A comparison of the CAPS-5 and PCL-5 to assess PTSD in military and veteran treatment-seeking samples

Effect of agreement between clinician-rated and patient-reported PTSD symptoms on intensive outpatient treatment outcomes

The American Cancer Society (ACS) estimates that 284,200 new cases of breast cancer will be diagnosed in 2021. According to the Texas Cancer Registry (TCR) an estimated 18,277 of those new diagnoses of female breast cancer will be made in the state of Texas. Studies have found that between 5% and 35% of breast cancer patients in the United States will develop diagnosable posttraumatic stress disorder (PTSD) or significantly impairing PTSD symptoms. The goal of the study was to gather data related to the presence of PTSD symptoms in a sample of West Texas female breast cancer patients. The proposed study aimed to:. (1)Determine the prevalence of PTSD in a sample of female, West Texas breast cancer patients(2)Identify elements of a breast cancer diagnosis and breast cancer treatment that may contribute to, or exacerbate these PTSD symptoms. Our sample consistent of 78 female breast cancer patients collected from a university medical center-affiliated cancer center in the West Texas region. The PTSD Checklist for DSM-5 (PCL5) was used to determine if a participant met diagnostic criteria for PTSD or fulfilled diagnostic criteria for any of the four symptom clusters – intrusive symptoms, avoidance symptoms, negative symptoms, and hyperarousal symptoms. PCL5 scores were then compared to a range of demographic variables including age, marital status, educational level, menopausal status, tobacco and alcohol use, time since diagnosis, as well as treatment modalities used. Further, PCL5 scores were compared to Her2, ER, and PR status of the tumor as well as clinical stage. Patients meeting criteria for PTSD and those with significant symptoms in distinct symptom clusters The only multi-group categorical variable that showed a significant relationship was lifetime tobacco use (F(2,75) = 4.97, p = 0.009) which showed a relationship such that current smokers were found to have higher PCL5 scores that either participants that were past smokers or those that had never smoked. Further, menopausal status (pre-menopausal versus post-menopausal) did was found to be related to PCL5 scores such that pre-menopausal women were found to have significantly higher PCL5 scores than post-menopausal women (t(71) = 2.558, p = 0.42). Living arrangement (alone or with others) was similarly, significantly related to PCL5 scores such that women living with others were found to have higher PCL5 scores than those living alone (t(74) = -1.904, p = .002). Receiving chemotherapy treatment or not was similarly related to PCL5 scores such that those that underwent chemotherapy treatment were found to have higher PCL5 scores (t(76), = -2.381, p = .008). HER2 positive status was also found to be related to PCL5 scores, such that HER2 positive patients were found to have higher PCL5 scores than HER2 negative patients (t(74) = -2.429, p = .001). While other samples identified larger percentages of diagnosable PTSD, our sample did find a percentage of patients with diagnosable PTSD consistent with the lower end of estimated rates. This. suggests that our sample is similar in some ways to that used in the existing body of literature. Future research could expand the scope of this study by including focusing on the significant variables identified in the current study, as well as by including more factors that may be particularly relevant to the patient population of the West Texas region, such as measures of religiosity, individualism, or self-reliance. nPercentage of total sampleNo significant symptoms4962.82%Significant symptoms in one symptom cluster1316.66%Significant symptoms in two symptom clusters67.69%Significant symptoms in three symptoms clusters33.85%Significant symptoms in all four symptom clusters (met criteria for PTSD diagnosis)78.97%Total78100% Citation Format: Evan Thomas Guidry, Nusrat Jahan, Catherine Jones. An investigation into the presence of posttraumatic stress disorder symptoms in breast cancer patients [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-09-06.

Effects of intranasal (S)-ketamine on Veterans with co-morbid treatment-resistant depression and PTSD: A retrospective case series

Event centrality, defined as the extent to which a traumatic event becomes a core component of a person's identity (Berntsen & Rubin, 2006), is both a correlate and predictor of posttraumatic stress disorder (PTSD) symptoms, over and above event severity. These findings suggest that decreasing the perceived centrality of a traumatic event to one's identity might result in decreases in PTSD symptom severity. To date, few studies have examined how centrality is affected by PTSD treatment. The present study tested the hypotheses that change in centrality would be associated with both change in PTSD symptom severity and discharge PTSD symptom severity in an exposure-based PTSD partial hospitalization program (N = 132; 86.0% White; 85.2% female; M age = 36 years). At discharge (i.e., after approximately 6 weeks of treatment), both PTSD symptoms and centrality had significantly decreased, ds = .70 and .98, respectively, with large effect sizes. Decreases in Centrality of Events Scale (CES) scores at posttreatment, baseline CES scores, and baseline PTSD Checklist for DSM-5 (PCL-5) scores were associated with change (i.e., decrease) in PCL-5 scores, p < .001, as well as with posttreatment PCL-5 scores, p < .001. Decreases in CES scores over time, baseline CES scores, and baseline PCL-5 scores explained 31% of the variance in PCL-5 change and 34% of the variance in posttreatment PCL-5 scores. The results indicate the potential importance of decreasing the centrality of a traumatic event in PTSD treatment and recovery.

The Clinician-Administered PTSD Scale (CAPS) is an extensively validated and widely used structured diagnostic interview for posttraumatic stress disorder (PTSD). The CAPS was recently revised to correspond with PTSD criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013). This article describes the development of the CAPS for DSM-5 (CAPS-5) and presents the results of an initial psychometric evaluation of CAPS-5 scores in 2 samples of military veterans (Ns = 165 and 207). CAPS-5 diagnosis demonstrated strong interrater reliability (к = .78 to 1.00, depending on the scoring rule) and test-retest reliability (к = .83), as well as strong correspondence with a diagnosis based on the CAPS for DSM-IV (CAPS-IV; к = .84 when optimally calibrated). CAPS-5 total severity score demonstrated high internal consistency (α = .88) and interrater reliability (ICC = .91) and good test-retest reliability (ICC = .78). It also demonstrated good convergent validity with total severity score on the CAPS-IV (r = .83) and PTSD Checklist for DSM-5 (r = .66) and good discriminant validity with measures of anxiety, depression, somatization, functional impairment, psychopathy, and alcohol abuse (rs = .02 to .54). Overall, these results indicate that the CAPS-5 is a psychometrically sound measure of DSM-5 PTSD diagnosis and symptom severity. Importantly, the CAPS-5 strongly corresponds with the CAPS-IV, which suggests that backward compatibility with the CAPS-IV was maintained and that the CAPS-5 provides continuity in evidence-based assessment of PTSD in the transition from DSM-IV to DSM-5 criteria. (PsycINFO Database Record

Randomized, Placebo-Controlled Trial of the Angiotensin Receptor Antagonist Losartan for Posttraumatic Stress Disorder

Introduction: Cardiovascular disease (CVD) remains the leading cause of death among women in the United States. Although premenopausal women are thought to be protected from CVD, trauma exposure increases their CVD risk. Poor sleep – a CVD risk factor – is common after trauma exposure. Further, accumulating evidence suggests that vascular dysfunction is independently associated with CVD. However, the link between sleep and vascular function in otherwise healthy, trauma-exposed young women is not known. Therefore, the purpose of the present study was to investigate the individual and combined effects of sleep quality and post-traumatic stress disorder (PTSD) symptom severity on endothelial function and arterial stiffness. Methods: We recruited 42 otherwise healthy women (18 –­ 40 years) from diverse backgrounds who had been exposed to trauma. We successfully collected data on sleep, vascular function, depression and PTSD symptom severity in 35 women, across two visits. Sleep efficiency (SE) was objectively measured as the relative time (%) spent asleep while in bed, using wrist actigraphy. Participants wore the ActiWatch for seven days between visits. During visit one, PTSD symptom severity was assessed using the PTSD checklist for DSM 5 (PCL5) and depressive symptom severity with the Beck Depression Inventory (BDI). At visit two, we assessed endothelial function via reactive hyperemia index (RHI) using peripheral arterial tone and arterial stiffness via pulse wave velocity (PWV) using applanation tonometry. Results: Participants’ mean age and body mass index (BMI) were 27±7 years and 27±6 kg/m2 respectively. Mean systolic and diastolic blood pressures were 103±9 and 67±8 mmHg respectively, and heart rate was 74±12 bpm. SE was positively correlated with RHI (r=0.35, p=0.019), and negatively correlated with PWV (r=-0.46, p=0.004). PCL5 score was negatively correlated with RHI (r=-0.52, p&lt;0.001), and not PWV (r=0.12, p=0.253). Additionally, a positive association was observed between age and PWV (r=0.50, p=0.001). BDI score was only correlated with PCL5 (r=0.60, p&lt;0.001). Next, to explore the predictive value of SE and PCL5 on RHI and PWV, we conducted separate multiple linear regression models with SE, PCL5 scores and age as predictors. The model predicting RHI was significant (R2=0.48, p&lt;0.001), with PCL5 emerging as the strongest predictor (β=-0.56, p&lt;0.001). Similarly, the model predicting PWV was significant (R2=0.45, p&lt;0.001), with both SE and age as the strongest predictors (β=-0.44, p=0.004 and β=0.49, p=0.001, respectively). Conclusion: Our results suggest that poor sleep may contribute to increased arterial stiffness after trauma exposure, while endothelial dysfunction could be driven by PTSD symptom severity. These findings could serve to distinguish trauma-exposed women at risk of CVD and identify specific interventions (i.e., targeting sleep efficiency or PTSD symptoms) to prevent or delay vascular dysfunction. UL1TR002494, NIH K01HL161027 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

ABSTRACTBackground: Previous research exploring the psychometric properties of the scores of measures of posttraumatic stress disorder (PTSD) suggests there is variation in their functioning depending on the target population. To date, there has been little study of these properties within UK veteran populations.Objective: This study aimed to determine optimally efficient cut-off values for the Impact of Event Scale-Revised (IES-R) and the PTSD Checklist for DSM-5 (PCL-5) that can be used to assess for differential diagnosis of presumptive PTSD.Methods: Data from a sample of 242 UK veterans assessed for mental health difficulties were analysed. The criterion-related validity of the PCL-5 and IES-R were evaluated against the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Kappa statistics were used to assess the level of agreement between the DSM-IV and DSM-5 classification systems.Results: The optimal cut-off scores observed within this sample were 34 or above on the PCL-5 and 46 or above on the IES-R. The PCL-5 cut-off is similar to the previously reported values, but the IES-R cut-off identified in this study is higher than has previously been recommended. Overall, a moderate level of agreement was found between participants screened positive using the DSM-IV and DSM-5 classification systems of PTSD.Conclusions: Our findings suggest that the PCL-5 and IES-R can be used as brief measures within veteran populations presenting at secondary care to assess for PTSD. The use of a higher cut-off for the IES-R may be helpful for differentiating between veterans who present with PTSD and those who may have some sy`mptoms of PTSD but are sub-threshold for meeting a diagnosis. Further, the use of more accurate optimal cut-offs may aid clinicians to better monitor changes in PTSD symptoms during and after treatment.

27 ways to meet PTSD: Using the PTSD-checklist for DSM-5 to examine PTSD core criteria

This study tested the efficacy of repeated intravenous ketamine doses to reduce symptoms of posttraumatic stress disorder (PTSD). Veterans and service members with PTSD (n = 158) who failed previous antidepressant treatment were randomized to 8 infusions administered twice weekly of intravenous placebo (n = 54), low dose (0.2 mg/kg; n = 53) or standard dose (0.5 mg/kg; n = 51) ketamine. Participants were assessed at baseline, during treatment, and for 4 weeks after their last infusion. Primary analyses used mixed effects models. The primary outcome measure was the self-report PTSD Checklist for DSM-5 (PCL-5), and secondary outcome measures were the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and the Montgomery Åsberg Depression Rating Scale (MADRS). There were no significant group-by-time interactions for PTSD symptoms measured by the PCL-5 or CAPS-5. The standard ketamine dose ameliorated depression measured by the MADRS significantly more than placebo. Ketamine produced dose-related dissociative and psychotomimetic effects, which returned to baseline within 2 h and were less pronounced with repeated administration. There was no evidence of differential treatment discontinuation by ketamine dose, consistent with good tolerability. This clinical trial failed to find a significant dose-related effect of ketamine on PTSD symptoms. Secondary analyses suggested that the standard dose exerted rapid antidepressant effects. Further studies are needed to determine the role of ketamine in PTSD treatment. ClinicalTrials.gov identifier: NCT02655692.

The posttraumatic stress disorder (PTSD) Checklist for DSM-5 (PCL-5) is among few validated measures of PTSD severity in line with the DSM-5. Validation efforts among veteran samples have recommended cut scores of 33 and 38 to indicate PTSD; cut scores vary across populations depending on factors such as trauma type. The purpose of this study was to evaluate the diagnostic utility of and identify optimal cut scores for the PCL-5 in relation to the gold standard Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) among traumatically injured individuals 6 months after discharge from a level I trauma center. A total of 251 participants completed the PCL-5 and CAPS-5 6 months after discharge from a level I trauma center following traumatic injury. Receiver operating characteristic curve analyses detailed diagnostic accuracy of the PCL-5 and identified the optimal cut score via Youden's J index. Cut scores were also broken down by intentional versus nonintentional injury. The PCL-5 produces satisfactory diagnostic accuracy, with adequate sensitivity and specificity, in a traumatically injured population. Estimates indicate the optimal cut score as>30; the optimal cut score for intentional injuries was>34 and>22 for nonintentional injuries. This investigation provides support for the PCL-5 in detection of PTSD among injured individuals 6 months after discharge from a level I trauma center. PCL-5 specificity and sensitivity suggest clinicians working with this population can feel confident in using this measure over more onerous structured interviews (e.g., CAPS-5). This study signifies a move toward ensuring those experiencing mental health difficulties after traumatic injury are identified and connected to resources.

Objective: To conduct an interim analysis of data collected from an ongoing multisite randomized clinical trial (RCT) assessing the effectiveness of Trauma Center Trauma-Sensitive Yoga (TCTSY) for post-traumatic stress disorder (PTSD) among women veterans with PTSD related to military sexual trauma (MST). The purpose of the interim analysis was to assess outcomes from the primary site, which is geographically, demographically, culturally, and procedurally distinct from the second site. Design: RCT was conducted within a Veterans Administration Health Care System. Data collection included preintervention through 3 months postintervention. Participants: Enrollment for the main site was 152 women. The sample size for the intent-to-treat analysis was 104. The majority were African American (91.3%) with a mean age of 48.46 years. Intervention: The TCTSY intervention (n = 58) was conducted by TCTSY-certified yoga facilitators and consisted of 10 weekly 60-min group sessions. The control intervention, cognitive processing therapy (CPT; n = 46), consisted of 12 90-min weekly group sessions conducted per Veterans Administration protocol by clinicians in the PTSD Clinic. Outcome measures: The Clinician Administered PTSD Scale for DSM-5 (CAPS-5) was used to assess current PTSD diagnosis and symptom severity, including overall PTSD and four symptom clusters. The PTSD checklist for DSM-5 (PCL-5) was used to obtain self-report of PTSD symptom severity, including total score and four symptom clusters. Results: The findings reported here are interim results from one clinical site. For both the CAPS-5 and PCL-5, total scores and all four criterion scores decreased significantly (p < 0.01) over time in all five multilevel linear models within both TCTSY and CPT groups, without significant differences between groups. There were clinically meaningful improvements seen for both TCTSY and CPT with 51.1%-64.3% of TCTSY subjects and 43.5%-73.7% of CPT decreasing their CAPS-5 scores by 10 points or more. Effect sizes for total symptom severity were large for TCTSY (Cohen's d = 1.10-1.18) and CPT (Cohen's d = 0.90-1.40). Intervention completion was higher in TCTSY (60.3%) than in CPT (34.8%). Symptom improvement occurred earlier for TCTSY (midintervention) than for CPT (2 weeks postintervention). Safety: There were no unanticipated adverse events in this study. Conclusion: The results of this study demonstrate that TCTSY may be an effective treatment for PTSD that yields symptom improvement more quickly, has higher retention than CPT, and has a sustained effect. TCTSY may be an effective alternative to trauma-focused therapy for women veterans with PTSD related to MST. The study is registered in ClinicalTrials.gov (CTR no.: NCT02640690).

Sex differences in the coherence of PCL5 and CAPS-5 assessments for post-traumatic stress disorder.

Brenner et al. (2021) developed and initially tested two computerized adaptive measures of posttraumatic stress disorder (PTSD), one that provides a provisional diagnosis (PTSD computerized adaptive diagnostic screen [CAD-PTSD]) and one that estimates symptom severity (PTSD computerized adaptive severity test [CAT-PTSD]). We expanded on the initial psychometric findings by collecting data regarding test-retest reliability, incremental validity, and respondent burden. A sample of veterans (N = 156, 32% women, 36% Black, 13% identified as Spanish, Hispanic, Latino, Puerto Rican, or Cuban) recruited from three Veterans Affairs medical centers completed the CAT-PTSD and CAD-PTSD, the Clinician-Administered PTSD Scale for DSM-5, the PTSD Checklist for DSM-5 (PCL-5), Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), and a battery of other self-rated scales. Fifty-three participants (34%) completed the measures a second time within 7 days (Mdays = 5.41; SD = 1.97) of their first visit. CAT-PTSD scores revealed good convergent validity (r = .78 with Clinician-Administered PTSD Scale for DSM-5 total score), discriminant validity, and test-retest reliability (r = .80). Scores on the PCL-5 and PC-PTSD-5 had similar characteristics. The CAD-PTSD demonstrated poor diagnostic efficiency, κ(.5, 0) = .40, and test-retest reliability (κ = .25), whereas previously established cut-scores for the PCL-5 and PC-PTSD-5 showed fair to good diagnostic utility and adequate to good test-retest reliability. Results suggest that the CAT-PTSD may provide a valid indicator of PTSD symptom severity, but does not offer incremental value beyond the PCL-5 and PC-PTSD-5. The CAD-PTSD was markedly inferior to the use of PCL-5 or PC-PTSD-5 cut scores. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Post-traumatic stress disorder (PTSD) is a multifaceted psychiatric disorder arising from exposure to traumatic events, characterized by intrusion symptoms, avoidance behaviors, heightened arousal, and negative cognitive and mood alterations. Military personnel are particularly vulnerable to PTSD because of frequent exposure to life-threatening situations during deployments. In France, studies have reported PTSD prevalence rates of 1.7% and 4.8% among military personnel. Early detection and intervention through regular psychological assessments are essential, as chronic PTSD offers limited therapeutic options. The PTSD Checklist for DSM-5 (PCL-5) is widely used for screening, with demonstrated validity in various settings, including the military. However, its application among non-native French speakers in the French Foreign Legion requires validation as a result of potential comprehension issues. This study assessed the psychometric properties of the French version of the PCL-5 in a cohort of French Foreign Legion soldiers deployed in Mali during Operation Barkhane in early 2022. The PCL-5 was administered approximately 1 month postdeployment. Two commonly accepted PCL-5 cutoff scores, 31 and 33, and 4 subscores were used based on recommendations. French proficiency levels were categorized into 5 levels based on validated oral and written examinations. Descriptive statistics, Spearman's correlation coefficients, analysis of variance, and the Kruskal-Wallis test were utilized to analyze the data. The final sample comprised 250 legionnaires. The mean PCL-5 score was 21.24 (SD=5.23). Six individuals scored above the cutoff; however, after clinical examination, only one was diagnosed with PTSD (prevalence rate of 0.40%), while the others had anxiety or interpersonal issues. The PCL-5 demonstrated excellent internal consistency (Cronbach's alpha=0.96). Subscale internal consistency ranged from 0.60 to 0.93. No significant correlation was found between PCL-5 scores and French proficiency levels. This study confirms the reliability of the PCL-5 as a PTSD screening tool within the French Foreign Legion, demonstrating strong internal consistency and applicability across diverse linguistic backgrounds. The high sensitivity of the PCL-5 resulted in false positives, underscoring the necessity of follow-up clinical evaluations to confirm PTSD diagnoses and provide appropriate care. The lack of significant correlations between PCL-5 scores and French proficiency suggests the tool effectively screens individuals regardless of language proficiency. Future research should aim to enhance item comprehension among non-native speakers and explore additional screening instruments to complement the PCL-5 in this unique linguistic population. 20230928_C2EDFRI_4.