment: Are results from human and animal studies comparable? Annals of the New York Academy of Sciences , 1071 , 313–323. https://doi.org/10.1196/annals.1364.024 Ünal, F., Öktem, F., Çetin Çuhadaroğlu, F., Çengel Kültür, S. E., Akdemir, D., Foto Özdemir, D., Çak, H. T., Ünal, D., Tiraş, K., Aslan, C., Kalayci, B. M., Aydos, B. S., Kütük, F., Taşyürek, E., Karaokur, R., Karabucak, B., Karakök, B., Karaer, Y., & Artik, A. (2019). Reliability and validity of the schedule for affective disorders and schizophrenia for school-age children-present and lifetime version, DSM-5 November 2016-Turkish adaptation (K-SADS-PL-DSM-5-T). Turk Psikiyatri Dergisi , 30 (1). https://doi.org/10.5080/U23408 Weathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx, B. P. , & Keane, T. M. (2013). The Life Events Checklist for DSM-5 (LEC-5). Instrument Available from the National Center for PTSD at Www.Ptsd.va.Gov . Worthington, R. L., & Whittaker, T. A. (2006). Scale Development Research. The Counseling Psychologist , 34 (6), 806–838. https://doi.org/10.1177/0011000006288127 Yildiz, N. G., Aydin, H. Z., Aydin, K., Yildiz, H., Sambo, G., Mwamulima, B., Zonda, J. M., Phiri, D., & Phiri, Y. V. A. (2024). Understanding adverse childhood experiences and the call for trauma-informed healthcare system in Turkey: a review. Health Research Policy and Systems , 22 (1), 63-. https://doi.org/10.1186/S12961-024-01137-3/PEER-REVIEW Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9327295","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":617984863,"identity":"e3cc81c7-2ebe-4293-9d92-548e8c998295","order_by":0,"name":"Fatma Zehra Bıçakcı","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIiWNgGAWjYBAC9gYehgMMDAkMbOwNQK6BBWEtPAdgWngOgLRIEKeFAaSFQSIBxCBGC//Zgwd+1KTJ80k+v7rhR4EEA397dwJ+LQznEg72HMsxbJPOKbvZA3SYxJmzG/BqsWfsMTjMwFaRwCadk3aDB6jFQCIXvxYeZh6gln9ALZJn0m7+IUoLG1ALY1tOApsE+7HbxNnCw5dwsLcvzbCNJ4fttoyBBA9BvwBD7PCHH9+S5eXbjz+7+eaPjRx/ey9+Lci6DcAkscpBgP0BKapHwSgYBaNgBAEAmIlD01DmizEAAAAASUVORK5CYII=","orcid":"","institution":"İstanbul Kanuni Sultan Süleyman Eğitim ve Araştırma Hastanesi","correspondingAuthor":true,"prefix":"","firstName":"Fatma","middleName":"Zehra","lastName":"Bıçakcı","suffix":""},{"id":617984864,"identity":"044993b5-3b52-476a-ac05-d8c983177bf6","order_by":1,"name":"Alperen Bıkmazer","email":"","orcid":"","institution":"Medeniyet Üniversitesi Göztepe Eğitim ve Araştırma Hastanesi","correspondingAuthor":false,"prefix":"","firstName":"Alperen","middleName":"","lastName":"Bıkmazer","suffix":""},{"id":617984865,"identity":"43a20d37-6001-41be-80f9-3e62132f5571","order_by":2,"name":"Ayşe Beyza Bıçakcı","email":"","orcid":"","institution":"Istanbul Sabahattin Zaim University","correspondingAuthor":false,"prefix":"","firstName":"Ayşe","middleName":"Beyza","lastName":"Bıçakcı","suffix":""},{"id":617984868,"identity":"d6d18df2-bc1d-45d9-ac46-a78b140afd0b","order_by":3,"name":"Vahdet Görmez","email":"","orcid":"","institution":"Hamad bin Khalifa University","correspondingAuthor":false,"prefix":"","firstName":"Vahdet","middleName":"","lastName":"Görmez","suffix":""}],"badges":[],"createdAt":"2026-04-05 15:53:15","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-9327295/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9327295/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106877723,"identity":"9023edc0-c341-4f2a-b5fe-721ac0e705ff","added_by":"auto","created_at":"2026-04-14 10:42:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":217528,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eConfirmatory Factor Analysis Path Diagram for the CPSS-5-I (left) and CPSS-5-SR (right)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNote.\u003c/em\u003e Values on arrows represent standardized factor loadings; double-headed arrows indicate interfactor correlations.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9327295/v1/be003a8831a35bffc9252a04.png"},{"id":107375062,"identity":"5e9fba2a-7849-4d01-90f1-b9a5ce0988ec","added_by":"auto","created_at":"2026-04-21 00:24:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":824637,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9327295/v1/0769b962-cffd-48a9-a38c-107a05e6d1bd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Psychometric Properties of the Child PTSD Symptom Scale for DSM-5 Interview and Self- Report Forms: Validation in a Clinical Sample","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTraumatic life events represent a major public health concern across all age groups. A large-scale World Health Organization study reported that 70.4% of respondents worldwide had experienced at least one traumatic event, with an average of 3.2 events per person (Kessler et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Among children and adolescents, approximately 40% have been exposed to at least one traumatic event (Costello et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2002\u003c/span\u003e). Of those exposed, approximately 15.9% develop post-traumatic stress disorder (PTSD), with rates varying considerably by trauma type and sex \u0026mdash; ranging from 8.4% in boys exposed to non-interpersonal trauma to 32.9% in girls exposed to interpersonal trauma (Alisic et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). In Turkey, similar patterns have been observed, with the country's geographic vulnerability to earthquakes, ongoing urbanization challenges, and rising rates of violence against children contributing to substantial trauma exposure among youth (Yildiz et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe psychological sequelae of trauma are diverse, ranging from full recovery to the development of PTSD and comorbid conditions including anxiety and depressive disorders (Kessler et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e1995\u003c/span\u003e; Lewis et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Between 60% and 80% of individuals who develop PTSD also meet criteria for at least one additional psychiatric disorder (Brady et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). Adverse childhood experiences are particularly consequential, as the neurobiological effects of early trauma are increasingly recognized as critical risk factors for adult psychopathology (Cross et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Orellana et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Teicher et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Clinical assessment of trauma and PTSD in children poses specific challenges: traumatic events are often difficult to disclose, PTSD presentations are influenced by developmental, cultural, and interpersonal factors, and the clinical interview itself may require sensitive navigation \u0026mdash; particularly when intrafamilial violence or abuse is involved.\u003c/p\u003e \u003cp\u003eThe publication of DSM-5 in 2013 brought significant revisions to the PTSD diagnostic criteria (APA, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Key changes included the introduction of a separate PTSD subtype for children aged six years and under, the removal of the subjective fear response from Criterion A, the explicit inclusion of sexual violence in the trauma definition, and the expansion from three to four symptom clusters by separating negative alterations in cognition and mood (Cluster D) from hyperarousal (Cluster E). Collectively, these revisions broadened the diagnostic framework beyond the fear-based conceptualization of DSM-IV, reconceptualizing PTSD as a heterogeneous syndrome that may also encompass anhedonic and dysphoric presentations. As a result, previously validated assessment tools required updating to reflect the revised criteria. The DSM-5-TR (2022) retained the PTSD diagnostic criteria without substantive modification (APA, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSeveral measures have been developed or revised to assess DSM-5 PTSD in children and adolescents, including the Kiddie Schedule for Affective Disorders and Schizophrenia \u0026ndash; Present and Lifetime Version (K-SADS-PL; (Kaufman et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e1997\u003c/span\u003e)), the Clinician-Administered PTSD Scale for DSM-5 Child/Adolescent version (CAPS-CA-5; (Pynoos et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2015\u003c/span\u003e)), the UCLA PTSD Reaction Index for DSM-5 (UCLA PTSD-RI-5; (Kaplow et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) ), the Child and Adolescent Trauma Screen 2 (CATS-2; (Sachser et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)), and the Child PTSD Symptom Scale for DSM-5 (CPSS-5; (Foa et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e)). In Turkey, the psychometric properties of the DSM-IV version of the CPSS were previously examined in an earthquake-affected sample (Kadak et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2014\u003c/span\u003e); however, the subsequent revision of diagnostic criteria in DSM-5 necessitated an updated validation study. At the time, this study was designed and conducted, the only DSM-5 PTSD measure with a validated Turkish adaptation for use with children and adolescents was the K-SADS-PL (\u0026Uuml;nal et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Since then, a Turkish adaptation of the UCLA PTSD-RI-5 has been published (Kucukardali et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2025\u003c/span\u003e); however, a comprehensive Turkish validation of the CPSS-5 \u0026mdash; incorporating both its interview and self-report forms \u0026mdash; has not yet been reported.\u003c/p\u003e \u003cp\u003eThe CPSS-5 (Foa et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) is a widely used measure that offers both a clinician-administered interview (CPSS-5-I) and a self-report version (CPSS-5-SR), providing flexibility for different clinical contexts. The scale comprises 20 symptom items aligned with DSM-5 PTSD criteria and 7 functional impairment items assessed separately. The original development study demonstrated excellent internal consistency (α\u0026thinsp;=\u0026thinsp;.92 for both forms), good to excellent test-retest reliability, high convergent validity between the interview and self-report versions, and adequate diagnostic accuracy in trauma-exposed youth (Foa et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The availability of parallel interview and self-report versions makes the CPSS-5 particularly suited to routine clinical use, enabling efficient screening and structured diagnostic evaluation within the same clinical encounter.\u003c/p\u003e \u003cp\u003eThe present study aimed to evaluate the psychometric properties of the Turkish CPSS-5-I and CPSS-5-SR in a clinical sample of trauma-exposed children and adolescents. Specifically, the study objectives were: (1) to examine the factor structure of both forms using EFA and CFA; (2) to evaluate internal consistency and test-retest reliability; (3) to assess convergent and discriminant validity; and (4) to determine optimal diagnostic cutoff scores using ROC analysis.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eParticipants were 102 Turkish children and adolescents (69 girls, 67.6%; 33 boys, 32.4%) between 8 and 18 years of age (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;14.8, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.75). All participants had experienced at least one traumatic event meeting the DSM-5 PTSD Criterion A definition. The sample was recruited from both outpatient (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;79, 77.5%) and inpatient (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;23, 22.5%) child and adolescent psychiatry services at a tertiary hospital in Istanbul, Turkey. Data were collected between August 2024 and March 2025.\u003c/p\u003e \u003cp\u003eIndex trauma types were assessed using the Life Events Checklist for DSM-5 (LEC-5) and covered a broad spectrum of traumatic experiences. The most frequently reported index trauma was sexual assault (n\u0026thinsp;=\u0026thinsp;32, 31.4%), followed by sudden violent death (n\u0026thinsp;=\u0026thinsp;15, 14.7%), physical assault (n\u0026thinsp;=\u0026thinsp;15, 14.7%), other unwanted or uncomfortable sexual experience (n\u0026thinsp;=\u0026thinsp;13, 12.7%), and sudden accidental death (n\u0026thinsp;=\u0026thinsp;5, 4.9%). Less frequently reported trauma types included natural disaster (n\u0026thinsp;=\u0026thinsp;5, 4.9%), assault with a weapon (n\u0026thinsp;=\u0026thinsp;6, 5.9%), life-threatening illness or injury (n\u0026thinsp;=\u0026thinsp;6, 5.9%), transportation accident (n\u0026thinsp;=\u0026thinsp;3, 2.9%), fire or explosion (n\u0026thinsp;=\u0026thinsp;1, 1.0%), and serious accident (n\u0026thinsp;=\u0026thinsp;1, 1.0%). Collectively, interpersonal trauma \u0026mdash; including sexual and physical assault \u0026mdash; constituted the majority of index trauma types (n\u0026thinsp;=\u0026thinsp;66, 64.7%).\u003c/p\u003e \u003cp\u003eInclusion criteria were: (1) age 8\u0026ndash;18 years; (2) exposure to a DSM-5 Criterion A traumatic event; (3) literacy in Turkish; and (4) voluntary participation with written informed consent from a parent or legal guardian and written assent from the participants. Exclusion criteria included intellectual disability, active psychotic illness, sensory impairment precluding participation, and neurological disorder affecting perception.\u003c/p\u003e \u003cp\u003eA total of 157 children and adolescents who had disclosed a history of at least one traumatic event during routine clinical interviews were contacted and assessed for eligibility. Of these, 46 were contacted by telephone but declined to participate before the formal assessment. The remaining 111 attended the assessment; of these, a further 9 were excluded: 6 declined to complete the scales after attending, 2 were identified as having intellectual impairment based on clinical assessment, and 1 was excluded due to active psychotic symptoms. The final sample comprised 102 participants.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003e This study was conducted in accordance with the Declaration of Helsinki and was approved by the local Clinical Research Ethics Committee (approval number: 2024.08.150). Written informed consent and assent were obtained from all parents and participants prior to data collection.\u003c/p\u003e \u003cp\u003eAll participants were individually assessed by the same child and adolescent psychiatrist. The CPSS-5-I was administered first, followed by the CPSS-5-SR, in a single session. Test-retest reliability was assessed in clinically stable subsamples re-evaluated after a 2\u0026ndash;3 weeks interval (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;16 for CPSS-5-I; \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;23 for CPSS-5-SR).\u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eChild PTSD Symptom Scale - Interview Version for DSM-5 (CPSS-5-I)\u003c/h2\u003e \u003cp\u003eThe CPSS-5-I is a 27-item semi-structured clinician-administered interview assessing the presence and severity of DSM-5 PTSD symptoms over the past month (Foa et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The first 20 items correspond to the DSM-5 PTSD symptom clusters: intrusion (items 1\u0026ndash;5), avoidance (items 6\u0026ndash;7), negative alterations in cognition and mood (items 8\u0026ndash;14), and alterations in arousal and reactivity (items 15\u0026ndash;20). Each item is rated on a 5-point frequency scale (0\u0026thinsp;=\u0026thinsp;never to 4\u0026thinsp;=\u0026thinsp;6 or more times a week), yielding a total severity score ranging from 0 to 80. The remaining 7 items assess functional impairment across home, school, peer, and leisure domains; these are rated by frequency during the interview but are not included in the total symptom severity score. Prior to symptom assessment, the clinician identifies the most distressing traumatic event as the index trauma. Administration takes approximately 30 minutes.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eChild PTSD Symptom Scale – Self-Report Version for DSM-5 (CPSS-5-SR)\u003c/h3\u003e\n\u003cp\u003eThe CPSS-5-SR is the self-report counterpart of the CPSS-5-I, comprising 27 items with identical symptom content and the same 5-point frequency rating scale (0\u0026ndash;80 total score range). The 7 functional impairment items differ from the interview version in that they are presented in a binary yes/no format and are similarly excluded from the total score. Completion takes approximately 5\u0026ndash;10 minutes.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eLife Events Checklist for DSM-5 (LEC-5)\u003c/h2\u003e \u003cp\u003eThis is a self-report questionnaire consisting of 17 items designed to determine the type of event (such as traffic accidents, natural disasters like earthquakes, gunshot injuries, sexual abuse, etc.) and the manner of experiencing it (e.g., directly experienced, witnessed, learned about, or job-related) according to the DSM-5 PTSD criterion A. In addition to 16 defined events, it includes an extra item for any other stressful events not listed. There are different scoring methods based on calculating the number of events or including multiple types of events experienced in various ways (Weathers et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eKiddie Schedule for Affective Disorders and Schizophrenia (K-SADS)\u003c/h3\u003e\n\u003cp\u003eThis is a semi-structured interview form developed to assess the past and current psychopathologies of children and adolescents aged 6\u0026ndash;18 years (Kaufman et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e1997\u003c/span\u003e). A diagnostic evaluation is conducted based on all the information gathered from interviews with parents and the child. The Turkish validity and reliability study of the DSM-5 revised version of the form has been conducted (\u0026Uuml;nal et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eRevised Child Anxiety and Depression Scale (RCADS)\u003c/h3\u003e\n\u003cp\u003eThe RCADS is a 47-item self-report questionnaire assessing anxiety disorders and depression in children and adolescents based on DSM criteria (Chorpita et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). It comprises six subscales: generalized anxiety disorder, separation anxiety disorder, social anxiety disorder, panic disorder, obsessive-compulsive disorder, and major depressive disorder. Items are rated on a 4-point scale (0\u0026thinsp;=\u0026thinsp;never to 3\u0026thinsp;=\u0026thinsp;always). In the present study, the total anxiety score (sum of all subscales excluding depression) and the depression subscale score were used to examine discriminant validity. The Turkish validity and reliability study of the RCADS demonstrated good internal consistency across all subscales (Cronbach's α\u0026thinsp;\u0026gt;\u0026thinsp;.70) (Gormez et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eTranslation Procedure\u003c/h2\u003e \u003cp\u003eThe Turkish adaptation of the CPSS-5 followed the translation protocol specified by the scale developers, as communicated directly by Dr. Foa's research team. First, the original English versions of the CPSS-5-I and CPSS-5-SR were translated into Turkish by the first author. An independent bilingual translator then back-translated the Turkish versions into English. The back-translations were submitted to Dr. Edna Foa and her research team at the University of Pennsylvania for review and feedback. Necessary revisions were incorporated into the Turkish versions, after which a second independent back-translation was conducted and resubmitted for review and approval. The final Turkish versions received formal approval from Dr. Foa prior to use in the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAll analyses were conducted using IBM SPSS Statistics Version 26 (IBM Corp., Armonk, NY, USA) and IBM SPSS AMOS. Data suitability for factor analysis was assessed using the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and Bartlett's test of sphericity. Exploratory factor analysis (EFA) was conducted using principal component extraction with varimax rotation; the number of factors was fixed at four, consistent with the DSM-5 PTSD symptom clusters. Confirmatory factor analysis (CFA) model fit was evaluated using multiple indices: the chi-square to degrees of freedom ratio (χ\u0026sup2;/df; acceptable\u0026thinsp;\u0026le;\u0026thinsp;3.0), the Root Mean Square Error of Approximation (RMSEA; good fit \u0026le; .05), the Comparative Fit Index (CFI; good \u0026ge; .97, acceptable \u0026ge; .95), the Tucker-Lewis Index (TLI; acceptable \u0026ge; .95), the Incremental Fit Index (IFI; acceptable \u0026ge; .95), and the Goodness-of-Fit Index (GFI; interpreted cautiously due to its known sensitivity to sample size). Internal consistency was assessed using Cronbach's alpha (α). Test-retest reliability was evaluated using the intraclass correlation coefficient (ICC; two-way mixed effects model, absolute agreement, single measures) with 95% confidence intervals. Convergent validity was examined using Spearman rank correlation coefficients (ρ) between the two CPSS-5 forms. Discriminant validity was assessed using Spearman correlations between CPSS-5 total scores and RCADS total anxiety and depression scores in a subsample with available concurrent data (n\u0026thinsp;=\u0026thinsp;37). Diagnostic accuracy was evaluated using receiver operating characteristic (ROC) analysis with K-SADS-based DSM-5 PTSD diagnosis as the reference standard; optimal cutoff scores were determined using the Youden Index (sensitivity\u0026thinsp;+\u0026thinsp;specificity\u0026thinsp;\u0026minus;\u0026thinsp;1). Statistical significance was set at \u003cem\u003ep\u003c/em\u003e \u0026lt; .05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eDescriptive Statistics\u003c/h2\u003e\n \u003cp\u003eThe sample included 102 participants (mean age 14.8 years, SD\u0026thinsp;=\u0026thinsp;2.75). K-SADS-based PTSD diagnosis was present in 48 participants (47.1%) and absent in 54 (52.9%). Index trauma types were assessed using the Life Events Checklist for DSM-5 (LEC-5) and are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Sexual assault was the most common index trauma, reported by approximately one third of the sample (n\u0026thinsp;=\u0026thinsp;32, 31.4%), followed by sudden violent death and physical assault (both n\u0026thinsp;=\u0026thinsp;15, 14.7%). Other unwanted or uncomfortable sexual experience was reported by 12.7% of participants (n\u0026thinsp;=\u0026thinsp;13).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\n \u003cp\u003eDemographic and Clinical Characteristics of the Sample (N\u0026thinsp;=\u0026thinsp;102)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cem\u003eSex\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e67.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e32.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cem\u003eClinical setting\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eOutpatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e77.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eInpatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e22.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cem\u003eIndex trauma type\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eSexual assault\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e31.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003ePhysical assault\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eSudden violent death\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eUnwanted sexual experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e12.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eAssault with a weapon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eLife-threatening illness/injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eSudden accidental death\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eNatural disaster\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eTransportation accident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eFire or explosion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eSerious accident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cem\u003ePTSD diagnosis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003ePTSD positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e47.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003ePTSD negative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e52.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\n \u003cp\u003e\u003cem\u003eNote.\u003c/em\u003e PTSD\u0026thinsp;=\u0026thinsp;post-traumatic stress disorder.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eThe remaining trauma types were less frequently endorsed, each representing fewer than 6% of the sample. Notably, interpersonal trauma types collectively accounted for the majority of index traumas (n\u0026thinsp;=\u0026thinsp;66, 64.7%), a distribution with potential implications for the interpretation of symptom profiles and factor loadings observed in the present study. Socioeconomic status was assessed and the majority reported low-to-middle income levels, with 82.5% falling within the very low, low, or middle categories. Sample characteristics are presented in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003eFactor Analyses\u003c/h2\u003e\n \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\n \u003ch2\u003eExploratory Factor Analysis\u003c/h2\u003e\n \u003cp\u003eKMO values indicated excellent (CPSS-5-SR: .901) and good (CPSS-5-I: .843) sampling adequacy. Bartlett\u0026apos;s tests were significant for both forms (\u003cem\u003ep\u003c/em\u003e \u0026lt; .001). The four-factor EFA solution explained 63.27% (SR) and 60.99% (I) of total variance. Factor loadings ranged from .37 to .83 (SR) and .43 to .81 (I), with items loading onto theoretically expected DSM-5 clusters. Two items in the self-report form (items 4 and 5) yielded loadings below .40 (.39 and .37, respectively). Factor loadings are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eExploratory Factor Analysis: Factor Loadings for CPSS-5-SR and CPSS-5-I (N\u0026thinsp;=\u0026thinsp;102)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"10\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eDSM-5 Cluster\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\n \u003cp\u003eSelf-Report Form\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e\n \u003cp\u003eInterview Form\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eF1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eF2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eF3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eF4\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eF1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eF2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c9\"\u003e\n \u003cp\u003eF3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c10\"\u003e\n \u003cp\u003eF4\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eIntrusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eIntrusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eIntrusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eIntrusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e.39\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eIntrusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e.37\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eAvoidance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003e.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eAvoidance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003e.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eChanges in Cognition/Mood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cp\u003e.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eChanges in Cognition/Mood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cp\u003e.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eChanges in Cognition/Mood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cp\u003e.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eChanges in Cognition/Mood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cp\u003e.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eChanges in Cognition/Mood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cp\u003e.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eChanges in Cognition/Mood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cp\u003e.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eChanges in Cognition/Mood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cp\u003e.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eArousal and Hyperreactivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c10\"\u003e\n \u003cp\u003e.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eArousal and Hyperreactivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c10\"\u003e\n \u003cp\u003e.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eArousal and Hyperreactivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c10\"\u003e\n \u003cp\u003e.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eArousal and Hyperreactivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c10\"\u003e\n \u003cp\u003e.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eArousal and Hyperreactivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c10\"\u003e\n \u003cp\u003e.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eArousal and Hyperreactivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c10\"\u003e\n \u003cp\u003e.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e\u003cem\u003eVariance explained (%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\n \u003cp\u003e\u003cem\u003e63.27%\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e\n \u003cp\u003e\u003cem\u003e60.99%\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\"\u003e\u003cem\u003eNote.\u003c/em\u003e F1\u0026thinsp;=\u0026thinsp;Intrusion; F2\u0026thinsp;=\u0026thinsp;Avoidance; F3\u0026thinsp;=\u0026thinsp;Changes in Cognition and Mood; F4\u0026thinsp;=\u0026thinsp;Arousal and Hyperreactivity. \u0026dagger; Factor loading below .40.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003eConfirmatory Factor Analysis\u003c/h2\u003e\n \u003cp\u003eCFA demonstrated good model fit for the CPSS-5-SR (\u0026chi;\u0026sup2;/\u003cem\u003edf\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.207, RMSEA = .045, CFI = .969, TLI = .962, IFI = .970, GFI = .852) and acceptable fit for the CPSS-5-I (\u0026chi;\u0026sup2;/\u003cem\u003edf\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.245, RMSEA = .046, CFI = .951, TLI = .941, IFI = .953, GFI = .857). The TLI for the interview form was marginally below .95, though all other indices were within acceptable ranges. Fit statistics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eConfirmatory Factor Analysis Model Fit Indices\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eIndex\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eGood Fit\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eAcceptable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eCPSS-5-SR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eCPSS-5-I\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;/df\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e1.207**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e1.245**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eRMSEA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e.05\u0026ndash;.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e.045**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e.046**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eCFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e.969**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e.951**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eTLI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e.90\u0026ndash;.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e.962**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e.941*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eIFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e.90\u0026ndash;.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e.970**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e.953**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eGFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e.85\u0026ndash;.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e.852*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e.857*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e\u003cem\u003eNote. * Acceptable fit. ** Good fit.\u003c/em\u003e RMSEA\u0026thinsp;=\u0026thinsp;Root Mean Square Error of Approximation; CFI\u0026thinsp;=\u0026thinsp;Comparative Fit Index; TLI\u0026thinsp;=\u0026thinsp;Tucker-Lewis Index; IFI\u0026thinsp;=\u0026thinsp;Incremental Fit Index; GFI\u0026thinsp;=\u0026thinsp;Goodness-of-Fit Index.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003eInternal Consistency and Test-Retest Reliability\u003c/h2\u003e\n \u003cp\u003eCronbach\u0026apos;s alpha was .936 for the CPSS-5-SR and .904 for the CPSS-5-I, indicating excellent internal consistency for both forms. Test-retest reliability over 2\u0026ndash;3 weeks was excellent for the CPSS-5-I (ICC = .896, 95% CI: .725\u0026ndash;.963, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001; \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;16) and good-to-excellent for the CPSS-5-SR (ICC = .871, 95% CI: .663\u0026ndash;.949, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001; \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;23). Wide confidence intervals reflect the small retest subsamples and should be interpreted cautiously.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003ch2\u003eConvergent and Discriminant Validity\u003c/h2\u003e\n \u003cp\u003eTotal score correlation between forms was \u0026rho;\u0026thinsp;=\u0026thinsp;.900 (\u003cem\u003ep\u003c/em\u003e \u0026lt; .001). Subscale correlations ranged from \u0026rho;\u0026thinsp;=\u0026thinsp;.644 (avoidance) to \u0026rho;\u0026thinsp;=\u0026thinsp;.869 (intrusion; all \u003cem\u003ep\u003c/em\u003e \u0026lt; .001). Full correlations are presented in Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003eDiscriminant validity was examined in a subsample of 37 participants with available RCADS data. Both CPSS-5 forms showed moderate correlations with RCADS total anxiety scores (CPSS-5-I: \u0026rho;\u0026thinsp;=\u0026thinsp;.326, p = .049; CPSS-5-SR: \u0026rho;\u0026thinsp;=\u0026thinsp;.461, p = .004) and depression scores (CPSS-5-I: \u0026rho;\u0026thinsp;=\u0026thinsp;.437, p = .007; CPSS-5-SR: \u0026rho;\u0026thinsp;=\u0026thinsp;.583, p \u0026lt; .001). These correlations were substantially lower than the inter-form convergent validity correlation (\u0026rho;\u0026thinsp;=\u0026thinsp;.900), supporting the discriminant validity of both Turkish CPSS-5 forms.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSpearman Correlations Between CPSS-5-I and CPSS-5-SR Total and Subscale Scores\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\n \u003cp\u003eCPSS-5-SR Total\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eCPSS-5-I Total\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eIntrusion (I)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eAvoidance (I)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eChanges in Cognition and Mood (I)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eArousal and Hyperreactivity (I)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e.900**\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e.813**\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e.598**\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e.782**\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e.766**\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eIntrusion (SR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e.855**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e.869**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e.602**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e.689**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e.691**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eAvoidance (SR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e.594**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e.591**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e.644**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e.462**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e.419**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eChanges in Cognition and Mood (SR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e.839**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e.715**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e.479**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e.823**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e.671**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eArousal and Hyperreactivity (SR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e.829**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e.691**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e.506**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e.694**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e.821**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e\u003cem\u003eNote.\u003c/em\u003e (I)= Interview version; (SR)= Self-report version; \u003cem\u003e** p \u0026lt;\u003c/em\u003e .001.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSpearman Correlations Between CPSS-5 Total Scores and RCADS Anxiety and Depression Scores (n\u0026thinsp;=\u0026thinsp;37)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\n \u003cp\u003eCPSS-5-I Total\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eRCADS Anxiety\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eRCADS Depression\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e.326*\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e.437**\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eCPSS-5-SR Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e.461**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e.583**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\"\u003e\u003cem\u003eNote.\u003c/em\u003e RCADS\u0026thinsp;=\u0026thinsp;Revised Child Anxiety and Depression Scale; CPSS-5-I\u0026thinsp;=\u0026thinsp;Child PTSD Symptom Scale Interview Version for DSM-5; CPSS-5-SR\u0026thinsp;=\u0026thinsp;Child PTSD Symptom Scale Self-Report Version for DSM-5. Analyses conducted in a subsample of participants with available concurrent data (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;37). * \u003cem\u003ep\u003c/em\u003e \u0026lt; .05. ** \u003cem\u003ep\u003c/em\u003e \u0026lt; .001.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n \u003ch2\u003eDiagnostic Accuracy\u003c/h2\u003e\n \u003cp\u003eROC analysis yielded excellent AUC values for both the CPSS-5-I (.927, 95% CI: .875\u0026ndash;.978) and CPSS-5-SR (.928, 95% CI: .879\u0026ndash;.977; both \u003cem\u003ep\u003c/em\u003e \u0026lt; .001). The optimal cutoff for the CPSS-5-I was 33.5 (sensitivity 91.5%, specificity 85.2%, Youden Index = .767); for the CPSS-5-SR, the cutoff was 44 (sensitivity 83.0%, specificity 90.7%, Youden Index = .737). Full results are in Table \u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eROC Analysis: Diagnostic Accuracy of CPSS-5-I and CPSS-5-SR\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eParameter\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eCPSS-5-I\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eCPSS-5-SR\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eAUC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e.927\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e.928\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e.875\u0026ndash;.978\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e.879\u0026ndash;.977\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eOptimal cutoff\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e33.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eSensitivity (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e91.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e83.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eSpecificity (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e85.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e90.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eYouden Index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e.767\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e.737\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\"\u003e\u003cem\u003eNote.\u003c/em\u003e AUC\u0026thinsp;=\u0026thinsp;Area Under the Curve; CI\u0026thinsp;=\u0026thinsp;Confidence Interval. Optimal cutoff by maximum Youden Index.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study examined the psychometric properties of the Turkish CPSS-5-I and CPSS-5-SR in a clinical sample of trauma-exposed children and adolescents. Both forms demonstrated strong and consistent psychometric properties across multiple indices, supporting their reliability and validity for DSM-5 PTSD assessment in Turkish-speaking youth.\u003c/p\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eFactor Structure\u003c/h2\u003e \u003cp\u003eEFA supported a four-factor structure for both forms, consistent with DSM-5 PTSD symptom clusters and accounting for 63.27% (SR) and 60.99% (I) of total variance. CFA confirmed adequate-to-good model fit (CPSS-5-SR: RMSEA = .045, CFI = .969; CPSS-5-I: RMSEA = .046, CFI = .951). The marginal TLI for the interview form (.941) may reflect variability inherent to clinician-administered interviews and the modest sample size, and should be considered alongside the other uniformly acceptable fit indices.\u003c/p\u003e \u003cp\u003eThe relatively lower factor loadings observed for items 4 and 5 in self-report form may reflect several overlapping factors. First, children and adolescents with prominent avoidance symptoms may have difficulty engaging with these items \u0026mdash; not because of content overlap, but because confronting trauma-related internal cues is itself an avoidance-driven response, leading to inconsistent or attenuated endorsement. Second, for the younger children in the sample \u0026mdash; approximately one quarter of participants were aged 8\u0026ndash;12 \u0026mdash; concrete-operational thinking may have contributed to differential interpretation of these items, which require introspective awareness of internal distress states. Third, in samples with high rates of sexual assault survivors, as in the present study (44.1%, both sexual assault and unwanted sexual experiences), intrusion symptoms may manifest atypically, with dissociative responses partially replacing or masking classic re-experiencing presentations \u0026ndash; potentially reducing the salience of these items. These findings warrant attention in future research, particularly in age-stratified analyses and in samples with varying trauma profiles.\u003c/p\u003e \u003cp\u003eThe confirmation of a four-factor structure is also noteworthy in the context of the Turkish literature: whereas the earlier Turkish adaptation of the DSM-IV version of the CPSS reported a three-factor structure (Kadak et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), the present findings support a successful transition to the DSM-5 four-factor model, consistent with the revised diagnostic framework and suggesting that the expanded symptom structure introduced in DSM-5 is similarly applicable in Turkish clinical populations.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eReliability\u003c/h2\u003e \u003cp\u003eBoth forms showed excellent internal consistency (α\u0026thinsp;=\u0026thinsp;.936 and .904, respectively), comparable to or exceeding values reported in the original development sample (n\u0026thinsp;=\u0026thinsp;64; α\u0026thinsp;=\u0026thinsp;.92 for both forms) (Foa et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The higher alpha value observed for the self-report form may reflect greater symptom heterogeneity arising from the diversity of trauma types in the present sample. Test-retest reliability was excellent (CPSS-5-I: ICC = .896) and good-to-excellent (CPSS-5-SR: ICC = .871), supporting temporal stability of both instruments. Wide confidence intervals are attributable to small retest subsample sizes (see Limitations).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eConvergent and Discriminant Validity\u003c/h2\u003e \u003cp\u003eThe two forms showed strong convergent validity (total score ρ\u0026thinsp;=\u0026thinsp;.900). The comparatively lower avoidance subscale correlation (ρ\u0026thinsp;=\u0026thinsp;.644) may reflect format-related differences in avoidance endorsement: clinician-administered interviews may elicit avoidance disclosures more effectively than self-report formats, where avoidant response tendencies may lead to underreporting. This pattern has been noted in prior cross-format comparisons (Foa et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) and underscores the complementary value of using both forms in clinical practice.\u003c/p\u003e \u003cp\u003eEvidence for discriminant validity was provided by moderate correlations between CPSS-5 total scores and concurrent measures of anxiety (ρ\u0026thinsp;=\u0026thinsp;.326\u0026ndash;.461) and depression (ρ\u0026thinsp;=\u0026thinsp;.437\u0026ndash;.583), which were substantially lower than the inter-form convergent validity coefficient (ρ\u0026thinsp;=\u0026thinsp;.900). The somewhat higher correlations with depression than anxiety scores are consistent with the well-documented comorbidity between PTSD and depressive disorders (Brady et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Foa et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Kessler et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e1995\u003c/span\u003e) and do not compromise the discriminant validity of the measure. These findings are broadly consistent with those reported in the original CPSS-5 validation study (Foa et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), which similarly observed moderate associations between CPSS-5 scores and concurrent measures of anxiety and depression, supporting the construct specificity of the scale.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eDiagnostic Accuracy\u003c/h2\u003e \u003cp\u003eBoth forms demonstrated excellent diagnostic accuracy (AUC = .927 and .928), among the highest reported for child PTSD measures. The elevated AUC values should be interpreted in light of sample characteristics: the inclusion of inpatients with severe symptom profiles likely enhanced discrimination between PTSD-positive and PTSD-negative cases. The interview form showed higher sensitivity (91.5% vs. 83.0%), supporting its utility for screening contexts, while the self-report form showed higher specificity (90.7% vs. 85.2%), supporting its use for confirmation. These complementary profiles suggest that using both forms in sequence represents optimal clinical practice. A particular strength of the present study is the administration of the K-SADS to the full sample (n\u0026thinsp;=\u0026thinsp;102), providing a comprehensive criterion validity framework for the ROC analyses.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eTurkish Context and Generalizability\u003c/h2\u003e \u003cp\u003eA key strength of this study is the breadth of trauma types represented, contrasting with prior Turkish PTSD measurement studies conducted predominantly with earthquake-affected samples. This diversity enhances ecological validity and supports the applicability of the Turkish CPSS-5 across the range of trauma presentations encountered in routine clinical practice in Turkey. The low-to-middle socioeconomic profile of the majority of participants (82.5%) reflects the demographic reality of public psychiatric services and adds to the representativeness of findings for this population. In this regard, the present study directly addresses gaps identified in the sole previously published Turkish validation of a CPSS version, using the DSM-IV iteration of the scale in a community sample of earthquake survivors (n\u0026thinsp;=\u0026thinsp;479) (Kadak et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). While that study demonstrated sound psychometric properties, the sample was restricted to a single trauma type and did not include a clinician-administered interview version or diagnostic accuracy analysis \u0026mdash; limitations the authors themselves acknowledged. By validating both the interview and self-report forms of the DSM-5 updated CPSS-5 in a clinical sample spanning a broad range of trauma types, including interpersonal violence, the current findings extend the evidence base for PTSD assessment in Turkish-speaking youth beyond earthquake-affected populations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eClinical Implications\u003c/h2\u003e \u003cp\u003eThe complementary psychometric profiles of the two forms have direct implications for clinical practice. Trauma-related clinical interviews present unique challenges for both clinicians and patients; the re-emergence of traumatic material, the patient's avoidance tendencies, and the risk of secondary traumatization in the clinician are among the foremost of these difficulties (Figley, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; Pearlman \u0026amp; Saakvitne, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e1995\u003c/span\u003e). The provision of a structured interview format enables clinicians to work with traumatic material in a systematic and comprehensive manner within a therapeutic framework; by reducing inter-clinician variability in questioning and interpretation, it safeguards the breadth of assessment and facilitates more reliable clinical judgements (Rogers, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). The brevity of the CPSS-5-SR (5\u0026ndash;10 minutes) makes it particularly suited for routine screening in busy outpatient settings, enabling rapid identification of at-risk individuals. The CPSS-5-I, with its structured clinical interview format and higher sensitivity (91.5%), is better suited for formal diagnostic evaluation \u0026mdash; ensuring that PTSD diagnoses are not missed in high-risk contexts such as emergency psychiatric assessments, child protection evaluations, or post-acute trauma presentations. The higher specificity of the CPSS-5-SR (90.7%) further supports its utility in research settings and treatment monitoring, where minimizing false positives is a priority. Used sequentially \u0026mdash; the self-report form for initial screening, followed by the interview for confirmation in screen-positive cases \u0026mdash; the two forms offer a clinically efficient and psychometrically robust assessment pathway for PTSD in children and adolescents.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eSeveral limitations warrant consideration. First, the sample size (n\u0026thinsp;=\u0026thinsp;102) is at the lower boundary for factor-analytic studies. The requirement for a verified DSM-5 Criterion A traumatic event as an inclusion criterion \u0026mdash; while methodologically rigorous \u0026mdash; necessarily restricted the eligible sample, as individuals presenting with distressing life experiences that did not meet the formal Criterion A definition were not enrolled; this may partially account for the relatively modest sample size. Second, test-retest subsamples were small, reflecting the practical challenges of re-assessing children in active psychiatric treatment \u0026mdash; including fluctuating motivation, irregular attendance, and early discharge. Third, EFA and CFA were conducted on the same sample. While this is a recognized methodological limitation, it is important to note that the factor solution was not empirically derived but theoretically constrained a priori to four factors, consistent with the DSM-5 PTSD symptom clusters. The EFA in the present study thus served a confirmatory rather than exploratory purpose \u0026mdash; examining whether items loaded onto their theoretically expected clusters rather than identifying an unknown factor structure. This approach is consistent with practice in cross-cultural validation studies where sample size precludes split-sample designs, and where the theoretical structure of the construct is well-established (Floyd \u0026amp; Widaman, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e1995\u003c/span\u003e; Worthington \u0026amp; Whittaker, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Nevertheless, future studies with larger samples should employ independent EFA and CFA samples to provide more rigorous factorial evidence. Fourth, the clinical sample limits generalizability to community populations, and asymptomatic trauma-exposed individuals were not included.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eFuture Directions\u003c/h2\u003e \u003cp\u003eFuture research should investigate the psychometric properties of the Turkish CPSS-5 in community and school-based samples to establish normative data and examine whether cutoff scores require adjustment for non-clinical populations. Trauma type-specific analyses and age-stratified investigations in larger samples would address developmental and contextual variability. Longitudinal studies examining treatment sensitivity would establish the CPSS-5's utility as an outcome measure in clinical trials.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study provides the first comprehensive psychometric evaluation of the Turkish CPSS-5-I and CPSS-5-SR in a clinical pediatric sample. Both forms demonstrated strong reliability, good factorial validity, robust convergent and discriminant validity, and excellent diagnostic accuracy. The Turkish CPSS-5 represents a valid and clinically useful instrument for DSM-5 PTSD assessment in Turkish-speaking children and adolescents, filling a significant gap in the available evidence-based measurement tools for this population.\u003c/p\u003e"},{"header":"Statements and Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eF.Z.B. conceptualized the study, collected and curated the data, conducted the formal analyses, and wrote the main manuscript text. A.B. contributed to conceptualization, methodology, and supervision. A.B.B. contributed to formal analysis and methodology. V.G. contributed to conceptualization, methodology, and supervision. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. The research was approved by the Clinical Research Ethics Committee of Istanbul Kanuni Sultan Süleyman Training and Research Hospital on August 29th, 2024, under the number 2024.08.150.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent for publication was obtained from all participants and their legal guardians.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for conducting this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are not publicly available due to their containing information that could compromise the privacy of research participants.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAlisic E, Zalta A, Wesel F, Larsen S, Hafstad G, Hassanpour K, \u0026amp; Smid G. 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Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): Initial Reliability and Validity Data. \u003cem\u003eJournal of the American Academy of Child \u0026amp; Adolescent Psychiatry\u003c/em\u003e, \u003cem\u003e36\u003c/em\u003e(7), 980\u0026ndash;988. https://doi.org/10.1097/00004583-199707000-00021\u003c/li\u003e\n \u003cli\u003eKessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Benjet, C., Bromet, E. J., Cardoso, G., Degenhardt, L., de Girolamo, G., Dinolova, R. V., Ferry, F., Florescu, S., Gureje, O., Haro, J. M., Huang, Y., Karam, E. G., Kawakami, N., Lee, S., Lepine, J. P., Levinson, D., \u0026hellip; Koenen, K. C. (2017). Trauma and PTSD in the WHO World Mental Health Surveys. \u003cem\u003eEuropean Journal of Psychotraumatology\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e. https://doi.org/10.1080/20008198.2017.1353383\u003c/li\u003e\n \u003cli\u003eKessler, R. 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Norton \u0026amp; Company.\u003c/li\u003e\n \u003cli\u003ePynoos, R. S., Weathers F. W., Steinberg, A. M. , Marx, B. P., Layne, C. M., Kaloupek, D. G., Schnurr, P. P., Keane, T. M., Blake, D. D., Newman, E., Nader, K. O., \u0026amp; \u0026amp; Kriegler, J. A. (2015). Clinician-Administered PTSD Scale for DSM-5 - Child/Adolescent Version. \u003cem\u003e[Assessment] Available from the National Center for PTSD at www.ptsd.va.gov.\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003eRogers, R. (2001). \u003cem\u003eHandbook of diagnostic and structured interviewing\u003c/em\u003e. Guilford Press.\u003c/li\u003e\n \u003cli\u003eSachser, C., Berliner, L., Risch, E., Rosner, R., Birkeland, M. S., Eilers, R., Hafstad, G. S., Pfeiffer, E., Plener, P. L., \u0026amp; Jensen, T. K. (2022). The child and Adolescent Trauma Screen 2 (CATS-2) \u0026ndash; validation of an instrument to measure DSM-5 and ICD-11 PTSD and complex PTSD in children and adolescents. \u003cem\u003eEuropean Journal of Psychotraumatology\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e(2). https://doi.org/10.1080/20008066.2022.2105580\u003c/li\u003e\n \u003cli\u003eTeicher, M. H., Tomoda, A., \u0026amp; Andersen, S. E. (2006). Neurobiological consequences of early stress and childhood maltreatment: Are results from human and animal studies comparable? \u003cem\u003eAnnals of the New York Academy of Sciences\u003c/em\u003e, \u003cem\u003e1071\u003c/em\u003e, 313\u0026ndash;323. https://doi.org/10.1196/annals.1364.024\u003c/li\u003e\n \u003cli\u003e\u0026Uuml;nal, F., \u0026Ouml;ktem, F., \u0026Ccedil;etin \u0026Ccedil;uhadaroğlu, F., \u0026Ccedil;engel K\u0026uuml;lt\u0026uuml;r, S. E., Akdemir, D., Foto \u0026Ouml;zdemir, D., \u0026Ccedil;ak, H. T., \u0026Uuml;nal, D., Tiraş, K., Aslan, C., Kalayci, B. M., Aydos, B. S., K\u0026uuml;t\u0026uuml;k, F., Taşy\u0026uuml;rek, E., Karaokur, R., Karabucak, B., Karak\u0026ouml;k, B., Karaer, Y., \u0026amp; Artik, A. (2019). Reliability and validity of the schedule for affective disorders and schizophrenia for school-age children-present and lifetime version, DSM-5 November 2016-Turkish adaptation (K-SADS-PL-DSM-5-T). \u003cem\u003eTurk Psikiyatri Dergisi\u003c/em\u003e, \u003cem\u003e30\u003c/em\u003e(1). https://doi.org/10.5080/U23408\u003c/li\u003e\n \u003cli\u003eWeathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx, B. P. , \u0026amp; Keane, T. M. (2013). The Life Events Checklist for DSM-5 (LEC-5). \u003cem\u003eInstrument Available from the National Center for PTSD at Www.Ptsd.va.Gov\u003c/em\u003e.\u003c/li\u003e\n \u003cli\u003eWorthington, R. L., \u0026amp; Whittaker, T. A. (2006). Scale Development Research. \u003cem\u003eThe Counseling Psychologist\u003c/em\u003e, \u003cem\u003e34\u003c/em\u003e(6), 806\u0026ndash;838. https://doi.org/10.1177/0011000006288127\u003c/li\u003e\n \u003cli\u003eYildiz, N. G., Aydin, H. Z., Aydin, K., Yildiz, H., Sambo, G., Mwamulima, B., Zonda, J. M., Phiri, D., \u0026amp; Phiri, Y. V. A. (2024). Understanding adverse childhood experiences and the call for trauma-informed healthcare system in Turkey: a review. \u003cem\u003eHealth Research Policy and Systems\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e(1), 63-. https://doi.org/10.1186/S12961-024-01137-3/PEER-REVIEW\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"PTSD, CPSS-5, psychometric validation, Turkish, children, DSM-5","lastPublishedDoi":"10.21203/rs.3.rs-9327295/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9327295/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePost-traumatic stress disorder (PTSD) affects a substantial proportion of trauma-exposed children and adolescents, yet validated DSM-5 PTSD assessment tools for Turkish-speaking youth remain limited, particularly measures offering both clinician-administered and self-report formats. This study aimed to evaluate the psychometric properties of the Turkish versions of the Child PTSD Symptom Scale for DSM-5 (CPSS-5) interview (CPSS-5-I) and self-report (CPSS-5-SR) forms in a clinical sample. Participants were 102 trauma-exposed children and adolescents (67.6% female; M age = 14.8 years, SD = 2.75) recruited from outpatient and inpatient child and adolescent psychiatry services. Psychometric properties were evaluated using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), internal consistency (Cronbach's α), test-retest reliability (ICC), convergent and discriminant validity (Spearman's ρ), and diagnostic accuracy (ROC analysis with K-SADS-based DSM-5 PTSD diagnosis as the reference standard). Both forms demonstrated excellent internal consistency (CPSS-5-SR: α = .936; CPSS-5-I: α = .904). EFA and CFA supported a four-factor structure consistent with DSM-5 PTSD symptom clusters (CPSS-5-SR: RMSEA = .045, CFI = .969; CPSS-5-I: RMSEA = .046, CFI = .951). Test-retest reliability was excellent for both forms (CPSS-5-I: ICC = .896; CPSS-5-SR: ICC = .871). Convergent validity was strong (ρ = .900, p \u0026lt; .001). Discriminant validity was supported by moderate correlations with anxiety (ρ = .326–.461) and depression (ρ = .437–.583; n = 37), substantially lower than the inter-form coefficient. ROC analysis revealed excellent diagnostic accuracy (CPSS-5-I: AUC = .927; CPSS-5-SR: AUC = .928), with optimal cutoffs of 33.5 (sensitivity 91.5%, specificity 85.2%) and 44 (sensitivity 83.0%, specificity 90.7%), respectively. The Turkish CPSS-5-I and CPSS-5-SR demonstrated strong psychometric properties and excellent diagnostic accuracy, supporting their use for PTSD screening, diagnosis, and treatment monitoring in clinical settings.\u003c/p\u003e","manuscriptTitle":"Psychometric Properties of the Child PTSD Symptom Scale for DSM-5 Interview and Self- Report Forms: Validation in a Clinical Sample","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-14 10:41:57","doi":"10.21203/rs.3.rs-9327295/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"80c4f367-e87b-4834-ac02-4781dbc7c098","owner":[],"postedDate":"April 14th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-21T00:24:05+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-14 10:41:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9327295","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9327295","identity":"rs-9327295","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}