Development and validation of the Continuous Traumatic Stress Response scale (CTSR) among adults exposed to ongoing security threats

Aviva Goral, Paula Feder-Bubis, Mooli Lahad, Sandro Galea, Norm O'Rourke, Limor Aharonson-Daniel

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background Current diagnostic criteria for posttraumatic stress disorder (PTSD) do not include symptoms resulting from exposure to continuous or ongoing traumatic stress. Thus existing assessment tools do not fully capture stress symptoms associated with exposure to threats that extend over months or years. To address this void, we enumerated the symptoms associate with ongoing exposure to stress including those that are distinct from existing PTSD diagnostic criteria. Objectives To develop the Continuous Traumatic Stress Response Scale (CTSR) and assess its psychometric properties. Method We sampled 313 adults exposed and unexposed to ongoing security threat between December 2016 and February 2017. Respondents lived in communities bordering the Gaza Strip in southern Israel where they are exposed to frequent rocket attacks, requiring they locate and find shelter in 30 seconds or less. We assessed the concurrent validity of CTSR relative to the Posttraumatic Diagnostic Scale (PDS). Results On the basis of exploratory factor analysis (EFA), we retained 11 of 25 items measuring three distinct factors: exhaustion/detachment, rage/betrayal, and fear/helplessness. We found moderate concurrence between the scales; that is, the CTSR appears to measure a construct related to, but distinct from PTSD. This conclusion is supported by confirmatory factor analysis (CFA) indicating that each factor significantly contributes to measurement of a higher-order, continuous traumatic stress latent construct. Conclusions These results support the psychometric properties of CTSR. Future research is required to confirm these findings in other countries and cultures and among individuals exposed to other forms of continuous traumatic stress.

Original languageEnglish GB
Article numbere0251724
JournalPLoS ONE
Issue number5
StatePublished - 27 May 2021

ASJC Scopus subject areas

  • General


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