PTSD Checklist For DSM-5 Scores Research Articles

Applying the PTSD Checklist-Civilian and PTSD Checklist for DSM-5 crosswalk in a traumatic brain injury sample: A veterans affairs traumatic brain injury model systems study.

This study evaluates the use of the crosswalk between the PTSD Checklist-Civilian (PCL-C) and PTSD Checklist for DSM-5 (PCL-5) designed by Moshier et al. (2019) in a sample of service members and veterans (SM/V; N = 298) who had sustained a traumatic brain injury (TBI) and were receiving inpatient rehabilitation. The PCL-C and PCL-5 were completed at the same time. Predicted PCL-5 scores for the sample were obtained according to the crosswalk developed by Moshier et al. We used three measures of agreement: intraclass correlation coefficient (ICC), mean difference between predicted and observed scores, and Cohen's κ to determine the performance of the crosswalk in this sample. Subgroups relevant to those who have sustained a TBI, such as TBI severity, were also examined. There was strong agreement between the predicted and observed PCL-5 scores (ICC = .95). The overall mean difference between predicted and observed PCL-5 scores was 0.07 and not statistically significant (SD = 8.29, p = .89). Significant mean differences between predicted and observed PCL-5 scores calculated between subgroups were seen in Black participants (MD = -4.09, SD = 8.41, p = .01) and those in the Year 5 follow-up group (MD = 1.77, SD = 7.14, p = .03). Cohen's κ across subgroups had a mean of κ = 0.76 (.57-1.0), suggesting that there was moderate to almost perfect diagnostic agreement. Our results suggest the crosswalk created by Moshier et al. can be applied to SM/V who have suffered a TBI. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Impact of veteran-led peer mentorship on posttraumatic stress disorder.

Peer mentorship shows promise as a strategy to support veteran mental health. A community-academic partnership involving a veteran-led nonprofit organization and institutions of higher education evaluated a collaboratively developed peer mentor intervention. We assessed posttraumatic stress disorder (PTSD), postdeployment experiences, social functioning, and psychological strengths at baseline, midpoint, and 12-week discharge using the PTSD Checklist for DSM-5 (PCL-5), Deployment Risk and Resilience Inventory-2, Social Adaptation Self-evaluation Scale, and Values in Action Survey. Brief weekly check-in surveys reinforced mentor contact and assessed retention. The sample included 307 veterans who were served by 17 veteran peer mentors. Mixed-effects linear models found a modest effect for PTSD symptom change, with a mean PCL-5 score reduction of 4.04 points, 95% CI [-6.44, -1.64], d = 0.44. More symptomatic veterans showed a larger effect, with average reductions of 9.03 points, 95% CI [-12.11, -5.95], d = 0.77. There were no significant findings for other outcome variables. Compared to younger veterans, those aged 32-57 years were less likely to drop out by 6 weeks, aORs = 0.32-0.26. Week-by-week hazard of drop-out was lower with mentors ≥ 35 years old, aHR = 0.62, 95% CI [0.37, 1.05]. Unadjusted survival differed by mentor military branch, p =.028, but the small mentor sample reduced interpretability. Like many community research efforts, this study lacked a control group, limiting the inferences that can be drawn. Continued study of veteran peer mentorship is important as this modality is often viewed as more tolerable than therapy.

Comparing effectiveness of residential versus intensive virtual treatment for veterans with posttraumatic stress disorder.

During the COVID-19 pandemic, restrictions imposed on residential treatment programs necessitated rapid implementation of virtual treatment delivery. Posttraumatic stress disorder (PTSD) Residential Rehabilitation Treatment Programs (P-RRTP) are a key mental health treatment for Veterans with PTSD who require more intensive interventions than outpatient care. During the pandemic, the W. G. (Bill) Hefner VA Healthcare System developed and implemented a Virtual Intensive Outpatient Program for PTSD (VIOPP) to meet the needs of the Veteran population. The purpose of this analysis was to compare the effectiveness of VIOPP to P-RRTP. Analyses included N = 370 Veterans, n = 193 who completed P-RRTP between January 2018 to April 2020 and n = 177 who completed VIOPP between June 2020 and November 2022 and provided pre- and posttreatment scores. Pre- and posttreatment scores of the PTSD Checklist for DSM-5 (PCL-5) were available for all patients. Pre- and posttreatment depressive symptom scores from the Nine-item Patient Health Questionnaire (PHQ-9) were available for n = 254 Veterans. Paired and independent samples t tests evaluated differences in change scores overall and by treatment modality (residential vs. virtual). Results indicated a significant decrease in PCL-5 scores regardless of treatment modality, p < .001. Despite beginning VIOPP with significantly higher PCL-5 scores than P-RRTP, there were no significant differences in PCL-5 change scores between virtual (M = -16.94) and residential treatment (M = -17.10), p = .910. PHQ-9 scores also decreased significantly for both treatment groups. These analyses suggest that intensive virtual treatment has similar effectiveness to residential treatment for PTSD. This supports the development of intensive virtual interventions as viable alternatives to residential treatments and a valuable component within the continuum of PTSD care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Impact of COVID-19 on posttraumatic stress disorder in ICU survivors: a prospective observational comparative cohort study

BackgroundPosttraumatic stress disorder (PTSD) after a stay in the intensive care unit (ICU) can affect one in five ICU survivors. At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, admission to the ICU for COVID-19 was stressful due to the severity of this disease. This study assessed whether admission to the ICU for COVID-19 was associated with a higher prevalence of PTSD compared with other causes of ICU admission after adjustment for pre-ICU psychological factors.MethodsThis prospective observational comparative cohort study included 31 ICUs. Eligible patients were adult ICU survivors hospitalized during the first wave of COVID-19 pandemic in France, regardless of the reason for admission. The prevalence of presumptive diagnosis of PTSD at 6 months was assessed using the PTSD Checklist for DSM-5 (PCL-5). Sociodemographics, clinical data, history of childhood trauma (Childhood Trauma Questionnaire [CTQ]), and exposure to potentially traumatic events (Life Events Checklist for DSM-5 [LEC-5]) were assessed.ResultsOf the 778 ICU survivors included during the first wave of COVID-19 pandemic in France, 417 and 361 were assigned to the COVID-19 and non-COVID-19 cohorts, respectively. Fourteen (4.9%) and 11 (4.9%), respectively, presented with presumptive diagnosis of PTSD at 6 months (p = 0.976). After adjusting for age, sex, severity score at admission, use of invasive mechanical ventilation, ICU duration, CTQ and LEC-5, COVID-19 status was not associated with presumptive diagnosis of PTSD using the PCL-5. Only female sex was associated with presumptive diagnosis of PTSD. However, COVID-19 patients reported significantly more intrusion and avoidance symptoms than non-COVID patients (39% vs. 29%, p = 0.015 and 27% vs. 19%, p = 0.030), respectively. The median PCL-5 score was higher in the COVID-19 than non-COVID-19 cohort (9 [3, 20] vs. 4 [2, 16], p = 0.034).ConclusionAdmission to the ICU for COVID-19 was not associated with a higher prevalence of PTSD compared with admission for another cause during the first wave of the COVID-19 pandemic in France. However, intrusion and avoidance symptoms were more frequent in COVID-19 patients than in non-COVID-19 patients.Trial Registration: Clinicaltrials.gov Identifier NCT03991611, registered on June 19, 2019.

Chronotype influences on posttraumatic stress disorder induced by the twin earthquakes in Turkey: A cross-sectional study among medical students

ABSTRACT This study aimed to investigate the correlation between chronotypes and posttraumatic stress disorder (PTSD) symptoms in medical students affected by earthquakes in Kahramanmaraş, Turkey, while elucidating if the PTSD manifestation varies among different chronotypes four months post-disaster. The study encompassed 193 medical students, subjected to the sociodemographic data form, the Morningness-Eveningness Questionnaire (MEQ) and the PTSD Checklist for DSM-5 (PCL-5). The results indicated that students identified as “evening types” reported significantly elevated PCL-5 scores (p < 0.001) relative to “morning” and “intermediate” types. According to PCL-5 scores, 43.5% of the participants exhibited PTSD, with a higher occurrence among the evening types. Multivariable linear regression analysis revealed that lower MEQ scores independently correlated with elevated PTSD symptoms (β = -0.1389 [95% CI = -0.273 ˗ −0.0048], p = 0.042), suggesting the potential of eveningness as a risk factor for PTSD post-disaster. These findings could enhance our understanding of PTSD, aid the development of preventive strategies, and underscore the importance of considering chronotypes. Further expansive, population-based studies with a longitudinal design are necessary to better understand the relationship between PTSD and the circadian system.

Improved Post-Traumatic Stress Disorder Symptoms and Related Sleep Disturbances after Initiation of Medical Marijuana Use: Evidence from a Prospective Single Arm Pilot Study

Introduction: Post-traumatic stress disorder (PTSD) is a debilitating disorder experienced by a subgroup of individuals following a life-threatening trauma. Several US states have passed laws permitting the medical use of marijuana (MMJ) by individuals with PTSD, despite very little scientific indication on the appropriateness of marijuana as a therapy for PTSD. This prospective pilot study of adults with confirmed PTSD in Florida (FL) investigated whether PTSD symptoms, sleep quality, affect, and general physical and mental health/well-being improved post-initiation of MMJ treatment. Methods: Participants, N = 15, were recruited from two MMJ clinics in Gainesville and Jacksonville, FL. To be eligible, participants had to be 18 years of age or older, not currently on MMJ, and willing to abstain from recreational marijuana, if using any, until the State Medical Cannabis Card was obtained, screen positive for PTSD. Participants were assessed at baseline (pre-MMJ initiation) and 30 and 70 days post-MMJ initiation using the Pittsburgh Sleep Quality Index (PSQI), PTSD Checklist for DSM-5 (PCL-5), Positive and Negative Affect Schedule (PANAS), PROMIS Global Health V1.2, and semi-structured marijuana and other substance use assessment. Results: PTSD symptom severity as measured by total PCL-5 score improved significantly at 30- and 70-day follow-ups. Similarly, statistically significant reductions in nightmares were reported at 30- and 70-day follow-ups. Corresponding improvements in sleep were noticed with participants reporting increased duration of sleep hours, sleep quality, sleep efficiency, and total PSQI score. Likewise, negative affect and global mental health improved significantly at follow-up. According to the post hoc analyses, the most statistically significant changes occurred between baseline and 30-day follow-up. The exception to this pattern was nightmares, which did not show significant improvement until day 70. Conclusion: The findings of this study highlight the potential of MMJ in improving patient outcomes for those with PTSD, particularly concerning sleep disturbances, which often do not respond to currently available treatments.

Self-rated personality disorder symptoms do not predict treatment outcome for posttraumatic stress disorder in routine clinical care.

To test the hypothesis that self-rated personality disorder (PD) symptoms are a significant and clinically relevant predictor of treatment outcomes in a naturalistic treatment setting specialized in trauma-focused treatment using a single-group pretest-posttest design. Treatment-seeking patients reporting clinical levels of posttraumatic stress disorder (PTSD) symptoms filled out questionnaires at intake and after treatment. The primary outcome was change in PTSD severity after treatment, measured by the PTSD Checklist for DSM-5 (PCL-5). PD symptoms were measured with the Structured Clinical Interview for DSM-5 Screening Personality Questionnaire (SCID-5-SPQ). Secondary outcomes were general mental health problems, treatment response, number of sessions and dropout. N =1174 patients (59% female, baseline PCL-5 score M [SD] = 53.0 [10.8]) were included for the primary analysis. Regression analysis revealed that PD symptoms explained 0.4% of variance in PTSD symptom change (p = .066). After controlling for baseline PTSD symptoms, PD symptoms explained 0.0% of variance (p = .311). The fully adjusted model including baseline PTSD symptom severity, age, gender, cumulative exposure to potentially traumatic experiences, PD symptoms, and number of sessions together explained 5% of the observed variance in PTSD symptom change. Baseline PTSD severity was the only significant predictor and negatively predicted outcome. Sensitivity analyses with imputed data from N = 2694 cases yielded comparable results. Finally, secondary analyses showed that PD symptoms did not predict significant or clinically relevant changes in treatment response status, general mental health problems, dropout rates or number of sessions. The findings provide no evidence that self-rated PD symptoms predict treatment outcomes for patients suffering from clinical levels of PTSD symptoms in a naturalistic treatment setting specializing in trauma-focused treatment. Self-report screening for these symptoms to inform clinicians about expected effects of PTSD treatment is not supported by the evidence.

Minimal important difference metrics and test-retest reliability of the PTSD Checklist for DSM-5 with a primary care sample.

The PTSD Checklist for DSM-5 (PCL-5) is a measure of posttraumatic stress disorder (PTSD) symptom severity that is widely used for clinical and research purposes. Although previous work has examined metrics of minimal important difference (MID) of the PCL-5 in veteran samples, no work has identified PCL-5 MID metrics among adults in primary care in the United States. In this secondary analysis, data were evaluated from primary care patients (N = 971) who screened positive for PTSD and participated in a large clinical trial in federally qualified health centers in three U.S. states. Participants primarily self-identified as women (70.2%) and White (70.3%). We calculated test-retest reliability using clinic registry data and multiple distribution- and anchor-based metrics of MID using baseline and follow-up survey data. Test-retest reliability (Pearson's r, Spearman's ρ, intraclass correlation coefficient) ranged from adequate to excellent (.79-.94), with the shortest time lag demonstrating the highest reliability estimate. The MID for the PCL-5 was estimated using multiple approaches. Distribution-based approaches indicated an MID range of 8.5-12.5, and anchor-based approaches indicated an MID range of 9.8-11.7. Taken together, the MID metrics indicate that PCL-5 change scores of 9-12 likely reflect real change in PTSD symptoms and indicate at least an MID for patients, whereas PCL-5 change scores of 5 or less likely are not reliable. These findings can help inform clinicians using the PCL-5 in similar populations to track patient responses to treatment and help researchers interpret PCL-5 score changes in clinical trials.

A - 129 An Examination of the Relationship between Posttraumatic Stress Disorder Symptom Severity and Cognitive Test Performance in a Veteran Sample.

This study examined the relationship between Posttraumatic Stress Disorder (PTSD) symptom severity and cognitive test performance in veterans, hypothesizing that PTSD Checklist for DSM-5 (PCL-5) scores would be correlated with test performance on commonly used neuropsychological measures. Clinically-referred veterans without a neurocognitive disorder who passed the Test of Memory Malingering (TOMM), completed the PCL-5, and completed Weschler Adult Intelligence Scale-Fourth Edition (WAIS-IV) Digit Span or Coding, Weschler Memory Scale-Fourth Edition (WMS-IV) Logical Memory (LMI/LMII), letter fluency (FAS), or Trail Making Test (Parts A and B) were included. The sample included 38 veterans (81.6% male); mean age = 58.79 (SD = 14.71; range 22-80) and mean education level = 13.97years (SD = 2.42, range 6-20). Primary diagnoses included PTSD (47.4%), depression (21.1%), and no diagnosis (23.7%). Pearson, Spearman, and partial correlations were calculated. Moderate negative correlations were found between PCL-5 and FAS raw scores (r = -0.41, p = 0.014; 95%CI [-0.654,-0.089]) and LMI raw scores (r = -0.453, p = 0.02; 95%CI [-0.715,-0.080]). After controlling for age and education, moderate negative correlations remained for FAS (r = -0.46, p = 0.004) and LMI (r = -0.43, p = 0.018) and a weak, non-significant correlation with LMII (r = -0.297, p = 0.079). In veterans with valid cognitive test performance and no neurocognitive disorder, PTSD symptom severity negatively correlated with FAS and WMS-IV LM performance. This suggests PTSD symptoms may influence performance on phonemic fluency and story recall task. Assessing and addressing PTSD symptoms may result in more accurate diagnoses and improved cognitive functioning. Understanding the PTSD-cognition relationship can inform interventions and support strategies to enhance veterans' quality of life.

A - 125 Posttraumatic Stress Disorder Symptom Severity and its Relationship to Performance on the Test of Memory Malingering in a Veteran Sample.

To examine relationships between Posttraumatic Stress Disorder (PTSD) symptom severity and performance on the Test of Memory Malingering (TOMM) trials in veterans without a diagnosis of neurocognitive disorder. A sample of 47 clinically-referred veterans (80.9% male; Mage = 57.47, SD = 14.83; Medu = 13.91, SD = 2.5) who did not meet criteria for a neurocognitive disorder completed the PTSD Checklist for DSM-5 (PCL-5) and the TOMM. Primary diagnoses included PTSD (48.9%), no diagnosis (23.4%), and depression (19.1%). A cutoff of 45 was used for each trial; 47 completed Trial 1 (TOMM-T1), 17 completed Trial 2 (TOMM-T2), and 10 completed Retention Trial (TOMM-Ret). Nine participants (19.1%) failed the TOMM. Analyses included Pearson correlation, Spearman correlation, and independent-samples t-tests. Age was negatively correlated with PCL-5 and positively correlated with TOMM-T1; therefore, relevant partial correlations were conducted. TOMM-T1 demonstrated a moderate, negative correlation with PCL-5, rs(45) = -0.469, p < 0.001, 95%CI(-0.688,-0.248). A moderate non-significant correlation was found between TOMM-T2 and PCL-5, rs(15) = -0.405, p = 0.053, 95%CI(-0.775,0.014). PCL-5 and TOMM-Ret were not correlated. Controlling for age, the correlation between PCL-5 and TOMM-T1 remained significant (rs[44] = -0.426, p = 0.002). Those who passed TOMM (M = 38.45, SD = 16.48) had significantly lower PCL-5 scores compared to those who failed (M = 57.67, SD = 13.83), t(45) = -3.231, p = 0.001, Cohen's D = 16.04. Among veterans, PTSD symptom severity was related to TOMM scores and/or failure. Findings highlight a need to consider the role PTSD symptoms may play in neuropsychological assessment. Findings further support recommendations for trauma-focused treatment before formal neuropsychological testing, as psychiatric symptoms may interfere with obtaining a valid assessment of cognition.

Changes in posttraumatic stress disorder symptom severity during the COVID-19 pandemic: Ten-wave findings from a longitudinal observational cohort study of community adults

Few studies have examined changes in posttraumatic-stress disorder (PTSD) symptomatology across an extended time period during the COVID-19 pandemic. This study used a longitudinal cohort design to examine: (1) changes in overall PTSD symptoms and symptom clusters; (2) moderators of change; (3) the clinical significance of observed changes; and (4) correlates of clinically meaningful changes. Community adults (N = 1412) were assessed using the PTSD Checklist for DSM-5 (PCL-5) at 10 timepoints (October 2018 - April 2022). Changes in overall PCL-5 score and symptom clusters were substantially moderated by pre-pandemic clinical severity (i.e., above/below PCL-5 cut-off). Pre-pandemic non-clinical participants exhibited increases in overall scores, Cluster D (negative cognitions), and Cluster E (arousal), while clinically elevated participants exhibited decreases overall and in all clusters. Regarding clinical significance, 12% of pre-pandemic non-clinical participants exhibited clinically meaningful increases, and 4% exhibited decreases. Conversely, 42% of the pre-pandemic elevated group exhibited clinically meaningful decreases, while 6% exhibited increases. Pandemic impacts in numerous psychosocial domains were associated with clinically meaningful change. Collectively, these findings reveal substantively divergent trajectories by pre-pandemic severity and PTSD symptom cluster. The large proportion of pre-pandemic high-severity participants exhibiting sizable decreases was an unexpected notable observation.

Suicidal ideation in veterans enrolled in evidence-based psychotherapy for posttraumatic stress disorder.

Suicidal ideation (SI) is a highly prevalent public health issue in the veteran population and is increasingly common in veterans who are diagnosed with other mental health conditions, such as posttraumatic stress disorder (PTSD; U.S. Department of Veterans Affairs, 2020). The present study has an initial aim of examining changes in SI over treatment, and it is hypothesized that SI will decrease across PTSD treatments. A second aim is to examine the association of SI status with PTSD symptoms across treatment, and it is hypothesized that PTSD symptomatology will decrease at similar rates over the course of treatment for those who did and did not endorse SI at pretreatment. Participants included 717 (86.3% male) veterans who participated in outpatient treatment within a Veterans Affairs Post Traumatic Stress Disorder (VA PTSD) specialty clinic between July 2014 and December 2017. Descriptive analyses found that 37.2% of veterans endorsed SI at pretreatment, while 18.6% endorsed SI at posttreatment. The relationship between pre- and posttreatment SI was significant, χ²(1, N = 247) = 23.77, p < .001. A significant proportion of veterans who endorsed SI at pretreatment no longer endorsed SI at posttreatment (64.7%). There were no differences in changes in PTSD Checklist for DSM-5 (PCL-5) scores across treatment for those with and without SI at pretreatment. While those who endorsed SI at pretreatment had higher PCL-5 scores throughout treatment, they experienced a similar rate of improvement in symptoms as those without SI at pretreatment. This finding suggests that the presence of SI does not reduce the effectiveness of PTSD treatment. Limitations include the use of a single-item measure of SI, lack of adequate power to detect difference among treatments, and a cross-sectional design. Clinical and research implications are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

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

ABSTRACT Background: This study was an examination of the puzzling finding that people assessed for symptoms of posttraumatic stress disorder (PTSD) consistently score higher on the self-report PTSD Checklist for DSM-5 (PCL-5) than the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Both scales purportedly assess PTSD severity with the same number of items, scaling, and scoring range, but differences in scores between measures make outcomes difficult to decipher. Objective: The purpose of this study was to examine several possible psychometric reasons for the discrepancy in scores between interview and self-report. Method: Data were combined from four clinical trials to examine the baseline and posttreatment assessments of treatment-seeking active duty military personnel and veterans. Results: As in previous studies, total scores were higher on the PCL-5 compared to the CAPS-5 at baseline and posttreatment. At baseline, PCL-5 scores were higher on all 20 items, with small to large differences in effect size. At posttreatment, only three items were not significantly different. Distributions of item responses and wording of scale anchors and items were examined as possible explanations of the difference between measures. Participants were more likely to use the full range of responses on the PCL-5 compared to interviewers. Conclusions: Suggestions for improving the congruence between these two scales are discussed. Administration of interviews by trained assessors can be resource intensive, so it is important that those assessing PTSD severity are afforded confidence in the equivalence of their assessment of PTSD regardless of the assessment method used.

0681 The Relationship between Safety Behaviors and Insomnia in individuals with Post-Traumatic Stress Disorder

Abstract Introduction Safety behaviors may perpetuate anxiety, maintain an individual’s perception of threats, and may lead to psychosocial impairment. Safety behaviors are commonly seen in those suffering from insomnia and post-traumatic stress disorder (PTSD). Despite their prevalence and associated impairments, there exists no data on the relationship between insomnia and safety behavior in those suffering from PTSD. The aim of this study is to evaluate the relationship between safety behavior and insomnia in those with PTSD. If such a relationship is seen, does the severity of nightmares or overall PTSD mediate this relationship between insomnia and safety behaviors? Methods The study extracted data from baseline assessments of a treatment study conducted at the VA Medical Center at Philadelphia. The subjects were treatment-seeking patients with PTSD (N =43). Safety behavior was evaluated using the 12-item brief Safety Behavior Assessment Form (SBAF), PTSD was evaluated using the PTSD checklist for DSM-5 (PCL-5), and insomnia with Insomnia Severity Index (ISI) scales. Bivariate analyses evaluated the relationship between SBAF total score and age, education, income, PCL-5, and ISI total scores. Nightmare severity was evaluated using item number 2 from the PCL-5 questionnaire. An analysis evaluated the role of the severity of nightmares or PTSD (PCL-5 total score after excluding the sleep and safety items) as independent mediators in the relationship between SBAF and ISI total scores. Results The mean±standard deviation of their age was 56.1±11.6 years and 13.1±2.1 years of education. They were mostly males (86.0%), black (61.9%) and unemployed over the past month (76.8%). The mean total score was 17.1±5.7 on the SBAF, 17.3±7.4 on the ISI, and 52.5±14.5 on the PCL-5. Bivariate analysis demonstrated that SBAF total score was associated with the ISI (β=0.32, p=0.0005 and PCL-5 (β=0.22, p=0.0004) total scores. Mediation analysis demonstrated a significant mediation effect of nightmares (R2=24.6%) and PTSD severity (R2=33.3%) on the association between safety behaviors and insomnia. Conclusion About sixty percent of the variance in safety behaviors was explained by insomnia and its association with PTSD or nightmare severity. Treatment of underlying insomnia, PTSD, or nightmares may improve the safety behaviors associated with PTSD. Support (if any) 1IK2CX000855 (S.C.), and 1 I01 CX001957 (S.C.).

As simple as possible, but not simpler: Revisiting the International Trauma Questionnaire (ITQ) complex PTSD items omitted in the shortened version

BackgroundThe risks of oversimplification of the symptomatology of Complex PTSD (CPTSD) have been highlighted in the literature. ObjectiveTo re-examine 10 items representing disturbances in self-organization (DSO) that were deleted from the original 28-item version of the International Trauma Questionnaire (ITQ) when creating the current 12-item version. Participants and settingAn online convenience sample of 1235 MTurk users. MethodsOnline survey comprising the fuller 28-item previous version of the ITQ, Adverse Childhood Experiences (ACEs) questionnaire, and PTSD Checklist for DSM-5 (PCL-5). ResultsFirst, averaged endorsement of the 10 omitted items was lower than the 6 retained DSO items (d’ = 0.34). Second, the 10 omitted DSO items accounted for incremental variance over and correlated equivalently to the 6 retained items with the PCL-5. Third, only the 10 omitted DSO items (r-part = 0.12) while not the 6 retained DSO items (r-part = −0.01) independently predicted ACE scores and, eight of these ten omitted DSO items differentiated higher ACE scores even among the subset of 266 participants who endorsed all 6 of the retained DSO items, most with medium effect sizes. Fourth, exploratory principal axis factor analysis differentiated two latent variables within the fuller set of 16 DSO symptoms, with the strongest indicators of the second factor, namely uncontrollable anger, recklessness, derealization, and depersonalization, being unmeasured within the 6 retained DSO items. Moreover, scores on both factors independently predicted both PCL-5 and ACE scores. ConclusionsThere are conceptual and pragmatic advantages to revisiting a more content-valid and comprehensive conceptualization of CPTSD and DSO, partially as may be measured by the recently deleted items from the original and fuller length ITQ.

Sleep quality and PTSD symptoms predict vascular dysfunction in young, trauma-exposed women

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/m 2 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 (R 2 =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 (R 2 =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.

Premenopausal women with PTSD display blunted vagal control of the heart and elevated central hemodynamics

Introduction: Post‐traumatic stress disorder (PTSD) is associated with significant cardiovascular disease (CVD) risk. Women are twice as likely as men to develop PTSD after a traumatic event. Although premenopausal women are thought to be protected from CVD, a diagnosis of PTSD increases CVD risk by up to three-fold. Available data in predominantly male cohorts point to autonomic nervous system dysfunction as a potential underlying mechanism. Therefore, the aim of this study was to determine if premenopausal women diagnosed with PTSD, compared to those without, present a blunted parasympathetic control of the heart and elevated cardiovascular hemodynamics. Methods: Thirty-five otherwise healthy young women (18-40 years) with a history of trauma exposure were included in this study, 14 with PTSD and 21 without PTSD diagnostic. The study took place during two visits. At visit one, we collected anthropometric measures, assessed PTSD symptom severity with the PTSD checklist for DSM 5 (PCL5) and depression severity using the Beck Depression Inventory (BDI). At visit two, we measured resting heart rate variability (HRV) using the finger volume pulse waveforms obtained from a peripheral arterial tone signal and central hemodynamics (i.e., aortic blood pressure and augmentation index) via pulse wave analysis using applanation tonometry. We compared the two groups with independent t-tests and we report two-tailed p-values. Results: Age (27±7years) and BMI (27±6 kg/m2) were comparable between the two groups (p&gt;0.05). Women diagnosed with PTSD had higher PCL5 (48±9 vs 32±18 a.u., p=.001) and BDI (27±10 vs 15±7 a.u., p&lt;0.001) scores compared to women without PTSD. Resting brachial blood pressure [systolic, 120±12 vs 108±8 mmHg, p=.001; diastolic, 76±6 vs 67±7 mmHg, p&lt;0.001] and heart rate (76±10 vs 66±7 bpm, p=0.002) were also higher in women with PTSD. Our primary outcome measures of HRV [SDNN, 40±25 vs 61±17 ms, p=0.005; RMSSD, 36±28 vs 57±23 ms, p=0.029] were lower in women with PTSD compared to women without PTSD. When examining central hemodynamics, aortic blood pressure [systolic, 110±11 vs 97±8 mmHg, p&lt;0.001; diastolic, 77±6 vs 67±7 mmHg, p&lt;0.001] was higher in women with PTSD compared to women without PTSD. Likewise, aortic augmentation index (26±14 vs 17±10 a.u., p=0.030) and augmentation pressure (9±4 vs 6±3 mmHg, p=0.017) were higher in women with PTSD. Conclusion: In sum, our results show that among premenopausal women with a PTSD diagnosis is associated with higher heart rate, higher peripheral and central blood pressure, and blunted parasympathetic control of the heart. These findings suggest that PTSD may impose a high allostatic load on the heart in young women, who are typically thought to be protected from CVD. These data also provide mechanistic insight into links between PTSD and hypertension prior to menopause. 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.

Repetitive Transcranial Magnetic Stimulation for Depression and Posttraumatic Stress Disorder in Veterans With Mild Traumatic Brain Injury

ObjectivesMild traumatic brain injury (mTBI) is a signature injury of military conflicts and is prevalent in veterans with major depressive disorder (MDD) and posttraumatic stress disorder (PTSD). Although therapeutic transcranial magnetic stimulation (TMS) can reduce symptoms of depression and PTSD, whether traumatic brain injury (TBI) affects TMS responsiveness is not yet known. We hypothesized mTBI would be associated with higher pretreatment symptom burden and poorer TMS response. Materials and MethodsWe investigated a registry of veterans (N = 770) who received TMS for depression across the US Veterans Affairs system. Of these, 665 (86.4%) had data on TBI and lifetime number of head injuries while 658 had complete data related to depression outcomes. Depression symptoms were assessed using the nine-item Patient Health Questionnaire and PTSD symptoms using the PTSD Checklist for DSM-5. Linear mixed effects models and t-tests evaluated whether head injuries predicted symptom severity before treatment, and how TBI status affected clinical TMS outcomes. ResultsOf the 658 veterans included, 337 (50.7%) reported previous mTBI, with a mean of three head injuries (range 1–20). TBI status did not predict depressive symptom severity or TMS-associated changes in depression (all p’s > 0.1). TBI status was associated with a modest attenuation of TMS-associated improvement in PTSD (in patients with PTSD Checklist for DSM-5 scores > 33). There was no correlation between the number of head injuries and TMS response (p > 0.1). ConclusionsContrary to our hypothesis, presence of mTBI did not meaningfully change TMS outcomes. Veterans with mTBI had greater PTSD symptoms, yet neither TBI status nor cumulative head injuries reduced TMS effectiveness. Limitations include those inherent to retrospective registry studies and self-reporting. Although these findings are contrary to our hypotheses, they support the safety and effectiveness of TMS for MDD and PTSD in patients who have comorbid mTBI.

Evaluating the Performance of the Primary Care Posttraumatic Stress Disorder Screen for DSM-5 (PC-PTSD-5) in a Trauma-Exposed, Socioeconomically Vulnerable Patient Population.

The properties and utility of the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) remain unstudied in community-based populations. This study evaluates the performance of the PC-PTSD-5 to determine whether it can be used as a brief alternative to the PTSD Checklist for DSM-5 (PCL-5) in a large public hospital in the southeastern United States. Participants (N = 422; 92.7% Black; 85.8% female; Mage = 42.0years, SDage = 13.4years) completed the PCL-5 and PC-PTSD-5 after recruitment from medical clinic waiting rooms and admission lists. Using chance-corrected test quality indices and item response theory (IRT) analyses, we determined optimal cut-scores for screening and examined item performance. Approximately 45.0% of the sample screened positive for probable DSM-5 PTSD using the PCL-5. The PC-PTSD-5 demonstrated high internal consistency and strong associations with PCL-5 scores (total, r = .79; items, rs = .51-.61). A cut-score of one was optimally sensitive for screening (κ[1] = .96), and a cut-score of four had the highest quality of probable efficiency (κ[.5] = .66) for detecting self-reported DSM-5 PTSD on the PCL-5. IRT analyses indicated Item 1 (nightmares, intrusive memories) provided the most information, and other items may not be incrementally useful for this sample. Findings provide preliminary support for the use of the PC-PTSD-5 as a brief alternative to the PCL-5 among chronically trauma-exposed patients in the public healthcare setting.

Psychometric properties of the post-traumatic stress disorder checklist for DSM-5 (PCL-5) in Chinese stroke patients

BackgroundStroke is a devastating disease and can be sufficiently traumatic to induce post-traumatic stress disorder (PTSD). Post-stroke PTSD is attracting increasing attention, but there was no study assessing the psychometric properties of the PCL-5 in stroke populations. Our study was conducted to examine the psychometric properties of the PTSD Checklist for DSM-5 (PCL-5) in Chinese stroke patients.MethodsThis was a cross-sectional observational study conducted at our hospital. Three hundred and forty-eight Chinese stroke patients came to our hospital for outpatient service were recruited. They were instructed to complete the PCL-5 scales and were interviewed for PTSD diagnosis with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5). The cutoff scores, reliability and validity of the PCL-5 were analyzed.ResultsPCL-5 scores in our sample were positively skewed, suggesting low levels of PTSD symptoms. The reliability of PCL-5 was good. Exploratory and confirmatory factor analyses indicated acceptable construct validity, and confirmed the multi-dimensionality of the PCL-5. By CFA analysis, the seven-factor hybrid model demonstrated the best model fit. The PCL-5 also showed good convergent validity and discriminant validity. Receiver operating characteristic (ROC) analyses revealed a PCL-5 score of 37 achieved optimal sensitivity and specificity for detecting PTSD.ConclusionsOur findings supported the use of PCL-5 as a psychometrically adequate measure of post-stroke PTSD in the Chinese patients.