Screening Instrument For Posttraumatic Stress Disorder Research Articles

The Child Behavior Checklist as a Screening Instrument for PTSD in Refugee Children.

Thousands of refugees who have entered Europe experienced threatening conditions, potentially leading to post traumatic stress disorder (PTSD), which has to be detected and treated early to avoid chronic manifestation, especially in children. We aimed to evaluate and test suitable screening tools to detect PTSD in children. Syrian refugee children aged 4–14 years were examined using the PTSD-semi-structured interview, the Kinder-DIPS, and the Child Behavior Checklist (CBCL). The latter was evaluated as a potential screening tool for PTSD using (i) the CBCL-PTSD subscale and (ii) an alternative subscale consisting of a psychometrically guided selection of items with an appropriate correlation to PTSD and a sufficient prevalence (presence in more than 20% of the cases with PTSD). For both tools we calculated sensitivity, specificity, and a receiver operating characteristic (ROC) curve. Depending on the sum score of the items, the 20-item CBCL-PTSD subscale as used in previous studies yielded a maximal sensitivity of 85% and specificity of 76%. The psychometrically guided item selection resulted in a sensitivity of 85% and a specificity of 83%. The areas under the ROC curves were the same for both tools (0.9). Both subscales may be suitable as screening instrument for PTSD in refugee children, as they reveal a high sensitivity and specificity.

Does This Patient Have Posttraumatic Stress Disorder?

Posttraumatic stress disorder (PTSD) is a relatively common mental health condition frequently seen, though often unrecognized, in primary care settings. Identifying and treating PTSD can greatly improve patient health and well-being. To systematically review the utility of self-report screening instruments for PTSD among primary care and high-risk populations. We searched MEDLINE and the National Center for PTSD's Published International Literature on Traumatic Stress (PILOTS) databases for articles published on screening instruments for PTSD published from January 1981 through March 2015. Study quality was rated using Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria. Studies of screening instruments for PTSD evaluated using gold standard structured clinical diagnostic interviews that had interview samples of at least 50 individuals. We identified 2522 citations, retrieved 318 for further review, and retained 23 cohort studies that evaluated 15 screening instruments for PTSD. Of the 23 studies, 15 were conducted in primary care settings in the United States (n = 14,707 were screened, n = 5374 given diagnostic interview, n = 814 had PTSD) and 8 were conducted in community settings following probable trauma exposure (ie, natural disaster, terrorism, and military deployment; n = 5302 were screened, n = 4263 given diagnostic interview, n = 393 were known to have PTSD with an additional 50 inferred by rates reported by authors). Two screens, the Primary Care PTSD Screen (PC-PTSD) and the PTSD Checklist were the best performing instruments. The 4-item PC-PTSD has a positive likelihood ratio of 6.9 (95% CI, 5.5-8.8) and a negative likelihood ratio of 0.30 (95% CI, 0.21-0.44) using the same score indicating a positive screen as used by the Department of Veterans Affairs in all of its primary care clinics. The 17-item PTSD Checklist has a positive likelihood ratio of 5.2 (95% CI, 3.6-7.5) and a negative likelihood ratio of 0.33 (95% CI, 0.29-0.37) using scores of around 40 as indicating a positive screen. Using the same score employed by primary care clinics in the Department of Veterans Affairs to indicate a positive screen, the 4-item PC-PTSD has a sensitivity of 0.69 (95% CI, 0.55-0.81), a specificity of 0.92 (95% CI, 0.86-0.95), a positive likelihood ratio of 8.49 (95% CI, 5.56-12.96) and a negative likelihood ratio of 0.34 (95% CI, 0.22-0.48). For the 17-item PTSD Checklist, scores around 40 as indicating a positive screen, have a sensitivity of 0.70 (95% CI, 0.64-0.77), a specificity of 0.90 (95% CI, 0.84-0.93), a positive likelihood ratio of 6.8 (95% CI, 4.7-9.9) and a negative likelihood ratio of 0.33 (95% CI, 0.27-0.40). Two screening instruments, the PC-PTSD and the PTSD Checklist, show reasonable performance characteristics for use in primary care clinics or in community settings with high-risk populations. Both are easy to administer and interpret and can readily be incorporated into a busy practice setting.

Diaries and memories following an ICU stay: a 2-month follow-up study.

Many patients lack a clear recollection from their stay in the intensive care unit (ICU). Diaries have been introduced as a tool to complete memories and reduce the risk of posttraumatic stress disorder (PTSD). To describe and compare patients' memories and PTSD in relation to having received and read or not received a diary and patients' experiences of having received and read their diary, without having discussed the contents with ICU staff. Descriptive and comparative. Patients received their diaries at ICU discharge. After 2 months patients answered the ICU Memory Tool, a screening instrument for PTSD (PTSS-14) and a questionnaire including space for own comments about the diaries. Of 96 patients, 52(54%) received a diary, 44 did not. Patients with diaries had significantly longer stay and more mechanical ventilation. Of these, 40 patients responded to PTSS-14 and had evaluated and read the diary and 34 patients served as controls. No significant differences were found in presence/absence of memories between these groups. In the diary-group patients with emotional memories had lower APACHE. Feelings of being anxious or frightened were more common in the diary-group. At 2 months, 12% scored above cut-off on the PTSS14 with no difference between groups. The diaries were helpful for understanding the ICU-stay. Diaries seem valuable in understanding what happened, as an act of caring and as a tool for discussion with relatives and friends. Patients valued reading their diaries. None expressed the wish to have read the diary together with a member of staff. The diary and non-diary groups however reported similar memories. Diaries seem to be valuable in understanding what happened, giving a feeling of trust and for talking about their ICU-stay. As many patients described stressful memories, sessions should be offered with ICU staff.

Trajectories of Scores on a Screening Instrument for PTSD Among World Trade Center Rescue, Recovery, and Clean-Up Workers.

The longitudinal course of posttraumatic stress disorder (PTSD) over 8-9 years was examined among 16,488 rescue and recovery workers who responded to the events of September 11, 2001 (9/11) at the World Trade Center (WTC; New York, NY), and were enrolled in the World Trade Center Health Registry. Latent class growth analysis identified 5 groups of rescue and recovery workers with similar score trajectories at 3 administrations of the PTSD Checklist (PCL): low-stable (53.3%), moderate- stable (28.7%), moderate-increasing (6.4%), high-decreasing (7.7%), and high-stable (4.0%). Relative to the low-stable group, membership in higher risk groups was associated with 9/11-related exposures including duration of WTC work, with adjusted odds ratios ranging from 1.3 to 2.0, witnessing of horrific events (range = 1.3 to 2.1), being injured (range = 1.4 to 2.3), perceiving threat to life or safety (range = 2.2 to 5.2), bereavement (range = 1.6 to 4.8), and job loss due to 9/11 (range = 2.4 to 15.8). Within groups, higher PCL scores were associated with adverse social circumstances including lower social support, with B coefficients ranging from 0.2 to 0.6, divorce, separation, or widowhood (range = 0.4-0.7), and unemployment (range = 0.4-0.5). Given baseline, exposure-related, and contextual influences that affect divergent PTSD trajectories, screening for both PTSD and adverse circumstances should occur immediately, and at regular intervals postdisaster.

Psychometric Properties of the Posttraumatic Diagnostic Scale (PDS) in Alcohol-Dependent Patients

ABSTRACTBackground: A high prevalence of comorbid posttraumatic stress disorder (PTSD) is found in patients with substance use disorders (SUDs). In the few existing studies, mixed results regarding the psychometric properties of common screening instruments for PTSD have been reported for patients with SUDs. No results are available for the Posttraumatic Diagnostic Scale (PDS), an established self-report measure for PTSD.Methods: The authors assessed 105 patients with alcohol dependence according to DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) (70% male) 2 weeks after their admission to an inpatient detoxification unit. Participants were administered the PDS, the PTSD module of the Structured Clinical Interview for DSM-IV (SCID), as well as measures of depression and anxiety. Patients with other substance use disorders were excluded as were patients reporting no traumatic event. Results: Internal consistencies were good to very good for the total scale (.93) and the subscales of the PDS (.82–.91). In our sample, the PDS had a high specificity (.89) but only moderate sensitivity (.57). Diagnostic agreement with the SCID was 83% (.46). The results of a receiver operating characteristic (ROC) analysis suggested that a PDS score of 8 was the optimal cutoff to screen for PTSD. The highest diagnostic agreement between PDS and SCID (89%; .60) was achieved using a cutoff score of 24. Conclusions: These findings confirm previous results suggesting that the psychometric properties of self-report measures of PTSD in patients with SUDs might differ from those in the general population. When the PDS is used in recently detoxified patients with alcohol dependence, it seems advisable to modify the cutoff score of this instrument to improve its sensitivity and diagnostic accuracy.

Validation of the Italian version of the Screening Questionnaire for Disaster Mental Health (SQD) in a post-earthquake urban environment.

Aim of this study was to implement and validate the Italian version of the Screening Questionnaire for Disaster Mental Health (SQD), a tool for the screening of post-traumatic stress disorder (PTSD) and depression in the long-term aftermaths of a natural disaster. A convenience sample of 116 subjects living in L'Aquila after the 2009 earthquake were administered the SQD and two gold-standard instruments for PTSD and depression. Reliability, concurrent validity and convergent validity of SQD were estimated. Cronbach's alpha was 0.86. Concurrent validity as measured by the Spearman correlation coefficient resulted statistically significant both for PTSD and depression SQD subscales, as well as convergent validity as measured by ROC-AUC method. SQD is a valid, efficient and easy-to-use screening instrument for PTSD and depression after natural disasters.

Validation of two screening instruments for PTSD in Dutch substance use disorder inpatients

Posttraumatic stress disorder (PTSD) is highly prevalent in substance use disorder (SUD) populations. Because resources for extensive and thorough diagnostic assessment are often limited, reliable screening instruments for PTSD are needed. The aim of the current study was to test two short PTSD measures for diagnostic efficiency in predicting PTSD compared to the Clinician-Administered PTSD Scale (CAPS). The sample consisted of 197 SUD patients receiving residential substance use treatment who completed questionnaires regarding substance use and trauma-related symptoms, all abstinent from substance for 4weeks. The PTSD section of the Mini International Neuropsychiatric Interview plus (MINIplus) and the Self-Report Inventory for PTSD (SRIP) are compared to the CAPS. Results showed low sensitivity (.58) and high specificity (.91) for the PTSD section of the MINIplus. The SRIP showed high sensitivity (.80) and moderately high specificity (.73) at a cut-off score of 48. The prevalence of PTSD as measured with the CAPS was 25.4% current and 46.2% lifetime. Results indicate that the MINIplus, a short clinical interview, has insufficient quality as a screener for PTSD. The SRIP, however, is a reliable instrument in detecting PTSD in a SUD inpatient population in The Netherlands. Screening for PTSD is time efficient and increases detection of PTSD in SUD treatment settings.

Screening for posttraumatic stress disorder in civilian substance use disorder patients: Cross-validation of the Jellinek-PTSD screening questionnaire

This study aimed to cross-validate earlier findings regarding the diagnostic efficiency of a modified version of the Primary Care Posttraumatic Stress Disorder (PC-PTSD) screening questionnaire (A. Prins, P. Ouimette, R. Kimerling, R. P. Cameron, D. S. Hugelshofer, J. Shaw-Hegwer, et al., 2004). The PC-PTSD is a four-item screening questionnaire for Posttraumatic Stress Disorder (PTSD). Based on former research, we adapted the PC-PTSD for use among civilian substance use disorder (SUD) patients (D. Van Dam, T. Ehring, E. Vedel, & P. M. G. Emmelkamp, 2010). This version will be referred to as the Jellinek-PTSD (J-PTSD) screening questionnaire. Results showed a high sensitivity (.87), specificity (.75), and overall efficiency (.77) of the J-PTSD in detecting PTSD when using a cutoff score of 2. This confirms findings in former research, and suggests that the J-PTSD is a useful screening instrument for PTSD within a civilian SUD population. Both PTSD and SUD are severe and disabling disorders causing great psychological distress. An early recognition of PTSD among SUD patients makes it possible to address PTSD symptoms in time, which may ultimately lead to an improvement of symptoms in this complex patient group.

The PSS‐SR as a screening tool for PTSD in first‐episode psychosis patients

We examined the validity of the PTSD Symptom Scale - Self-Report (PSS-SR) as a screening instrument for post-traumatic stress disorder (PTSD) in patients recovering from first-episode psychosis. Sixty-one patients from the Early Psychosis Intervention Programme in Singapore completed the PSS-SR questionnaire. The Clinician-Administered PTSD Scale was administered by a blinded interviewer as the 'gold standard' to identify patients with PTSD. The sensitivity, specificity and receiver operating characteristic curve were used to determine the screening performance of the PSS-SR. The score representing the optimal cut-off point for the PSS-SR was 14, with a sensitivity and specificity of 0.83 and 0.71, respectively. The area under the curve was determined to be 0.82 (95% CI: 0.70-0.95). These data suggest that the PSS-SR can be a useful screening instrument for PTSD in patients recovering from their first psychotic episode.

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.

Posttraumatic stress disorder among parents of children on cancer treatment: a longitudinal study

The main aim of this study was to investigate the occurrence of cancer-related posttraumatic stress disorder (PTSD) among parents of children on cancer treatment. A longitudinal design with assessments at one week (T1), two (T2), and four (T3) months after the child's diagnosis was used. Two hundred and fourteen parents (107 mothers, 107 fathers) participated at T1-T3. The PTSD Checklist Civilian (PCL-C), a self-report screening instrument for PTSD, was answered by parents over the telephone. According to the PCL-C symptom criteria method 33%, more mothers than fathers, score as potential cases of acute stress disorder (ASD) at T1, whereas 28% as potential cases of PTSD at T2 and 22% at T3. The levels of acute- and posttraumatic stress symptoms show a linear, descending pattern, and mothers report higher levels than fathers. Half of the parents who score as potential cases of ASD a week after the child's diagnosis score as potential cases of PTSD four months later. The findings illustrate that a group of parents of children with cancer experience serious psychological distress related to their child's disease. A traumatic stress perspective on childhood cancer should be applied to paediatric oncology care and appropriate psychosocial interventions should be offered to parents when needed.

The predictive value of post-traumatic stress disorder symptoms for quality of life: a longitudinal study of physically injured victims of non-domestic violence

BackgroundLittle is known about longitudinal associations between post-traumatic stress disorder (PTSD) and quality of life (QoL) after exposure to violence. The aims of the current study were to examine quality of life (QoL) and the predictive value of post-traumatic stress disorder (PTSD) for QoL in victims of non-domestic violence over a period of 12 months.MethodsA single-group (n = 70) longitudinal design with three repeated measures over a period of 12 months were used. Posttraumatic psychological symptoms were assessed by using the Impact of Event Scale, a 15-item self-rating questionnaire comprising two subscales (intrusion and avoidance) as a screening instrument for PTSD. The questionnaire WHOQOL-Bref was used to assess QoL. The WHOQOL-BREF instrument comprises 26 items, which measure the following broad domains: physical health, psychological health, social relationships, and environment. Results of the analysis were summarized by fitting Structural Equation Modelling (SEM).ResultsFor each category of PTSD (probable cases, risk level cases and no cases), the mean levels of the WHOQOL-Bref subscales (the four domains and the two single items) were stable across time of assessment. Individuals who scored as probable PTSD or as risk level cases had significantly lower scores on the QoL domains such as physical health, psychological health, social relationships and environmental than those without PTSD symptoms. In addition, the two items examining perception of overall quality of life and perception of overall health in WHOQOL showed the same results according to PTSD symptoms such as QoL domains. PTSD symptoms predicted lower QoL at all three assessments. Similarly PTSD symptoms at T1 predicted lower QoL at T2 and PTSD symptoms at T2 predicted lower QoL at T3.ConclusionThe presence of PTSD symptoms predicted lower QoL, both from an acute and prolonged perspective, in victims of non-domestic violence. Focusing on the individual's perception of his/her QoL in addition to the illness may increase the treatment priorities and efforts.

The Children's Revised Impact of Event Scale (CRIES): Validity as a Screening Instrument for PTSD

The Children's Revised Impact of Event Scale (CRIES) is a brief child-friendly measure designed to screen children at risk for Posttraumatic Stress Disorder (PTSD). It has good face and construct validity, a stable factor structure, correlates well with other indices of distress, and has been used to screen very large samples of at-risk-children following a wide range of traumatic events. However, few studies have examined the scale's validity against a structured diagnostic interview based on the DSM-IV criteria for PTSD. In the present study, the CRIES and the PTSD section of the Anxiety Disorders Interview Schedule-Child and Parent Version (ADIS-CP) were administered to a sample of children and adolescents (n=63) recruited from hospital accident and emergency rooms and the validity of the CRIES as a screening tool evaluated. Cutoff scores were chosen from this sample with a low base-rate of PTSD (11.1%) to maximize sensitivity and minimize the likelihood that children with a diagnosis of PTSD would fail to be identified. Cutoff scores were then cross-validated in a sample of 52 clinically referred children who had a high base-rate of PTSD (67.3%). A cutoff score of 30 on the CRIES-13 and a cutoff score of 17 on the CRIES-8 maximized sensitivity and specificity, minimized the rate of false negatives, and correctly classified 75–83% of the children in the two samples. The CRIES-8 (which lacks any arousal items) worked as efficiently as the CRIES-13 (which includes arousal items) in correctly classifying children with and without PTSD. Results are discussed in light of the current literature and of the need for further development of effective screens for children at-risk of developing PTSD.

Posttraumatic stress disorder in the primary care medical setting

Posttraumatic stress disorder (PTSD) is a prevalent disorder that adversely affects 2–5% of the general population. Little is known about PTSD in the primary care setting. The purpose of the present study was to evaluate the utility of a screening instrument for PTSD (the PCL-C) in primary care and to examine comorbidity, disability, and patterns of healthcare utilization among persons with PTSD in this setting. Adult, English-speaking patients attending for routine medical care (N=368) participated in a two-stage screening consisting of the administration of a self-report measure for posttraumatic stress disorder (the PCL-C) followed by a structured diagnostic interview. Current (1-month) prevalence of PTSD was determined, as were current comorbid disorders. Brief functional impairment and disability indices were administered, and healthcare utilization in the prior 6 months was ascertained. 11.8% (standard error 1.7%) of primary care attendees met diagnostic criteria for either full or partial PTSD. Comorbidity with major depression (61% of cases of PTSD) and generalized anxiety disorder (39%) was common, but less so with social phobia (17%) and panic disorder (6%). Substance use disorder comorbidity (22%) was also fairly common. Patients with PTSD reported significantly more functional impairment than patients without mental disorders. Patients with PTSD also made greater use of healthcare resources than not mentally ill patients. PTSD frequently is encountered in primary care, and is associated with considerable functional impairment and healthcare utilization. Comorbidity with other mood and anxiety disorders is extensive. It remains to be seen if greater awareness and more aggressive treatment of PTSD in primary care will lead to improved functioning and reduced (or more appropriate) healthcare utilization. These are topics for further study.

The validity of screening for post‐traumatic stress disorder and major depression among Vietnamese former political prisoners

The aim of this study was to investigate the validity of the Harvard Trauma Questionnaire (HTQ) and the depression sub-scale of the Hopkins Symptom Checklist-25 (HSCL-25) in screening for post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) among Vietnamese former political prisoners (POWs). The study population included Vietnamese POWs (n = 51) who migrated to the Boston metropolitan area between January 1990 and July 1992 under the Special Released Re-education Center Detainees Resettlement Program. The criterion validity of the HTQ in assessing PTSD and of the depression sub-scale of the HSCL-25 in assessing MDD is supported by the results. Consideration of an appropriate cut-off score should include examination of the utility of a given screening instrument for PTSD or MDD within different settings, such as refugee camps vs. countries of third asylum.