Posttraumatic Diagnostic Scale Research Articles

Validation of a Mental Health Assessment in an African Conflict Population

We studied the validity of the assessment of posttraumatic stress disorder (PTSD) and depression within the context of an epidemiological mental health survey among war-affected adolescents and young adults in northern Uganda. Local language versions of the Posttraumatic Diagnostic Scale (PDS) and the Depression section of the Hopkins Symptom Checklist (DHSCL) were administered by trained local interviewers. Correlations with probable predictor variables (i.e., trauma exposure), outcomes (e.g., impaired functioning), and local idioms of distress (i.e., spirit possession) were determined to estimate criterion-related construct validity. To assess convergent validity, expert clinicians reinterviewed a subsample using structured interviews (the Clinician Administered PTSD Scale [CAPS] and the Mini International Neuropsychiatric Interview [MINI]). Depression and PTSD symptoms as assessed by the local interviewers correlated with the context variables as predicted. After optimizing the scoring algorithm, we found good agreement between the PDS-based diagnoses and expert diagnoses. However, the concordance for depression diagnoses was not satisfactory. Results show that mental health assessments in African languages can produce reliable and valid data but that caution is warranted in the unevaluated transfer of cutoff scores and scoring algorithms.

Return to work after 9/11

This case study is a report of a rehabilitative employment program that used trauma focused group treatment with individuals who suffered from Posttraumatic Stress Disorder (PTSD) post 9/11. The program was developed in order to assist them to return to the work force. These Individuals lost their jobs because of the 9/11 terrorist attack and experienced financial difficulty, yet because of their PTSD symptoms, had difficulty seeking employment. Individuals were selected for group treatment based on the presence of PTSD symptoms as measured by The Posttraumatic Stress Diagnostic Scale, an external locus of control determined by the Internal and External Locus of Control Scale, low self-esteem as per the Self-Efficacy Scale, and hopelessness, as assessed through the Hopelessness Scale. Additional assessments (Role Checklist, Psychiatric Rehabilitation Determination, Vocational Sentence Completion, Activity Record of the Occupational Questionnaire, and an interview that included a work history) were administered by an occupational therapist. Results of these assessments were used to inform group co-leaders (one social worker and one occupational therapist per group) of their members' symptoms, coping mechanisms, attitudes towards work, rehabilitation readiness, life roles and values, and use of time in order to plan appropriate group intervention. Groups met for once-a-week 90 minute sessions. Group leaders used restructuring and systematic prolonged exposure to encourage group members to describe their traumatic experiences in order to neutralize negative affect states, mange symptoms, and work through guilt and distorted perceptions. Members attended until they began gainful employment. Descriptive data revealed that during the first year of the program, 9/11/2001-9/11/2002, 262 of the 3,567 clients seen (13.6%) returned to the work force.

Post-traumatic stress in Crohn's disease and its association with disease activity

ObjectiveViolence, accidents and natural disasters are known to cause post-traumatic stress, which is typically accompanied by fear, suffering and impaired quality of life. Similar to chronic diseases, such events preoccupy...

The structure of post-traumatic stress symptoms in young survivors of war

Research on the dimensionality of post-traumatic stress disorder (PTSD) has generally failed to provide support for the three clusters of PTSD suggested in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). However, much research has been restricted to samples in North America and Western European countries. The aim of the current study was to test four alternative factor models among a relatively understudied population–young civilian survivors of war who had experienced war-related events as adolescents–in order to establish whether the factor structure of PTSD is consistent among various traumatized populations and age groups. Using the Posttraumatic Stress Diagnostic Scale, the results indicated that the four-factor model including intrusion, avoidance, hyperarousal, and numbing factors provided a better fit than the three-factor model suggested by the DSM-IV. The current study offers additional support from another population for a four-factor model of PTSD that implies a separation of avoidance and numbing items. Case conceptualization and treatment implications are discussed.

The Concurrent and Incremental Validity of the Trauma Symptom Inventory in Women Reporting Histories of Sexual Maltreatment

The Trauma Symptom Inventory (TSI), Minnesota Multiphasic Personality Inventory-2 (MMPI-2), and Posttraumatic Diagnostic Scale (PDS) were administered to 71 women who reported histories of childhood and/or adult sexual maltreatment and 25 women who did not report a history of victimization. The TSI validity scales were not effective in identifying MMPI-2 defined invalid responding although were moderately related to MMPI-2 validity scales designed to identify similar response styles. In contrast, the TSI clinical scales displayed good convergent validity with conceptually related scales on the MMPI-2 and PDS. Also, the TSI added incrementally, albeit modestly, to the MMPI-2 in prediction of PDS defined PTSD.

Validation of the Primary Care Posttraumatic Stress Disorder screening questionnaire (PC-PTSD) in civilian substance use disorder patients

This study aimed to cross-validate and extend earlier findings regarding the diagnostic efficiency of the four-item Primary Care Posttraumatic Stress Disorder Screen (PC-PTSD) as a screening questionnaire for posttraumatic stress disorder (PTSD) among civilian patients with substance use disorder (SUD). The PC-PTSD was originally developed in a Veteran Affairs primary care setting (Prins, Ouimette, Kimerling, Cameron, Hugelshofer, Shaw-Hegwer, et al., 2004) and has been widely used in the U.S. army. The diagnostic efficiency of the screener was compared to those of an extended eight-item version of the PC-PTSD and the Posttraumatic Diagnostic Scale (PDS). The sample consisted of 142 participants with SUD and most of the participants (89%) were still using substances in the month preceding the assessment. Results showed a high sensitivity (.86) and moderate specificity (.57) for the PC-PTSD when using a cutoff score of 2. The diagnostic efficiency of the PC-PTSD was equivalent to the extended eight-item version and the 17-item PDS. Results suggest that the original PC-PTSD is a useful screening instrument for PTSD within a civilian SUD population. These findings have important clinical implications because screening for PTSD among patients with SUD is crucial to ascertain appropriate treatment allocation.

Trauma and Current Posttraumatic Stress Symptoms in Elderly German Women Who Experienced Wartime Rapes in 1945

The aim of this study was to determine the persistent trauma impact and significant posttraumatic stress symptoms in a sample of very elderly German women who survived the mass rapes committed by soldiers at the end of World War II. A total of 27 women were recruited, interviewed, and then administered a modified Posttraumatic Diagnostic Scale. They all reported a very severe degree of trauma exposure in 1945; 19% reported significant current posttraumatic stress symptoms indicating a possible posttraumatic stress disorder at the time of the study, and 30% fulfilled the criteria of a current partial posttraumatic stress disorder. The results highlight the necessity for prevention and treatment programs for women exposed to wartime rapes in current conflict settings worldwide, and the need to identify and treat posttraumatic conditions in the elderly generation of all countries exposed to World War II trauma.

Impact of War Trauma and Posttraumatic Stress Disorder on Psychopathology in Croatian and German Patients with Severe Mental Illness

To explore posttraumatic stress symptoms and current psychopathology in a binational sample of Croatian and German participants with severe mental illness. We studied 178 inpatients from the Greifswald University (German patients, n=89) and University Hospital Zagreb and Ivan Barbot Neuropsychiatric Hospital (Croatian patients, n=89) with either major depression (n=150), schizophrenia (n=26), or bipolar disorder (n=2). Measurements included Posttraumatic Diagnostic Scale and the Symptom Check List-90-R. Participants were matched according to age, sex, and diagnosis. Croatians reported significantly more war traumatic events (64/82 vs 5/74, chi(2)(1)=77.142, P<0.001) and significantly more Croatians met the criteria for posttraumatic stress disorder (55/89 vs 27/89, chi(2)(1)=17.73, P<0.001). They also suffered from a higher level of psychopathological distress as they scored significantly higher at all Symptom Check List-90-R revised version subscales (P<0.001). The regression models demonstrated that predictors of general psychopathological distress were war trauma (P<0.001), posttraumatic stress disorder (P<0.001), and diagnosis (P=0.01). This is the first study comparing the impact of war trauma on psychopathology of participants with severe mental illness between two nations. Our results clearly indicate the importance of trauma assessment in subjects with severe mental illness, particularly in post-conflict settings.

Compensation claim lodgement and health outcome developmental trajectories following whiplash injury: A prospective study

This study aimed to identify distinctive trajectories for pain/disability and posttraumatic stress disorder (PTSD) symptoms following whiplash injury and to examine the effect of injury compensation claim lodgement on the trajectories. In a prospective study, 155 individuals with whiplash were assessed at <1 month, 3, 6 and 12 months post injury. Outcomes at each time point were Neck Disability Index (NDI) and the Posttraumatic Stress Diagnostic Scale (PDS). Group-based trajectory analytical techniques were used to identify outcome profiles. The analyses were then repeated after including third party compensation claim lodgment as a binary time-changing covariate. Three distinct NDI trajectories were determined: (1) Mild: mild or negligible pain/disability for the entire 12 months (45%), (2) Moderate: initial moderate pain/disability that decreased to mild levels by 3 months (39%) and (3) Chronic-severe: severe pain/disability persisting at moderate/severe levels for 12 months (16%). Three distinct PTSD trajectories were also identified: (1) Resilient: mild symptoms throughout (40%), (2) Recovering: initial moderate symptoms declining to mild levels by 3 months (43%) and (3) Chronic moderate-severe: persistent moderate/severe symptoms throughout 12 months (17%). Claim submission had a detrimental effect on all trajectories ( p < 0.001) except for the Chronic-severe NDI trajectory ( p = 0.098). Following whiplash injury, there are distinct pathways of recovery for pain/ disability and PTSD symptoms. Management of whiplash should consider the detrimental association of compensation claim with psychological recovery and recovery of those with mild to moderate pain/disability levels. However, claim lodgement has no significant association with a more severe pain and disability trajectory.

Clinical Re-Examination 10 or More Years After Polytrauma: Is There a Gender Related Difference?

: Previous studies documented that premenopausal women better tolerate severe injuries than men in regards to mortality and intensive care complications. We test the hypothesis whether surviving women have a better long-term outcome than surviving men. : We reassessed 637 polytrauma patients 10 or more years (mean 17 +/- 5 years) after trauma. Mental health was assessed by the posttraumatic stress diagnostic scale and the Hospital Anxiety and Depression Scale. The clinical outcome was assessed by standardized scores (Hannover Score for Polytrauma Outcome and short form-12). A physical examination was performed by an orthopedic surgeon. : We studied 479 men (M; 75.4%) and 158 women (F; 24.6%) aged M = 26.7 +/- 12.2 versus F = 25.9 +/- 13.0 years (p = 0.47). Injury Severity Score showed M = 20.4 +/- 9.9 versus F = 21.7 +/- 9.7 (p = 0.13). Women showed a higher rate of posttraumatic stress disorder (F = 14.5% vs. M = 6.2%; p = 0.035) and psychologic support (F = 28.0% vs. M = 15.0%; p < 0.001), longer duration of rehabilitation, and longer sick leave time. Quality-of-life was significantly lower in women (Short form-12 psychologic F = 48.6 +/- 10.8 vs. M = 50.8 +/- 9.4; p = 0.02), but the same rate of women (75.3%) and men (75.4%; p = 0.995) felt well rehabilitated. : Late after polytrauma, women suffer more severe psychologic impairment than men who had similar injuries. This finding is independent of physical impairment and the subjective feeling of a good rehabilitation outcome. Clinically, women require special support even years after injury to improve their psychologic status. In the future, they might benefit from early concomitant psychologic treatment if mental problems are suspected.

Post-Traumatic Stress Disorder in Israeli Survivors of Childhood Cancer

To investigate the prevalence, symptom severity, and risk factors associated with post-traumatic stress disorder (PTSD) in childhood cancer survivors. Descriptive, correlational study. Follow-up clinic in Petach Tikva, Israel. Convenience sample of 70 adult Israeli survivors of childhood cancer. Questionnaires (the Post-Traumatic Diagnostic Scale and the Multidimensional Scale of Perceived Social Support) were distributed to participants, and demographic and clinical data were obtained from medical records. Post-traumatic stress, social support, and clinical and demographic data. Twenty (29%) of the participants met the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for PTSD; 10% experienced mild, 40% moderate, and 50% moderate to severe symptoms. Only 16% of the sample did not experience any symptoms of PTSD. A statistically significant negative relationship was found between PTSD symptom scores and the current age of the respondent (r(s) = -0.27, p = 0.03) and time since medical treatment (r(s) = -0.34, p = 0.004) but not any other demographic or clinical variables or social support. Higher severity of PTSD symptoms was found, possibly because of local living conditions. Most clinical and demographic variables were not risk factors. This population should be studied further in an effort to prevent PTSD via early diagnosis. Oncology nurses should be aware of the potential risk factors (recent completion of treatment and younger current age) and the high prevalence and severity of PTSD among survivors of childhood cancer to identify patients at higher risk and develop programs that prevent, limit, and treat PTSD.

Psychometric Qualities of the Korean Version of the Posttraumatic Diagnosis Scale(PDS-K)

외상 후 스트레스 진단 척도(Posttraumatic Diagnostic Scale, PDS, Foa et al., 1997)는 외상 후 스트레스 장애를 진단내리고, 증상의 심각도를 평가할 수 있는 유용한 도구로 알려져 있다. 본 연구의 목적은 외상 후 스트레스 진단 척도를 한국판으로 타당화 하고 그 심리 측정적 속성을 살펴본 후, 한국판에 맞는 절단점을 산출하는 것이었다. 본 연구의 참가자들은 총 47명으로, 이 중 DSM-IV 진단 기준에 따라 외상 후 스트레스 장애 진단 기준을 충족시키는 사람은 21명, 외상을 경험하였지만, 외상 후 스트레스 장애 진단기준을 충족시키지 않는 통제 집단 26명이었다. 이들을 대상으로 진단 면접과 2차례에 걸쳐 한국판 외상 후 스트레스 진단 척도를 실시하였다. 그 결과 한국판 PDS는 높은 내적 일치도(Cronbach's alpha = .90)와 검사-재검사 신뢰도(r = .81)를 나타냈으며, SCID-I(Structured Clinical Interview for DSM-IV Axis I Disorders)를 통한 진단과도 높은 일치도를 나타냈다(r = .84). ROC 곡선 분석을 실시한 결과, 절단점이 20일 때, 민감도는 1.00, 특이도는 .84로 나타났으며 이러한 수치는 외상 후 스트레스 진단 척도의 높은 진단 유용성을 시사한다. 마지막으로 본 연구의 제한점과 추후 연구 방향에 대해 논의하였다.

Physical and Mental Health of Disaster Victims: A Comparative Study on Typhoon and Oil Spill Disasters

The purpose of this study was to compare the physical and mental health status of disaster victims according to disaster types, such as a typhoon disaster and an oil spill disaster, and to suggest adequate health care services for them. A total of 484 people who suffered disasters were selected for this study, and data were collected from July to August, 2008. The data-set for this study included 286 victims of typhoon disasters in Jeju and Jeollanamdo district in South Korea, and 198 victims of the oil spill disaster in Taean. Physical health status was measured using revised Patient Health Questionnaire and mental health status was measured using the Korean version of 'Post-traumatic Diagnostic Scale'. According to the comparative analyses of typhoon disaster victims and oil spill disaster victims, poorer physical health outcomes were shown among the oil spill disaster victims when compared to the typhoon disaster victims. Also, the oil spill disaster victims showed symptoms of depression, anxiety, and post-traumatic stress disorder, at rates higher than those found among the typhoon disaster victims. These findings suggest that there is a need to provide adequate physical and mental health-related care services for oil spill disaster victims. The seriousness of oil spill disaster should be realized and reconsidered in developing recovery strategies and disaster preparedness for physical and mental health services.

Validation of a mental health assessment in an African conflict population.

We studied the validity of the assessment of posttraumatic stress disorder (PTSD) and depression within the context of an epidemiological mental health survey among war-affected adolescents and young adults in northern Uganda. Local language versions of the Posttraumatic Diagnostic Scale (PDS) and the Depression section of the Hopkins Symptom Checklist (DHSCL) were administered by trained local interviewers. Correlations with probable predictor variables (i.e., trauma exposure), outcomes (e.g., impaired functioning), and local idioms of distress (i.e., spirit possession) were determined to estimate criterion-related construct validity. To assess convergent validity, expert clinicians reinterviewed a subsample using structured interviews (the Clinician Administered PTSD Scale [CAPS] and the Mini International Neuropsychiatric Interview [MINI]). Depression and PTSD symptoms as assessed by the local interviewers correlated with the context variables as predicted. After optimizing the scoring algorithm, we found good agreement between the PDS-based diagnoses and expert diagnoses. However, the concordance for depression diagnoses was not satisfactory. Results show that mental health assessments in African languages can produce reliable and valid data but that caution is warranted in the unevaluated transfer of cutoff scores and scoring algorithms.

Síndrome de estrés postraumático en mujeres embarazadas abusadoras de drogas

IntroductionTrauma exposure is very coomon among women with substance abuse problems, but not all develop post-traumatic stress syndrome (PTSD). Patients with PTSD have more medical problems, interpersonal issues, drug use and are more resistant to addiction treatment than patients without this disorder. MethodTo study the prevalence of SEP in 87 pregnant women in treatment for drug addiction, who reported current or history of violence and accepted lifetime assessment and interventions to improve areas affected by the trauma, using the Posttraumatic Stress Diagnostic Scale (PDS), and associated psychological symptoms using the Symptom Checklist Questionnaire-90 Revised (SCL-90R). ResultsOver half (50.6%) of patients fulfilled criteria for PTSD. The women with PTSD scored significantly higher on all subscales of the SCL-90R, the Global Severity Index (1.58 vs. 0.89) and the Positive Symptoms Distress Index (2.24 vs.1.78) than women without PTSD. ConclusionResults highlight the importance of assessing trauma and its consequences in pregnant women receiving treatment for substance abuse and the need to implement more effective interventions for women with addiction problems and PTSD.

Psychopathology and resilience following traumatic injury: A latent growth mixture model analysis.

To investigate trajectories of PTSD and depression following traumatic injury using latent class growth curve modeling. A longitudinal study of 330 injured trauma survivors was conducted and participants were assessed during hospitalization, and at 1, 3, and 6 months follow-up. Acute Stress Disorder (ASD) was assessed during hospitalization using the Acute Stress Disorder Interview (ASD-I), PTSD was measured at all follow-up with the Post-Traumatic Stress Diagnostic Scale (PDS) and depression was measured at hospitalization with the (BSI) and at follow-up with the Center for Epidemiologic Studies Depression Scale (CESDS). Covariates were explored, including coping self-efficacy, anger, education level, and mechanism of injury. Four latent classes were identified for PTSD and Depression symptoms: chronic distress, delayed distress, recovered, and resilience. When compared to the resilient group, individuals with chronic distress were more likely to have been assaulted, had higher levels of anger, and had less coping self-efficacy. The delayed distress group had lower education levels, higher levels of coping self-efficacy, and higher levels of anger. Individuals in the recovered group had fewer years of education, and higher levels of anger. The majority of the injured trauma sample demonstrated resiliency, with those exhibiting distress doing so as a delayed, chronic, or recovered trajectory. Coping self efficacy, education, assaultive trauma type, and anger were important covariates of depression and PTSD trajectories. These results are similar to studies of individuals who experienced a major health threat and with survivors from the World Trade Center attacks in the U.S.

Cognitive appraisals and posttraumatic stress disorder symptoms in informal caregivers of stroke survivors.

To examine associations between cognitive appraisals (i.e., negative appraisals about the self, negative appraisals about the world, and self-blame) and the severity of posttraumatic stress disorder (PTSD) symptoms in informal caregivers (i.e., family relatives or close associates) of stroke survivors. A cross-sectional study was conducted in which informal caregivers (N = 51) of recent stroke survivors completed the Posttraumatic Diagnostic Scale and the Posttraumatic Cognitions Inventory. PTSD symptom severity correlated significantly with the Posttraumatic Cognitions Inventory Self, World, and Self-Blame subscales and with time since stroke and age (negative relationship). Cognitive appraisals explained 58% of the variance in PTSD symptom severity. The associations found between negative cognitive appraisals and the severity of PTSD symptoms are consistent with current cognitive models of PTSD and the recommended use of trauma-related cognitive-behavioral therapy for individuals with PTSD.

Screening for HIV-related PTSD: Sensitivity and specificity of the 17-item Posttraumatic Stress Diagnostic Scale (PDS) in identifying HIV-related PTSD among a South African sample

The identification of HIV-positive patients who exhibit criteria for Posttraumatic Stress Disorder (PTSD) and related trauma symptomatology is of clinical importance in the maintenance of their overall wellbeing. This study assessed the sensitivity and specificity of the 17-item Posttraumatic Stress Diagnostic Scale (PDS), a self-report instrument, in the detection of HIV-related PTSD. An adapted version of the PTSD module of the Composite International Diagnostic Interview (CIDI) served as the gold standard. 85 HIV-positive patients diagnosed with HIV within the year preceding data collection were recruited by means of convenience sampling from three HIV clinics within primary health care facilities in the Boland region of South Africa. A significant association was found between the 17-item PDS and the adapted PTSD module of the CIDI. A ROC curve analysis indicated that the 17-item PDS correctly discriminated between PTSD caseness and non-caseness 74.9% of the time. Moreover, a PDS cut-off point of > or = 15 yielded adequate sensitivity (68%) and 1-specificity (65%). The 17-item PDS demonstrated a PPV of 76.0% and a NPV of 56.7%. The 17-item PDS can be used as a brief screening measure for the detection of HIV-related PTSD among HIV-positive patients in South Africa.

Posttraumatic Growth, Social Acknowledgment as Survivors, and Sense of Coherence in Former German Child Soldiers of World War II

To examine posttraumatic growth (PTG) and its predictors social acknowledgment as survivors, sense of coherence (SOC), trauma severity, and further factors in former child soldiers more than 60 years after deployment. Cross-sectional. University-based geropsychiatric center in Germany. One hundred three former German child soldiers of World War II, mean age 78 years in which 96% experienced at least one war trauma. Subjects completed the Posttraumatic Growth Inventory, Social Acknowledgment Questionnaire (SAQ), and SOC Scale. Trauma exposure and posttraumatic stress disorder (PTSD) symptoms were assessed by the Posttraumatic Diagnostic Scale. Depression, anxiety, and somatization were assessed using the Brief Symptom Inventory. Number of traumas, recognition by significant others, and general disapproval as facets of social acknowledgment as a survivor, and meaningfulness as a dimension of SOC correlated significantly with PTG. In a multiple hierarchical regression analysis, recognition as a survivor by significant others (SAQ) and meaningfulness (SOC) remained the only significant predictors of PTG. Social acknowledgment as a survivor by significant others and the belief that the world is meaningful are among the most important factors contributing to PTG. Further research should investigate whether treatments of PTSD in people who experienced war traumas recently or many years ago might benefit from a focus on the belief system and the role of family and social support.

Impaired Sexual Function in Patients with Borderline Personality Disorder is Determined by History of Sexual Abuse

Patients suffering from a Borderline Personality Disorder (BPD) display altered sexual behavior, such as sexual avoidance or sexual impulsivity, which has repeatedly been linked to the sexual traumatization that occurs in a high percentage of BPD patients. Until now, no empirical data exists on whether these patients concomitantly suffer from sexual dysfunction. This study investigates sexual function and the impact of sexual traumatization on this issue in women with BPD as compared to healthy women. Sexual function was measured using the Female Sexual Function Index. Additionally, diagnoses were made with SCID II Interviews for Axis II and with the Mini International Neuropsychiatric Interview for Axis I disorders. The Post-traumatic Stress Diagnostic Scale for trauma evaluation was used. Sexual orientation was assessed by self-evaluation. Forty-five women with BPD as diagnosed according to DSM-IV criteria and 30 healthy women completed questionnaires on sexual function and sexual abuse history, as well as interviews on axis I and II disorders and psychotropic medication. The BPD group showed a significantly higher prevalence of sexual dysfunction. Subgroup analyses revealed that BPD with concomitant sexual traumatization, and not BPD alone, best explains impaired sexual function. Sexual inactivity was mainly related to current major depression or use of SSRI medication. In sexually active participants, medication and symptoms of depression had no significant impact on sexual function. Not BPD alone, but concomitant sexual traumatization, predicts significantly impaired sexual function. This may have a therapeutic impact on BPD patients reporting sexual traumatization.