Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
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Validation of the Korean Version of the Trauma Symptom Checklist-40 among Psychiatric Outpatients

정신건강의학과 외래환자 대상 한국판 외상 증상 체크리스트(Trauma Symptom Checklist-40)의 타당도 연구

  • Park, Jin (Department of Psychiatry, Hanyang University College of Medicine) ;
  • Kim, Daeho (Department of Psychiatry, Hanyang University College of Medicine) ;
  • Kim, Eunkyung (Trauma and Stress Program, Hanyang University Guri Hospital) ;
  • Kim, Seokhyun (Department of Psychiatry, Hanyang University College of Medicine) ;
  • Yun, Mirim (Department of Psychiatry, Hanyang University College of Medicine)
  • 박진 (한양대학교 의과대학 정신건강의학과교실) ;
  • 김대호 (한양대학교 의과대학 정신건강의학과교실) ;
  • 김은경 (한양대학교 구리병원 트라우마 스트레스 프로그램) ;
  • 김석현 (한양대학교 의과대학 정신건강의학과교실) ;
  • 윤미림 (한양대학교 의과대학 정신건강의학과교실)
  • Received : 2017.12.16
  • Accepted : 2018.02.06
  • Published : 2018.06.30
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Abstract

Objectives : Effects of multiple trauma are complex and extend beyond core PTSD symptoms. However, few psychological instruments for trauma assessment address this issue of symptom complexity. The Trauma Symptom Checklist-40 (TSC-40) is a self-report scale that assesses wide range of symptoms associated with childhood or adult traumatic experience. The purpose of the present study was to evaluate the validity of the Korean Version of the TSC-40 in a sample of psychiatric outpatients. Methods : Data of 367 treatment-seeking patients with DSM-IV diagnoses were obtained from an outpatient department of psychiatric unit at a university hospital. The diagnoses were anxiety disorder, posttraumatic stress disorder, depressive disorder, adjustment disorder and others. Included in the psychometric data were the TSC-40, the Life events checklist, the Impact of Event Scale-Revised, the Zung's Self-report Depression Scale, and the Zung's Self-report Anxiety Scale. Cronbach's ${\alpha}$ for internal consistency were calculated. Convergent and concurrent validity was approached with correlation between the TSC-40 and other scales (PTSD, anxiety and depression). Results : Exploratory factor analysis of the Korean Version of TSC-40 extracted seven-factor structure accounted for 59.55% of total variance that was contextually similar to a six-factor structure and five-factor structure of the original English version. The Korean Version of TSC-40 demonstrated a high level of internal consistency. (Cronbach's ${\alpha}=0.94$) and good concurrent and convergent validity with another PTSD scale and anxiety and depression scales. Conclusions : Excellent construct validity of The Korean Version of TSC-40 was proved in this study. And subtle difference in the factor structure may reflect the cultural issues and the sample characteristics such as heterogeneous clinical population (including non-trauma related disorders) and outpatient status. Overall, this study demonstrated that the Korean version of TSC-40 is psychometrically sound and can be used for Korean clinical population.

연구목적 복합 외상을 겪는 경우에는 PTSD의 증상을 넘어선 증상들이 다양하게 나타난다. 그러나 그러한 다양한 증상을 평가하는 도구가 부족한 실정이다. 외상 증상 체크리스트-40은 자기보고식 검사로 아동기 혹은 성인기의 외상 경험과 관련된 이러한 다양한 증상들을 측정하기 위한 도구로 원척도 연구에서 높은 신뢰도와 타당도가 검증된 검사 도구이다. 이번 연구의 목적은 정신건강의학과 외래 환자를 대상으로 한국판 외상 증상 체크리스트-40 (KTSC-40)의 타당도를 검증하기 위해 설계 되었다. 방 법 한양대학교 구리병원 정신건강의학과 외래를 진료 목적으로 방문한 367명의 환자를 대상으로 하였다. 환자들의 자기보고식 평가 자료를 사용하였으며 외상 증상 체크리스트-40 (TSC-40), 사건 충격척도 개정판(IES-revised), 일생 사건 체크리스트(LEC), Zung 자가평가 우울척도(Zung's Self-Rating Depression Scale), Zung 자가평가 불안척도(Zung's Self-Rating Anxiety Scale)를 이용하였다. 신뢰도는 내적 일치도(Cronbach's ${\alpha}$)로 산출하였고, 요인타당도는 Varimax 직각 회전을 이용한 탐색적 주성분 분석, 각 척도와의 수렴 및 공존 타당도를 위해서는 Spearman 상관분석을 하였다. 결 과 KTSC-40은 Varimax 직각회전을 이용한 주성분 요인 분석을 통해 7개의 요인을 추출하였고, 총 분산의 59.55%를 설명하였다. 이는 원척도 연구에서의 6개의 요인, 5개의 요인과 요인 수는 다르지만 그 내용은 비슷하였다. KTSC-40은 Cronbach's ${\alpha}$ 값이 0.94로 높은 내적 일치도를 가졌다. 또한 다른 PTSD scale과 우울, 불안 척도와의 비교에서 높은 수렴 및 공존 타당도를 보였다. 결 론 KTSC-40의 정신측정학 성질을 조사하여 우수한 타당도를 보이는 것을 확인하였다. 다만, 요인 분석에서의 원척도와의 약간의 차이를 보였는데 이는 문화적인 요소와 외상 관련 질환이 아닌 정신건강의학과 환자군 등 이질적인 외래 구성 집단에 따른 것으로 보인다. 결과적으로 KTSC-40은 높은 타당도로 향 후 다양한 임상영역에서 외상과 관련된 증상들을 평가 하는데 유용할 것으로 예상된다.

Keywords

References

  1. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1995;52:1048-1060. https://doi.org/10.1001/archpsyc.1995.03950240066012
  2. Eun HJ, Lee SM, Kim TH. The epidemiological study of posttraumatic stress disorder in an urban area J Korean Neuropsychiatr Assoc 2001;40:581-591.
  3. Donald W. Black, Jon E. Grand, M.P.H. DSM-5 Guidebook: The Essential Companion to the Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition, 1st Ed. Texas: American Psychiatric Publication;2014. p.169-190.
  4. Herman JL. Sequelae of prolonged and repeated trauma: evidence for a complex posttraumatic syndrome (DESNOS). In: Davidson JRT, Foa ED, editors. Posttraumatic stress disorder: DSM-IV and beyond. Washington DC: American Psychiatric Press;1993. p.213-228.
  5. Van der Kolk BA, Pelcovitz D, Roth S, Mandel FS, McFar- lane A, Herman JL. Dissociation, somatization, and affect dysregulation: the complexity of adaptation of trauma. Am J Psychiatry 1996;153:83-93. https://doi.org/10.1176/ajp.153.1.83
  6. Pelcovitz D, Van der Kolk B, Roth S, Mandel F, Kaplan S, Resick P. Development of a criteria set and a structured inter- view for disorders of extreme stress (SIDES). J Trauma Stress 1997;10:3-16.
  7. Briere J, Elliott DM, Harris K, Cotman A. Trauma Symptom Inventory: psychometrics and association with childhood and adult victimization in clinical samples. J Interpersonal Violence 1995;10:387-401. https://doi.org/10.1177/088626095010004001
  8. Briere J, Runtz M. The Trauma Symptom Checklist (TSC-33) early data on a new scale. J Interpersonal Violence 1989;4:151-163. https://doi.org/10.1177/088626089004002002
  9. Elliott DM, Briere J. Sexual abuse trauma among professional women: validating the Trauma Symptom Checklist-40 (TSC-40). Child Abuse Negl 1992;16:391-398. https://doi.org/10.1016/0145-2134(92)90048-V
  10. Zlontnick C, Shea MT, Begin A, Pearlstein T, Simpson E, Costello E. The validation of the trauma symptom checklist-40 in a sample of inpatient. Child Abuse Negl 1996;20: 503-510. https://doi.org/10.1016/0145-2134(96)00032-4
  11. Ghee AC, Johnson CS, Burlew AK. Measurement Equivalence of the Trauma Symptom Checklist-40 for Chemically Dependent African American and Caucasian Women: a preliminary study. J Aggress Maltreat 2010;19:820-838. https://doi.org/10.1080/10926771.2010.522949
  12. Whiffen VE, Benazon NR, Bradshaw C. Discriminant validity of the TSC-40 in an outpatient setting. Child Abuse Negl 1997;21:107-115. https://doi.org/10.1016/S0145-2134(96)00134-2
  13. Gold JW, Cardena, E. Convergent validity of three posttraumatic symptoms inventories among adult sexual abuse survivors. J Trauma Stress 1998;11:173-180. https://doi.org/10.1023/A:1024425603790
  14. Gold SR, Milan LD, Mayall A, Johnson AE. A cross-validation study of the Trauma Symptom Checklist: the role of mediating variables. J Interpersonal Violence 1994;9:12-26. https://doi.org/10.1177/088626094009001002
  15. Neal TMS, Nagle JE. Measuring abuse sequelae: validating and extending the trauma symptom checklist-40. J Aggress Maltreat 2013;22:231-247. https://doi.org/10.1080/10926771.2013.764953
  16. Choi KR, Kim D, Jang EY, Bae H, Kim SH. Reliability and Validity of the Korean Version of the Lifetime Stressor Checklist-Revised in Psychiatric Outpatients with Anxiety or Depressive Disorders. Yonsei Med J 2017;58:226-233. https://doi.org/10.3349/ymj.2017.58.1.226
  17. Briere J. Psychometric review of the Trauma Symptom Checklist-40. In: BH Stamm Ed. Measurement of stress, trauma, and adaptation. Lutherville MD: Sidran Press;1996. p.29-36.
  18. Weiss DF, Marmer CR. The Impact of Event Scale-Revised. In: Wilson JP, Keane TM, editors. Assessing psychological trauma and PTSD: a practitioners handbook. New York: Guilford Press;1997. p.399-411.
  19. Lim HK, Woo JM, Kim TS, Kim TH, Choi KS, Chung SK, Chee IS, Lee KU, Paik KC, Seo HJ, Kim W, Jin B, Chae JH. Reliability and validity of the Korean version of the Impact of Event Scale-Revised. Compr Psychiatry 2009;50:385-390. https://doi.org/10.1016/j.comppsych.2008.09.011
  20. Gray MJ, Litz BT, Hsu JL, Lombardo TW. Psychometric properties of the life events checklist. Assessment 2004;11: 330-341. https://doi.org/10.1177/1073191104269954
  21. Bae H, Kim D, Koh H, Kim Y, Park JS. Psychometric properties of the life events checklist-Korean version. Psychiatry Investig 2008;5:163-167. https://doi.org/10.4306/pi.2008.5.3.163
  22. Zung WW. A self-rating depression scale. Arch Gen Psychiatry 1965;12:63-70. https://doi.org/10.1001/archpsyc.1965.01720310065008
  23. Lee JH. Development of the Korean form of Zung's Self-Rating Depression Scale. Yeungnam Univ J Med 1995;12:292- 305. https://doi.org/10.12701/yujm.1995.12.2.292
  24. Zung WW. A rating instrument for anxiety disorders. Psychosomatics 1971;12:371-379. https://doi.org/10.1016/S0033-3182(71)71479-0
  25. Lee JH. Development of the Korean form of Zung's Self-Rating Anxiety Scale. Yeungnam Univ J Med 1996;13:279-294. https://doi.org/10.12701/yujm.1996.13.2.279
  26. Lee SM. The basis of the factor analysis. Paju: Kyoyookkwahaksa;2010. p.78-86.
  27. Freeman RC, Collier K, Parillo KM. Early life sexual abuse as a risk factor for crack cocaine use in a sample of community-recruited women at high risk for illicit drug use. Am J Drug Alcohol Abuse 2002;28:109-131. https://doi.org/10.1081/ADA-120001284
  28. Charney DA, Palacios-Boix J, Gill KJ. Sexual abuse and the outcome of addiction treatment. Am J Addict 2007;16: 93-100. https://doi.org/10.1080/10550490601184225
  29. Lin KM. Hwa-byung; A Korean culture-bound syndrome? Am J Psychiatry 1983;140:105-107. https://doi.org/10.1176/ajp.140.1.105
  30. Roberts ME1, Han K, Weed NC. Development of a scale to assess Hwa-Byung, a korean culture-bound syndrome, using the Korean MMPI-2. Transcult Psychiatry 2006;43:383-400. https://doi.org/10.1177/1363461506067715