Understanding the clinical profile of Continuous Traumatic Stress Responses: insights from the adaptation of the Continuous Traumatic Stress Response Scale (CTSR) in Ukrainian military personnel

Background: Despite ongoing debate on the necessity of using the Continuous Traumatic Stress Response (CTSR) concept in contexts of repetitive threat - where the traditional post-traumatic stress disorder (PTSD) paradigm is insufficient Goral, A., Feder-Bubis, P., Lahad, M., & Aharonson-Daniel, L. (2022). 'In the middle, between anxiety victims and PTSD, there are people that have some kind of a disorder that has no name yet' Insights about the traumatic stress consequences of exposure to ongoing threat. Trauma Care, 2(2), 185-196. https://doi.org/10.3390/traumacare2020015, validated measurement tools remain scarce. Moreover, because previous operationalizations focused primarily on civilian populations, adapting CTSR measures to military contexts is essential given their sensitivity to contextual factors.Objective: The present study aimed to adapt the CTSR scale Goral, A., Feder-Bubis, P., Lahad, M., Galea, S., O'Rourke, N., & Aharonson-Daniel, L. (2021). Development and validation of the Continuous Traumatic Stress Response scale (CTSR) among adults exposed to ongoing security threats. PLoS One, 16(5), e0251724. https://doi.org/10.1371/journal.pone.0251724 for Ukrainian military personnel by examining their specific psychoemotional responses to continuous traumatic stress (CTS).Methods: A total of 1,902 military personnel completed 25 CTSR items, the Patient Health Questionnaire-9, the International Trauma Questionnaire, and a sociodemographic survey. Exploratory and confirmatory factor analyses were used to identify context-specific psychological responses to CTS, followed by assessments of homogeneity and discriminant validity.Results: Cross-validation procedure resulted in a three-factor structure encompassing psychoemotional responses of exhaustion, helplessness - depression, and psychosocial disruption. This structure was confirmed by CFA and supported by Cronbach's α values ranging from 0.74 to 0.87. Correlation between PTSD and CTSR remained below the 0.7 threshold, indicating good construct discrimination. Notably, higher CTSR scores were observed among younger personnel with shorter service length and among administrative staff compared to combat and combat-support personnel.Conclusions: The adapted CTSR scale revealed a focused clinical profile of CTSR in a military context. While PTSD-related events increased CTSR levels, discriminant validity analysis confirmed the two constructs as clearly distinct. Further analyses indicated that CTSR may be more applicable to military personnel operating in settings of mild-to-moderate ongoing stress rather than in high-exposure combat situations. Content analysis further revealed overlap between CTSR and depressive or burnout-like manifestations. The findings suggest that the CTSR framework may offer a more comprehensive conceptualization of psychological responses to recurrent, yet not high-exposure, threat.