Identification of the Clinical Specificities of Complex Posttraumatic Stress Disorder

Early Maladaptive Schema

The YSQ-S3 is a self-report measure assessing 18 early maladaptive schemas. The items are categorized in four schema factors which replaced Young's previous five schema domains (Young et al., 2003): Disconnection, Impaired Autonomy, Exaggerated Standards, and Impaired Limits (Hoffart, et al., 2005). Participants are asked to rate descriptive statements on a 6-step Likert-scale which ranges from "completely untrue of me" (1) to "describes me perfectly" (6). The YSQ-S3 provides a total score and higher values are associated with a stronger presence of early maladaptive schema. This measure has demonstrated good psychometric properties and has shown age neutrality when administered across the lifespan (Pauwels et al., 2014).

Time frame: 10 minutes for questionnaire completion

Personality Disorders

The PDQ-4+ (Hyler, 1994) which includes 107 items, and which is used to evaluate 12 kinds of personality disorders in the DSM-IV system. The PDQ-4+ is a 99-item self-report measure of DSM-IV personality disorders on which items are answered using a yes/no format. Personality disorders symptom counts are computed by summing the yes items for each personality disorder. The PDQ-4+ provides a total score and higher values are associated with a stronger presence of personality disorders.

Time frame: baseline

Depressive symptoms

The PHQ-9 is used to assess depressive symptoms over the last two weeks (Kroenke et al., 2001). Respondents indicate on a 0-3 scale, the frequency with which they experience the following symptoms: (1) anhedonia, (2) depressed mood, (3) sleep disturbance, (4) fatigue, (5) appetite changes, (6) low self-esteem, (7) concentration problems, (8) psychomotor disturbances, and (9) suicidal ideation. Total scores range from 0 to 27, with scores ≥10 representing clinically significant depressive symptoms (Kroenke \& Spitzer, 2002). Furthermore, the PHQ-9 is validated as a depressive symptom severity measure (total score 1-4: minimal depression, 5-9: mild depression, 10-14: moderate depression, 15-19: moderately severe depression, and 20-27: severe depression; Kroenke et al., 2001). The PHQ-9 demonstrates high internal consistency and good sensitivity and specificity for identifying cases of MDD (Kroenke et al., 2001).

Time frame: baseline

Anxiety State and Trait

The STAI consists for a 40 items self-evaluation questionnaire which includes separate measures of state and trait anxiety. The State-Anxiety scale (STAI Form Y-1) consists of twenty statements that evaluate how respondents' feel about anxiety "right now, at this moment" through four scales: one (not at all), two (somewhat), three (moderately so), and four (very much so). The Trait-anxiety scale consists of twenty statements that assess how people "generally feel" about anxiety with four scales: one (almost never), two (sometimes), three (often), and four (almost always). A rating of four indicates the presence of a high level anxiety and one indicates the absence of a high level anxiety (Spielberger et al., 1983). The anxiety level was found by calculation of scores, The range of scores is from 20-80, the higher the score indicating greater anxiety (Spielberger et al., 1983).

Time frame: baseline

Peritraumatic Dissociation

The Peritraumatic Dissociation Experiences Questionnaire (PDEQ) (Marmar et al., 1994) is a 10-item self-administered test measuring dissociative experiences during a traumatic event and in the minutes and hours following the event. Each item is scored from 1 (not at all true) to 5 (extremely true). A score of 15 or higher indicates significant peri-traumatic dissociation. The PDEQ has demonstrated good psychometric qualities in its original version (Marmar et al., 1994) and in its French version (Birmes et al., 2005). It has satisfactory test-retest reliability (r = .72) and internal consistency (α = .78), as well as good convergent validity with the PDI \[15\] and the IES-R (Brunet, St-Hilaire, Jehel \& King, 2003, Birmes et al., 2005).

Time frame: Less than five minutes for questionnaire completion

Peritraumatic Distress

The Peritraumatic Distress Inventory (PDI) (Brunet et al., 2001) is a self-administered scale composed of 13 items. It measures the emotional distress reactions that a person experienced at the time of a traumatic event and in the minutes and hours following the event. These reactions are measured retrospectively from the DSM-4 PTSD criterion A. This scale identifies two factors; dysphoric emotions and perceived life threat. Each item is scored from 0 (not at all true) to 4 (extremely true). The total score is obtained by summing all items. A score of 15 or more indicates significant peri-traumatic distress.

Time frame: baseline

Childhood Trauma

The Childhood Trauma Questionnaire short-form (CTQ) is a standardized, retrospective 28-item self-report inventory that measures the severity of different types of childhood trauma (Bernstein \& Fink, 1998). For each of the five clinical subscales, Emotional Abuse, Physical Abuse, Sexual Abuse, Emotional Neglect and Physical Neglect, the participants respond to each item in the context of "when you were growing up" and answer according to a five-point Likert scale ranging from "never" = 1 to "very often" = 5, producing scores of 5 to 25 for each trauma subscale. The higher the score the greater the severity of maltreatment. Scores above the recommended cut-off score for "low" severity on each of the subscales are considered cases of abuse and neglect (Bernstein \& Fink, 1998).

Time frame: baseline

Alcohol misuse

The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item self-report instrument used for assessing alcohol misuse (Saunders, Aasland, Babor, de la Puente, \& Grant, 1993). The measure contains two subscales assessing alcohol use (3 items; Cronbach's α = .85) and alcohol-related consequences (7 items; Cronbach's α = .83). Responses range from 0 to 40. Higher scores indicate greater likelihood of hazardous and harmful drinking. However, total scores of 8 or more are recommended as indicators of hazardous and harmful alcohol use, as well as possible alcohol dependence. As well, guidelines establish that AUDIT scores in the range of 8-15 represent a medium level of alcohol problems, scores in the range of 16-19 represent a high level of alcohol problems and scores of 20 or above clearly warrant further diagnostic evaluation for alcohol dependence. The validity and reliability of the AUDIT with early adult samples has been established (DeMartini \& Carey, 2012).

Time frame: baseline

Resilience

Resilience will be measured using the French version of the Connor-Davidson Resilience Scale (CD-RISC; Connor \& Davidson 2003). This 25-item self-administered questionnaire measures resilience by combining five factors (tenacity, sense of self-efficacy, emotional and cognitive control, adaptability, tolerance of negative affect). Each item is coded on a 5-point scale ranging from 0 to 4. The addition of the scores for each item gives an overall resilience score ranging from 0 to 100. The higher the score, the more resilient the individual. The CD-RISC-25 has demonstrated good psychometric qualities. A French version of the questionnaire has been validated.

Time frame: baseline

Well Being

The French version of the WHO-5 (World Health Organization-Five Well Being Index, 1999) was used to measure current mental well-being. It is a short, unidimensional, self-reported scale composed of 5 items ranged from 0 ("at no time") to 5 ("all the time"). Total score is obtained by adding all of the item scores. Total raw scores range from 0 to 25. High scores reflect a high well-being. The scale is known to have high psychometric and clinimetric properties (Topp et al., 2015) and used for both screening and clinical trial purposes.

Time frame: baseline