Abstract
Background
Scientific research into mental health outcomes following trauma is undergoing a revolution as scientists refocus their efforts to identify underlying dimensions of health and psychopathology. This effort is in stark contrast to the previous focus which was to characterize individuals based on Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic status (Insel et al., 2010). A significant unresolved issue underlying this shift is how to characterize clinically relevant populations without reliance on the categorical definitions provided by the DSM. Classifying individuals based on their pattern of stress adaptation over time holds significant promise for capturing inherent inter-individual heterogeneity as responses including chronicity, recovery, delayed onset, and resilience can only be determined longitudinally (Galatzer-Levy & Bryant, 2013) and then characterizing these patterns for future research (Depaoli, Van de Schoot, Van Loey, & Sijbrandij, 2015). Such an approach allows for the identification of phenominologically similar patterns of response to diverse extreme environmental stressors (Bonanno, Kennedy, Galatzer-Levy, Lude, & Elfstom, 2012; Galatzer-Levy & Bonanno, 2012; Galatzer-Levy, Brown, et al., 2013; Galatzer-Levy, Burton, & Bonanno, 2012) including translational animal models of stress adaptation (Galatzer-Levy, Bonanno, Bush, & LeDoux, 2013; Galatzer-Levy, Moscarello, et al., 2014). The empirical identification of heterogeneous stress response patterns can increase the identification of mechanisms (Galatzer-Levy, Steenkamp, et al., 2014), consequences (Galatzer-Levy & Bonanno, 2014), treatment effects (Galatzer-Levy, Ankri, et al., 2013), and prediction (Galatzer-Levy, Karstoft, Statnikov, & Shalev, 2014) of individual differences in response to trauma.
Method
Methodological and theoretical considerations for the application of Latent Growth Mixture Modeling (LGMM) and allied methods such as Latent Class Growth Analysis (LCGA) for the identification of heterogeneous populations defined by their pattern of change over time will be presented (Van De Schoot, 2015). Common pitfalls including non-identification, over identification, and issues related to model specification will be discussed as well as the benefits of applying such methods along with the theoretical grounding of such approaches.
Conclusions
LGMM and allied methods have significant potential for improving the science of stress pathology as well as our understanding of healthy adaptation (resilience).
Keywords: Latent growth mixture modeling, latent growth curve analysis, mixture modeling
Acknowledgements
The author was supported by a grant from the National Institute of Mental Health: K01MH102415.
References
- Bonanno G. A, Kennedy P, Galatzer-Levy I. R, Lude P, Elfstom M. L. Trajectories of resilience, depression, and anxiety following spinal cord injury. Rehabilitation Psychology. 2012;57:236–247. doi: 10.1037/a0029256. [DOI] [PubMed] [Google Scholar]
- Depaoli S, Van de Schoot R, Van Loey N, Sijbrandij M. Using Bayesian statistics for modeling PTSD through latent growth mixture modeling: implementation and discussion. European Journal of Psychotraumatology. 2015;6 doi: 10.3402/ejpt.v6.27516. 27516, doi: http://dx.doi.org/10.3402/ejpt.v6.27516. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Galatzer-Levy I. R, Ankri Y, Freedman S, Israeli-Shalev Y, Roitman P, Gilad M, et al. Early PTSD symptom trajectories: persistence, recovery, and response to treatment: results from the Jerusalem trauma outreach and prevention study (J-TOPS) PLoS One. 2013;8(8):e70084. doi: 10.1371/journal.pone.0070084. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Galatzer-Levy I. R, Bonanno G. A. Beyond normality in the study of bereavement: Heterogeneity in depression outcomes following loss in older adults. Social Science Medicine. 2012;74(12):1987–1994. doi: 10.1016/j.socscimed.2012.02.022. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Galatzer-Levy I. R, Bonanno G. A. Optimism and death predicting the course and consequences of depression trajectories in response to heart attack. Psychological Science. 2014;25:2177–2188. doi: 10.1177/0956797614551750. [DOI] [PubMed] [Google Scholar]
- Galatzer-Levy I. R, Bonanno G. A, Bush D. E, LeDoux J. E. Heterogeneity in threat extinction learning: Substantive and methodological considerations for identifying individual difference in response to stress. Frontiers in Behavioral Neuroscience. 2013;7:55. doi: 10.3389/fnbeh.2013.00055. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Galatzer-Levy I. R, Brown A. D, Henn-Haase C, Metzler T. J, Neylan T. C, Marmar C. R. Positive and negative emotion prospectively predict trajectories of resilience and distress among high-exposure police officers. Emotion. 2013;13(3):545. doi: 10.1037/a0031314. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Galatzer-Levy I. R, Bryant R. A. 636,120 ways to have posttraumatic stress disorder. Perspectives on Psychological Science. 2013;8(6):651–662. doi: 10.1177/1745691613504115. [DOI] [PubMed] [Google Scholar]
- Galatzer-Levy I. R, Burton C. L, Bonanno G. A. Coping flexibility, potentially traumatic life events, and resilience: A prospective study of college student adjustment. Journal of Social and Clinical Psychology. 2012;31(6):542–567. [Google Scholar]
- Galatzer-Levy I. R, Karstoft K.-I, Statnikov A, Shalev A. Y. Quantitative forecasting of PTSD from early trauma responses: A machine learning application. Journal of Psychiatric Research. 2014;59:68–76. doi: 10.1016/j.jpsychires.2014.08.017. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Galatzer-Levy I. R, Moscarello J, Blessing E. M, Klein J, Cain C. K, LeDoux J. E. Heterogeneity in signaled active avoidance learning: Substantive and methodological relevance of diversity in instrumental defensive responses to threat cues. Frontiers in Systems Neuroscience. 2014;8:179. doi: 10.3389/fnsys.2014.00179. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Galatzer-Levy I. R, Steenkamp M. M, Qian M, Inslicht S, Henn-Haase C, Otte C, et al. Cortisol response to an experimental stress paradigm prospectively predicts long-term distress and resilience trajectories in response to active police service. Journal of Psychiatric Research. 2014;56:36–42. doi: 10.1016/j.jpsychires.2014.04.020. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Insel T, Cuthbert B, Garvey M, Heinssen R, Pine D. S, Quinn K, et al. Research domain criteria (RDoC): Toward a new classification framework for research on mental disorders. The American Journal of Psychiatry. 2010;167(7):748–751. doi: 10.1176/appi.ajp.2010.09091379. [DOI] [PubMed] [Google Scholar]
- Van de Schoot R. Latent trajectory studies: The basics, how to interpret the results and what to report. European Journal of Psychotraumatology. 2015;6 doi: 10.3402/ejpt.v6.27514. 27514, doi: http://dx.doi.org/10.3402/ejpt.v6.27514. [DOI] [PMC free article] [PubMed] [Google Scholar]