Psychometric evaluation of the Continuous Traumatic Stress Response Scale under intensified national threat.

Abstract

The Continuous Traumatic Stress Response Scale (CTSR) was developed to assess traumatic stress responses under ongoing threat. This study evaluated whether the original 11-item, three-factor CTSR structure retained psychometric support after the October 7, 2023, attacks and subsequent war in Israel. The cross-sectional confirmatory factor analysis (CFA) sample used each participant's first available assessment, yielding 756 unique participants; longitudinal analyses included 337 participants who completed both waves. CFA supported the prespecified three-factor structure of exhaustion/detachment, rage/betrayal, and fear/helplessness, CFI = .994, TLI = .992, RMSEA = .069, 90% CI [.059, .079], SRMR = .048, with standardized loadings from .69 to .90. A one-factor model showed acceptable but weaker fit, and parallel robust maximum likelihood analyses favored the three-factor model per Akaike and Bayesian information criteria. Longitudinal CFA supported temporal measurement invariance; latent mean analyses showed no significant change in exhaustion/detachment or rage/betrayal and a small decrease in fear/helplessness. Multigroup CFA supported measurement invariance across sex and age, whereas trauma-exposure invariance was supported only for a one-factor sensitivity model. Internal consistency was high for the total scale, Cronbach's α = .908, McDonald's ω = .909, and adequate-to-good for subscales. CTSR scores showed good temporal stability, ICC = .812; strong associations with PTSD symptoms, ρ = .699, and functional impairment, ρ = .701; and higher scores among trauma-exposed participants, d = 0.37. Findings support the CTSR as a valuable research measure and encourage continued evaluation of its three-factor structure under ongoing threat.