Abstract
BackgroundPosttraumatic stress disorder (PTSD) symptoms are common in acute respiratory distress syndrome (ARDS) survivors. Brief screening instruments are needed for clinical and research purposes. We evaluated internal consistency, external construct, and criterion validity of the Impact of Event Scale-6 (IES-6; 6 items) compared to the original Impact of Event Scale—Revised (IES-R; 22 items) and to the Clinician Administered PTSD Scale (CAPS) reference standard evaluation in ARDS survivors.MethodsThis study is a secondary analysis from two independent multi-site, prospective studies of ARDS survivors. Measures of internal consistency, and external construct and criterion validity were evaluated.ResultsA total of 1001 ARDS survivors (51% female, 76% white, mean (SD) age 49 (14) years) were evaluated. The IES-6 demonstrated internal consistency over multiple time points up to 5 years after ARDS (Cronbach’s alpha = 0.96; 95% confidence interval (CI) 0.94 to 0.97). The IES-6 demonstrated stronger correlations with related constructs (e.g., anxiety and depression; |r| = 0.32 to 0.52) and weaker correlations with unrelated constructs (e.g., physical function and healthcare utilization measures (|r| = 0.02 to 0.27). Criterion validity evaluation with the CAPS diagnosis of PTSD in a subsample of 60 participants yielded an area under receiver operating characteristic curve (95% CI) of 0.93 (0.86, 1.00), with an IES-6 cutoff score of 1.75 yielding 0.88 sensitivity and 0.85 specificity.ConclusionsThe IES-6 is reliable and valid for screening for PTSD in ARDS survivors and may be useful in clinical and research settings.
Highlights
Posttraumatic stress disorder (PTSD) symptoms are common in acute respiratory distress syndrome (ARDS) survivors
The prior validation study in ARDS survivors compared the Impact of Event Scale—Revised (IES-R) to the Clinician-Administered PTSD Scale for the DSM-IV (CAPS), a semi-structured clinician interview that serves as a reference standard for PTSD diagnosis
Participants Data used for this analysis were collected as part of two multi-site prospective studies of ARDS survivors: (1) ARDS Network Long-term Outcomes Study (ALTOS) [12, 13] and (2) Improving Care of Acute Lung Injury (ALI) Patients (ICAP) [1]
Summary
Posttraumatic stress disorder (PTSD) symptoms are common in acute respiratory distress syndrome (ARDS) survivors. Survivors of acute respiratory distress syndrome (ARDS) and other critical illnesses frequently experience symptoms of posttraumatic stress disorder (PTSD) [1,2,3,4]. The Impact of Event Scale—Revised (IES-R) is a 22-item screening instrument, with demonstrated reliability and validity for measuring PTSD symptoms in ARDS survivors [10]. The prior validation study in ARDS survivors compared the IES-R to the Clinician-Administered PTSD Scale for the DSM-IV (CAPS), a semi-structured clinician interview that serves as a reference standard for PTSD diagnosis. An IES-R score of 1.6 was associated with 100% sensitivity, 85% specificity, and 100% negative and 50% positive predictive values when compared to the CAP-derived clinical diagnosis of PTSD [10]
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