South Korean validation of the COVID-related-PTSD scale in a non-clinical sample exposed to the COVID-19 pandemic

(2022) 10:135 Lee et al. BMC Psychology https://doi.org/10.1186/s40359-022-00844-2 Open Access RESEARCH South Korean validation of the COVID‑related‑PTSD scale in a non‑clinical sample exposed to the COVID‑19 pandemic Hwa Jung Lee, Ye Jin Kim and Dong Hun Lee* Abstract The threat of COVID-19 outbreak in South Korea and around the globe challenged not only physical health but also mental health, increasing the chances of disorders such as posttraumatic stress disorder (PTSD). Such pandemic situation can be referred to a traumatic event for citizens. The present study aims to examine the psychometric properties of the PTSD Checklist (PCL-5), which is named the K-COVID-related-PTSD. The scale measures PTSD symptomology in the context of the COVID-19 pandemic in South Korea. A total of 1434 South Korean citizens were included in this study. The data were statistically analyzed using SPSS 21.0 and Mplus 8.0. The results of confirmatory factor analysis demonstrated a superior fit for the seven-factor hybrid model (x2 = 1425.445 (df = 149), CFI = 0.950, TLI = 0.937, SRMR = 0.033, RMSEA = 0.077) consisting of re-experiencing, negative affect, anxious arousal, dysphoric arousal, avoidance, anhedonia, and externalizing behaviors. Furthermore, the K-COVID-related-PTSD showed a satisfactory level of internal consistency (α = 0.793 to α = 0.939) with good convergent and discriminant validity. Finally, concurrent validity was confirmed by the significant correlations with all the negative mental health outcomes, such as PTSD symptoms, somatization, depression, anxiety, anger, negative affect, job burnout, and suicidal ideation. Overall, the current results demonstrate the K-COVID-related-PTSD is a valid scale and therefore has important implications for future pandemic-related studies. Keywords: COVID pandemic, Posttraumatic stress disorder checklist, PCL-5, COVID-related-PTSD, Validation, South Korea Introduction The COVID-19 outbreak was declared a pandemic by the World Health Organization (WHO) on March 11, 2020, and the disease continues to cause significant damage worldwide. In response to the pandemic crisis, health organizations and ministries have adopted several nonpharmacological measures, such as social/physical distancing and lockdowns, isolation of COVID-19 positive and suspected COVID-19 patients, and quarantine of exposed individuals. While these efforts have reduced *Correspondence: Traumatic Stress Center, Department of Education, Sungkyunkwan University, Seoul, Republic of Korea the spread of COVID-19, isolation and social distancing have negatively impacted the mental health of many individuals [1, 2]. Apart from the physical toll of the disease itself, individuals experience psychological distress due to traumatic stressors related to isolation, disturbed routines, and family and social life (e.g., loss of family and loved ones due to COVID-19) [3]. In particular, several studies have shown that individuals may experience the spread of COVID-19, and social distancing and self-quarantine measures are instituted to mitigate its spread as a traumatic stressor [4, 5]. Notably, trauma exposure is the primary etiologic risk factor for many mental illnesses, including posttraumatic stress disorder (PTSD). © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Lee et al. BMC Psychology (2022) 10:135 PTSD refers to specific negative symptoms that might occur in individuals after exposure to one or more traumatic events [6]. Although the rate of PTSD in the general population is between 5 and 10%, its incidence can be as high as 45.9% among direct victims of disasters [7, 8]. During previous serious infectious disease outbreaks, the prevalence of PTSD ranged from 40 to 76%. A survey of survivors 3 years after the SARS epidemic in Hong Kong and China showed that over 40% of them displayed symptoms of PTSD [9]. In addition, results from a 1-year follow-up study of Ebola-infected patients in Sierra Leone documented a PTSD diagnosis rate of 76% [10]. With regard to South Korean samples, 41.7% of Middle East respiratory syndrome survivors displayed PTSD symptoms 12 months after their diagnosis [11]. As such, a pandemic of an unrecognized infection can be defined as a traumatic experience of acute and chronic effects at the individual and community levels. The fear of contagion and the risk of death for oneself and loved ones refers to a direct threat. In addition, indirect consequences were found to result in comorbid conditions including psychological distress, mood disorders, and general psychological symptoms of PTSD. Moreover, previous studies on the COVID-19 pandemic have found that a high risk of developing PTSD is not only valid in survivors, victim families, healthcare workers, and individuals with direct contact with infection, but also in the general population subjected to prolonged restrictive measures [12]. PTSD is classified as a type of trauma- and stressorrelated disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Specific criteria focused on identifying the causes and symptoms are required for the diagnosis of PTSD. PTSD can be diagnosed after exposure to a traumatic event and includes four specific dimensions (re-experiencing the trauma, avoiding reminders of the trauma, negative alterations in cognitions and mood, and alterations in arousal and reactivity) [6]. Following this criterion, the PCL-5 is one of the most studied screening instruments for adults at risk of developing PTSD. Initially, it was developed with four sub-factors (re-experiencing, avoidance, negative alterations in cognition and mood, and alterations in arousal). However recent PCL-5 studies have shown that PTSD symptoms can be described as having as many as six or seven factors [13–16] The anhedonia model, as proposed by a Chinese study from a sample of the Wenchuan earthquake, has six factors: intrusion, avoidance, (...truncated)