Desenvolvimento e validação de ferramenta abrangente para medição da experiência peritraumática multidimensional

Coutinho, Evandro Silva Freire; Reichenheim, Michael Eduardo; Carvalho, Thaiza Dutra Gomes de; Pereira, Leticia Rocha; Figueira, Ivan; Andreoli, Sérgio Baxter; Quintana, Maria Inês; Mari, Jair de Jesus

doi:10.1590/0102-311XEN062225

person Evandro Silva Freire Coutinho

study conceptualization · data analysis · writing and review · approved the final version

school Instituto de Medicina Social Hesio Cordeiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.

0000-0002-4649-7353

person Michael Eduardo Reichenheim

study conceptualization · data analysis · writing and review · approved the final version

school Instituto de Medicina Social Hesio Cordeiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.

0000-0001-7232-6745

person Thaiza Dutra Gomes de Carvalho

data analysis · writing and review · approved the final version

school Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.

0000-0002-8499-9215

person Leticia Rocha Pereira

data analysis and interpretation · writing and review · approved the final version

school Serviço de Medicina Interna, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.

0000-0002-9899-1695

person Ivan Figueira

writing and review · approved the final version

school Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil.

0000-0002-8155-0519

person Sérgio Baxter Andreoli

writing and review · approved the final version

school Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brasil.school Universidade Católica de Santos, Santos, Brasil.

0000-0002-1976-0881

person Maria Inês Quintana

writing and review · approved the final version

school Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brasil.

0000-0002-3808-8189

person Jair de Jesus Mari

writing and review · approved the final version

school Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brasil.

0000-0002-5403-0112

personCorrespondence L. R. Pereira Departamento de Reumatologia, Serviço de Medicina Interna, Universidade do Estado do Rio de Janeiro. Av. Marechal Rondon 381, térreo, Rio de Janeiro, RJ 20950-003, Brasil.
leticia.capucci@gmail.com

Associate Editor

Evaluation coordinator: Rosane Harter Griep (0000-0002-6250-2036)

TIS *		PDEQ **		PERITRAUMATIC PHYSICAL REACTIONS *** ^#
tis1	Rate the degree to which you froze or felt paralyzed during your most recent experience	pdeq1	I had moments of losing track of what was going on - I “blanked out” or “spaced out” or in some way felt I was not part of what was going on	ppr1	Sensations of shortness of breath or smothering
tis2	Rate the degree to which you were unable to move, although unrestrained	pdeq2	I found that I was on “automatic pilot” - I ended up doing things I later realized I had not actively decided to do	ppr2	Feeling dizzy, unsteady, lightheaded, or faint
tis3	Rate the degree to which your body was trembling/shaking during the event	pdeq3	My sense of time changed - things seemed to be happening in slow motion	ppr3	Palpitations, pounding heart, or accelerated heart rate
tis4	Rate the degree to which you were unable to call out or scream during the event	pdeq4	What was happening seemed unreal to me, like I was in a dream or watching a movie or play	ppr4	Trembling or shaking
tis5	Rate the degree to which you felt numb or no pain during the event	pdeq5	I felt as though I were a spectator watching what was happening to me, as if I were floating above the scene or observing it as an outsider	ppr5	Sweating
tis6	Rate the degree to which you felt cold during the event	pdeq6	There were moments when my sense of my own body seemed distorted or changed, I felt disconnected from my own body, or that it was unusually large or small	ppr6	Nausea or abdominal distress
tis7	Rate the extent to which you felt feelings of fear/panic during the event	pdeq7	I felt as though things that were actually happening to others were happening to me, like I was being trapped when I really was not	ppr7	Paresthesias (numbness or tingling sensations)
tis8	Rate the extent to which you feared for your life or felt as though you were going to die	pdeq8	I was surprised to find out afterward that a lot of things had happened at the time that I was not aware of, especially things I ordinarily would have noticed	ppr8	Chills or hot flushes
tis9	Rate the extent to which you felt detached from yourself during the event	pdeq9	I felt confused; that is, there were moments when I had difficulty making sense of what was happening	ppr9	Feeling of choking
tis10	Rate the extent to which you felt detached from what was going on around you during the event	pdeq10	I felt disoriented; that is, there were moments when I felt uncertain about where I was or what time it was	prs10	Chest pain or discomfort
ADDITIONAL ITEMS SUGGESTED BY THE EXPERTS
res_it1	[Tell us how much you felt unable to escape even though you wanted to]	res_pd1	[I felt “numbed” or emotionless]	res_ppr1	[Difficulty controlling your bladder or bowel]
res_it2	[Say how guilty or ashamed you felt after the event]			res_ppr2	[If passed out during the trauma]
res_it3	[Say how much you can remember the details of the event]

Item source	São Paulo				Rio de Janeiro
Item source	λ_i(f1) *	λ_i(f2) *	λ_i(f3) *	δ_i **	λ_i(f1) *	λ_i(f2) *	λ_i(f3) *	δ_i **
Peritraumatic tonic immobility
tis1	0.728	0.192	-0.031	0.035	0.676	0.178	0.078	0.285
tis2	0.786	0.233	-0.128	0.249	0.713	0.231	-0.001	0.226
tis3	0.570	-0.012	0.313	0.398	0.616	-0.023	0.383	0.285
tis4	0.605	0.203	0.058	0.395	0.681	0.083	0.118	0.357
tis5	0.600	0.244	0.009	0.403	0.525	0.308	-0.021	0.437
tis6	0.388	0.250	0.234	0.443	0.499	0.222	0.146	0.433
tis7	0.513	0.046	0.305	0.427	0.646	0.017	0.243	0.360
tis8	0.599	-0.103	0.306	0.453	0.483	0.037	0.279	0.528
res_it1 ***	0.703	0.029	0.115	0.377	0.700	0.119	0.083	0.316
Peritraumatic dissociation
pdeq1	0.133	0.683	0.048	0.357	0.133	0.769	-0.085	0.337
pdeq2	0.116	0.594	0.045	0.510	0.078	0.491	0.140	0.594
pdeq3	0.135	0.660	0.085	0.348	0.117	0.688	0.080	0.330
pdeq4	-0.009	0.774	-0.019	0.428	0.134	0.701	-0.003	0.371
pdeq5	-0.056	0.858	-0.014	0.331	-0.001	0.835	-0.027	0.330
pdeq6	0.105	0.743	0.102	0.222	-0.045	0.925	0.021	0.175
pdeq7	-0.023	0.808	0.026	0.340	-0.161	0.857	0.096	0.329
pdeq8	-0.052	0.869	-0.020	0.316	-0.002	0.736	0.077	0.389
pdeq9	-0.006	0.894	-0.074	0.291	0.002	0.786	0.107	0.272
pdeq10	0.033	0.860	-0.005	0.233	0.077	0.741	0.129	0.235
res_pd1 ***	0.052	0.784	0.001	0.335	0.016	0.771	0.090	0.301
tis9	0.366	0.467	0.077	0.365	0.354	0.555	-0.031	0.341
tis10	0.289	0.514	-0.024	0.505	0.355	0.465	-0.049	0.484
Peritraumatic physical reactions
ppr1	-0.002	0.010	0.805	0.342	0.070	0.112	0.704	0.341
ppr2	0.012	0.026	0.782	0.350	0.103	0.046	0.753	0.303
ppr3	0.226	-0.122	0.697	0.425	0.332	-0.105	0.679	0.337
ppr4	0.212	-0.057	0.703	0.365	0.321	-0.074	0.707	0.273
ppr5	0.041	0.019	0.763	0.361	0.186	0.005	0.744	0.280
ppr6	-0.099	0.023	0.857	0.323	0.073	0.231	0.675	0.239
ppr7	0.019	0.000	0.837	0.282	-0.082	0.294	0.758	0.164
ppr8	0.019	0.051	0.798	0.288	0.009	0.242	0.686	0.271
ppr9	-0.049	0.067	0.876	0.196	0.072	0.186	0.697	0.261
ppr10	-0.003	0.069	0.805	0.274	-0.023	0.163	0.761	0.272
res_ppr1 ***	-0.019	0.096	0.688	0.445	-0.077	0.267	0.717	0.266
res_ppr2 ***	0.069	0.037	0.457	0.725	-0.024	0.062	0.484	0.740
RMSEA ^#	0.022 (0.020-0.024)			0.021 (0.017-0.024)
CFI	0.987			0.989
TLI	0.984			0.986

Item * **		São Paulo		Rio de Janeiro
Item * **		λ_i ***	δ ^#	λ_i ***	δ ^#
Peritraumatic tonic immobility
pr1	(tis1)	0.815	0.337	0.840	0.294
pr2	(tis2)	0.819	0.329	0.858	0.263
pr3	(tis3)	0.788	0.379	0.857	0.266
pr4	(tis4)	0.786	0.382	0.785	0.383
pr5	(tis5)	0.766	0.414	0.741	0.451
pr6	(tis7)	0.787	0.381	0.797	0.364
pr7	(tis8)	0.716	0.487	0.708	0.498
pr8	(res_it1) ^##	0.764	0.416	0.800	0.361
$\sqrt{{a v e}_{(f 1)}}$		0.785		0.801
Peritraumatic dissociation
pr9	(pdeq1)	0.810	0.343	0.793	0.370
pr10	(pdeq3)	0.827	0.316	0.836	0.302
pr11	(pdeq4)	0.747	0.442	0.797	0.365
pr12	(pdeq5)	0.794	0.370	0.794	0.370
pr13	(pdeq6)	0.902	0.186	0.885	0.217
pr14	(pdeq7)	0.811	0.342	0.799	0.361
pr15	(pdeq8)	0.805	0.353	0.784	0.385
pr16	(pdeq9)	0.825	0.319	0.860	0.260
pr17	(pdeq10)	0.874	0.237	0.897	0.196
pr18	(res_pd1) ^##	0.817	0.332	0.843	0.289
$\sqrt{{a v e}_{(f 2)}}$		0.837		0.838
Peritraumatic physical reactions
pr19	(ppr1)	0.803	0.355	0.806	0.351
pr20	(ppr2)	0.797	0.365	0.812	0.341
pr21	(ppr3)	0.762	0.420	0.809	0.346
pr22	(ppr4)	0.819	0.329	0.852	0.273
pr23	(ppr5)	0.797	0.365	0.833	0.306
pr24	(ppr6)	0.785	0.383	0.889	0.210
pr25	(ppr7)	0.839	0.297	0.903	0.184
pr26	(ppr8)	0.843	0.289	0.855	0.269
pr27	(ppr9)	0.889	0.210	0.865	0.251
pr28	(ppr10)	0.855	0.270	0.834	0.304
pr29	(res_ppr1) ^##	0.750	0.438	0.845	0.286
$\sqrt{{a v e}_{(f 3)}}$		0.814		0.844
$\emptyset_{f_{(1)} \leftrightarrow f_{(2)}}$		0.743		0.799
$\emptyset_{f_{(1)} \leftrightarrow f_{(3)}}$		0.726		0.764
$\emptyset_{f_{(2)} \leftrightarrow f_{(3)}}$		0.709		0.737
RMSEA ^###		0.024 (0.022-0.026)		0.023 (0.020-0.027)
CFI		0.986		0.988
TLI		0.985		0.988

	São Paulo			Rio de Janeiro
	$\sqrt{{a v e}_{(f 1)}}$	$\sqrt{{a v e}_{(f 2)}}$	$\sqrt{{a v e}_{(f 3)}}$	$\sqrt{{a v e}_{(f 1)}}$	$\sqrt{{a v e}_{(f 2)}}$	$\sqrt{{a v e}_{(f 3)}}$
$\emptyset_{f_{(1)} \leftrightarrow f_{(2)}}$	0.048 *	0.100 **		0.002	0.038 **
$\emptyset_{f_{(1)} \leftrightarrow f_{(3)}}$	0.057 *		0.086 **	0.033		0.076 **
$\emptyset_{f_{(2)} \leftrightarrow f_{(3)}}$		0.130 **	0.107 **		0.103 **	0.109 **

TONIC IMMOBILITY	SEVERITY RATING
Rate the degree to which you froze or felt paralyzed during your most recent experience	0	1	2	3	4	5	6
	Not at all						Extremely/Very much
Rate the degree to which you were unable to move even though not restrained	0	1	2	3	4	5	6
	Not at all						Extremely/Very much
Rate the degree to which your body was trembling/shaking during the event	0	1	2	3	4	5	6
	Not at all						Extremely/Very much
Rate the degree to which you were unable to call out or scream during the event	0	1	2	3	4	5	6
	Not at all						Extremely/Very much
Rate the degree to which you felt numb or in no pain during the event	0	1	2	3	4	5	6
	Not at all						Extremely/Very much
Rate the extent to which you felt fear/panic during the event	0	1	2	3	4	5	6
	Not at all						Extremely/Very much
Rate the extent to which you feared for your life or felt as though you were going to die	0	1	2	3	4	5	6
	Not at all						Extremely/Very much
Tell us how much you felt unable to escape even though you wanted to	0	1	2	3	4	5	6
	Not at all						Extremely/Very much
DISSOCIATION	SEVERITY RATING
I had moments of losing track of what was going on - I “blanked out” or “spaced out” or in some way felt that I was not part of what was going on	0	1		2			Extremely/Very much	3	4
	Not at all true	Slightly true		Somewhat true		Very true	Extremely true
My sense of time changed - things seemed to be happening in slow motion	0	1		2		3	4
	Not at all true	Slightly true		Somewhat true		Very true	Extremely true
What was happening seemed unreal to me, like I was in a dream or watching a movie or play	0	1		2		3	4
	Not at all true	Slightly true		Somewhat true		Very true	Extremely true
I felt as though I were a spectator watching what was happening to me, as if I were floating above the scene or observing it as an outsider	0	1		2		3	4
	Not at all true	Slightly true		Somewhat true		Very true	Extremely true
There were moments when my sense of my own body seemed distorted or changed. I felt disconnected from my own body or that it was unusually large or small	0	1		2		3	4
	Not at all true	Slightly true		Somewhat true		Very true	Extremely true
I felt as though things that were actually happening to others were happening to me, like I was being trapped when I really was not	0	1		2		3	4
	Not at all true	Slightly true		Somewhat true		Very true	Extremely true
I was surprised to find out afterward that a lot of things had happened at the time that I was not aware of, especially things I ordinarily would have noticed	0	1		2		3	4
	Not at all true	Slightly true		Somewhat true		Very true	Extremely true
I felt confused; that is, there were moments when I had difficulty making sense of what was happening	0	1		2		3	4
	Not at all true	Slightly true		Somewhat true		Very true	Extremely true
I felt disoriented; that is, there were moments when I felt uncertain about where I was or what time it was	0	1		2		3	4
	Not at all true	Slightly true		Somewhat true		Very true	Extremely true
I felt “numbed” or emotionless	0	1		2		3	4
I felt “numbed” or emotionless	Not at all true	Slightly true		Somewhat true		Very true	Extremely true
PHYSICAL PANIC REACTIONS	SEVERITY RATING
Sensations of shortness of breath or smothering	0		1		2		3
Sensations of shortness of breath or smothering	No		A little		Moderate		Extreme
Feeling dizzy, unstead, lightheaded, or faint	0		1		2		3
Feeling dizzy, unstead, lightheaded, or faint	No		A little		Moderate		Extreme
Palpitations, pounding heart, or accelerated heart rate	0		1		2		3
Palpitations, pounding heart, or accelerated heart rate	No		A little		Moderate		Extreme
Trembling or shaking	0		1		2		3
Trembling or shaking	No		A little		Moderate		Extreme
Sweating	0		1		2		3
Sweating	No		A little		Moderate		Extreme
Nause or abdominal distress	0		1		2		3
Nause or abdominal distress	No		A little		Moderate		Extreme
Paresthesias (numbness or tingling sensations)	0		1		2		3
Paresthesias (numbness or tingling sensations)	No		A little		Moderate		Extreme
Chills or hot flushes	0		1		2		3
Chills or hot flushes	No		A little		Moderate		Extreme
Feeling of choking	0		1		2		3
Feeling of choking	No		A little		Moderate		Extreme
Chest pain or discomfort	0		1		2		3
Chest pain or discomfort	No		A little		Moderate		Extreme
Difficulty controlling bladder or bowel	0		1		2		3
Difficulty controlling bladder or bowel	No		A little		Moderate		Extreme

[TFN1] * Fuse et al. ¹⁸;

[TFN2] ** Marmar et al. ⁴;

[TFN3] *** American Psychiatric Association ⁹;

[TFN4] ^# Items from the “Panic Attack Criteria” of the 4^th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) ⁹.