Screening Tool For Posttraumatic Stress Disorder Research Articles

A PTSD Screen for Forensic Populations

Posttraumatic stress disorder (PTSD) has been observed in a sizable proportion of the U.S. adult correctional population. Jail administrators must pay particularly close attention to inmates with PTSD symptoms, considering these facilities serve as the gateway to the criminal justice system and inmates with PTSD may pose a risk to themselves, other inmates, and staff. The reality of conducting behavioral health assessments in a jail environment is wrought with significant challenges, including limited time. The current study examined prior research on PTSD screening tools to establish an empirical basis for a practical screen to be used among adults recently booked into local jails. Data from a random sample of 283 adults assessed specificity and sensitivity rates of different combinations of criteria. Results indicated a two-item screen achieved an 86.4% sensitivity rate as well as an 80.4% specificity rate. This evidence demonstrates a practical and clinically relevant approach to conducting PTSD screens among adult jail inmates.

Validation of the posttraumatic stress disorder checklist \u2013 5 (PCL-5) in a primary care population with high HIV prevalence in Zimbabwe

BackgroundThere is a dearth of validated tools measuring posttraumatic stress disorder (PTSD) in low and middle-income countries in sub-Saharan Africa. We validated the Shona version of the PTSD Checklist for DSM-5 (PCL-5) in a primary health care clinic in Harare, Zimbabwe.MethodAdults aged 18 and above attending the clinic were enrolled over a two-week period in June 2016. After obtaining written consent, trained research assistants administered the tool to eligible participants. Study participants were then interviewed independently using the Clinician Administered PTSD Scale (CAPS-5) as the gold standard by one of five doctors with training in mental health.ResultA total of 204 participants were assessed. Of these, 91 (44.6%) were HIV positive, 100 (49%) were HIV negative, while 13 (6.4%) did not know their HIV status. PTSD was diagnosed in 40 (19.6%) participants using the gold standard procedure. Using the PCL-5 cut-off of ≥33, sensitivity and specificity were 74.5% (95%CI: 60.4–85.7); 70.6% (95%CI: 62.7–77.7), respectively. The area under the ROC curve was 0.78 (95%CI: 0.72–0.83). The Shona version of the PCL-5 demonstrated good internal consistency (Cronbach’s alpha = 0.92).ConclusionThe PCL-5 performed well in this population with a high prevalence of HIV. There is need to explore ways of integrating screening tools for PTSD in interventions delivered by lay health workers in low and middle-income countries (LMIC).

Number and Type of Post-Traumatic Stress Disorder Symptom Domains Are Associated With Patient-Reported Outcomes in Patients With Chronic Pain

Post-traumatic stress disorder (PTSD) commonly accompanies complex chronic pain, yet PTSD is often overlooked in chronic pain management. Using the 4-item Primary Care (PC)-PTSD screening tool, we evaluated the relationship between the number and type of PC-PTSD symptoms endorsed and a set of patient-reported outcomes, including: pain intensity and interference, function, mood, quality of life, and substance abuse risk in a consecutive sample of patients with chronic pain (n = 4,402). Patients completed PainTracker, a Web-based patient-reported outcome tool that provides a multidimensional evaluation of chronic pain, as part of their intake evaluation at a specialty pain clinic in a community setting. Twenty-seven percent of the sample met PC-PTSD screening criteria for PTSD by endorsing 3 of the 4 symptom domains. Significant ordinal trends were observed between increasing number of PTSD symptoms and all outcomes evaluated. The occurrence of even 1 PTSD symptom was associated with overall poorer outcomes, suggesting that subsyndromal PTSD is clinically significant in the context of chronic pain. Among the 4 PTSD domains assessed, “numbness/detachment” was most strongly associated with negative pain outcomes in relative weight analysis. Results from this cross-sectional study suggest that a range of pain-related outcomes may be significantly related to comorbid PTSD. PerspectiveWe present evidence that PTSD symptoms are significantly related to a broad set of pain-related patient-reported outcomes. These findings highlight the need to evaluate for PTSD symptoms in patients with chronic pain, especially feelings of numbness or detachment from others, to improve understanding and management of chronic pain.

A Brief Screening Tool for PTSD: Validation of the Korean Version of the Primary Care PTSD Screen for DSM-5 (K-PC-PTSD-5)

The purpose of this study was to develop and evaluate psychometrically the Korean version of the Primary Care Posttraumatic Stress Disorder Screen for the Diagnostic and Statistical Manual-fifth edition (K-PC-PTSD-5). In total, 252 participants were interviewed with the Structured Clinical Interview for Diagnostic and Statistical Manual-fifth edition-research version (SCID-5-RV). The K-PC-PTSD-5 showed good internal consistency (α = 0.872), test-retest reliability (r = 0.89), and concurrent validity (r = 0.81). A score of 3 was identified as the threshold for clinically significant posttraumatic stress disorder (PTSD) symptoms. Overall, the results indicate that the K-PC-PTSD-5 is a useful, timesaving instrument for screening PTSD symptoms.

The Psychosocial Trauma of ACL Ruptures in Young Athletes

Objectives:Sustaining severe injuries requiring operative fixation causes emotional harm in addition to physical damage in young athletes. While the fear of re-injury following an anterior cruciate ligament ruptures and reconstruction has been established, the extent of the psychosocial trauma, including hyperarousal and intrusion, is largely unknown. We hypothesize that post-traumatic stress disorder symptoms are present young athletes with strong athletic identities following ACL ruptures.Methods:The impact of events scale, the athletic identity measurement score, and a novel specialization instrument were administered to 7 to 21 year old patients following ACL rupture. These instruments represent a modified post-traumatic stress disorder screening tool psychometrically validated in children, a validated tool to measure athletic identity, and an athlete specialization questionnaire designed by the authors respectively. Athletes were recruited from the sports medicine clinic at the senior authors’ academic institution and the instruments were administered upon the patients’ first orthopedic visit following the diagnosis of an ACL rupture. The full extent of the knee injury and any history of prior knee injuries were also assessed.Results:Twenty-one patients with a mean age of 14.9 ± 2.9 years completed the emotional trauma assessment and 52.2% of respondents were female. The most common concurrent injury was a meniscal tear (47.8%) and 9.5% of patients reported a prior ACL rupture and reconstruction. Regarding specialization, one-third of athletes played one sport only, 52.4% of athletes played multiple sports while focusing on one above the others, and 14.2% of athletes balanced their sports equally. Single-sport athletes scored significantly higher on the athletic identity questionnaire (single-sport mean 57.2; multi-sport mean 52.1; p = .02). The majority of patients experience traumatic symptoms in all three major categories as 86.4% endorsed avoidance symptoms, 81.8% admitted intrusion symptoms, and 81.8% admitted hyperarousal symptoms. Older athletes were significantly more likely to experience stronger emotionally traumatic symptoms (p = .03) as 16 - 21 year old athletes scored a mean of 62.6 on the Impact of Events Scale compared to 39.6 for 7 - 15 year old athletes. While male patients experienced stronger traumatic symptoms than female patients, the separation was not found to be statistically significant (male 50.2; female 43.6; p = .12).Conclusion:The emotional trauma for young athletes following ACL ruptures extends beyond the avoidance symptoms that have been previously established. Psychological evaluation and support is imperative to providing holistic care following this injury.Demographics and Psychosocial Symptom PrevalenceAge14.9 ± 2.9Female52.8%Male47.2%Meniscal Injury47.2%Prior ACL Injury9.5%Traumatic Symptoms:Avoidance86.4%Intrusion81.8%Hyperarousal81.8%

Toxic trauma: Household water quality experiences predict posttraumatic stress disorder symptoms during the Flint, Michigan, water crisis

We examined the relationship between perceptions of household tap water quality and posttraumatic stress disorder (PTSD) symptoms during the Flint, Michigan, water crisis in 2015–2016. The Speak to Your Health Community Survey is a community-based participatory component of the health surveillance system in Genesee County, Michigan. Perceptions of household tap water quality was added to the 2015–2016 survey wave after inadequate official response to concerns over water quality after a change in Flint's municipal water supply. Respondents (N = 786) also completed a brief PTSD screening tool. We examined the relationships of perceived household tap water quality to PTSD symptomatology and positive screening criteria for PTSD, controlling for sociodemographics. Perceived tap water quality predicted PTSD symptomatology and positive screening criteria for PTSD, independent of sociodemographics. The adverse mental health impact of municipal toxic contamination may generalize to other similar environmental contamination incidents.

The Second Victim: Can We Identify Those Most At Risk? [18G

INTRODUCTION: Maternal and perinatal deaths impact those providing care to these patients (“second victims”). Limited research exists to determine who is likely to experience post traumatic stress disorder (PTSD), depression or anxiety after a maternal or perinatal death. METHODS: A survey was distributed by email to all Women’s Services staff (including Neonatal ICU) at an urban university hospital. The survey asked about experiences with perinatal and maternal death and included questions from validated screening tools for PTSD (PC-PTSD) and depression (PQH4). RESULTS: There were 105 responses to the survey. 43 of the responders were physicians. The remaining responders were midwives, nurses, techs and administrative staff. A multivariate model was used to test the independent association of predictors with outcomes and was used to develop prediction models. Four variables were predictive of a “negative outcome” (defined as experiencing anxiety, depression, post-traumatic stress symptoms, or work problems). These included: (1) a non-physician role, (2) substance use, (3) career change consideration, and (4) seeking mental health treatment after an event. With each additional risk factor, the negative outcome score increased significantly. Age, sex, religious beliefs, marital or parental status, and level of clinical involvement with patient/baby were not significantly correlated with negative outcomes. CONCLUSION: When providing support for team members involved in a maternal or perinatal death, individuals at risk for PTSD, anxiety, depression and work related problems should be identified and supported. Future studies will focus on the best way to assist those impacted by these events.

Predictive validity of the Trauma Screening Questionnaire in detecting post-traumatic stress disorder in patients with psychotic disorders.

Post-traumatic stress disorder (PTSD) is highly prevalent in patients with a psychotic disorder. Because a PTSD diagnosis is often missed in patients with psychosis in routine care, a valid screening instrument could be helpful. To determine the validity of the Trauma Screening Questionnaire (TSQ) as a screening tool for PTSD among individuals with psychotic disorders. Among 2608 patients with a psychotic disorder, the rate of trauma exposure was determined and the TSQ was administered to screen for PTSD. PTSD status was verified in 455 patients using the Clinician-Administered PTSD Scale (trial registration: ISRCTN 79584912). Trauma exposure was reported by 78.2% of the 2608 patients. PTSD prevalence was estimated at 16% (95% CI 14.6-17.4%) compared with 0.5% reported in the patients' clinical charts. A TSQ cut-off score of six predicted PTSD with 78.8% sensitivity, 75.6% specificity, 44.5% correct positives and 93.6% correct negatives. The TSQ seems to be a valid screening tool for PTSD in patients with a psychotic disorder.

Factor Structure and Psychometric Properties of the Posttraumatic Stress Disorder (PTSD) Checklist and DSM-5 PTSD Symptom Set in a Long-Term Postearthquake Cohort in Armenia.

Psychometric properties of the Armenian-language posttraumatic stress disorder (PTSD) Checklist-Civilian version (PCL-C) and the DSM-5 PTSD symptom set were examined in a long-term cohort of earthquake survivors. In 2012, 725 survivors completed the instruments. Item-/scale-level analysis and confirmatory factor analysis (CFA) were performed for both scales. In addition, exploratory factor analysis (EFA) was conducted for DSM-5 symptoms. Also, the differential internal versus external specificity of PTSD symptom clusters taken from the most supported PTSD structural models was examined. Both scales had Cronbach's alpha greater than .9. CFA of PCL-C structure demonstrated an excellent fit by a four-factor (reexperiencing, avoidance, numbing, and hyperarousal) model known as numbing model; however, a superior fit was achieved by a five-factor model (Elhai et al.). EFA yielded a five-factor structure for DSM-5 symptoms with the aforementioned four domains plus a negative state domain. This model achieved an acceptable fit during CFA, whereas the DSM-5 criteria-based model did not. The Armenian-language PCL-C was recommended as a valid PTSD screening tool. The study findings provided support to the proposed new classification of common mental disorders, where PTSD, depression, and generalized anxiety are grouped together as a subclass of distress disorders. Recommendations were made to further improve the PTSD diagnostic criteria.

Diagnostic Utility of the Impact of Event Scale–Revised in Two Samples of Survivors of War

The study aimed at examining the diagnostic utility of the Impact of Event Scale-Revised (IES-R) as a screening tool for post-traumatic stress disorder (PTSD) in survivors of war. The IES-R was completed by two independent samples that had survived the war in the Balkans: a sample of randomly selected people who had stayed in the area of former conflict (n = 3,313) and a sample of refugees to Western European countries (n = 854). PTSD was diagnosed using the MINI International Neuropsychiatric Interview. Prevalence of PTSD was 20.1% in the Balkan sample and 33.1% in the refugee sample. Results revealed that when considering a minimum value of specificity of 0.80, the optimally sensitive cut-off score for screening for PTSD in the Balkan sample was 34. In both the Balkan sample and the refugee sample, this cut-off score provided good values on sensitivity (0.86 and 0.89, respectively) and overall efficiency (0.81 and 0.79, respectively). Further, the kappa coefficients for sensitivity for the cut-off of 34 were 0.80 in both samples. Findings of this study support the clinical utility of the IES-R as a screening tool for PTSD in large-scale research studies and intervention studies if structured diagnostic interviews are regarded as too labor-intensive and too costly.

Psychometric Properties of IES-R, Short Arabic Version in Contexts of Military Violence

Objective: Professional social workers and emergency workers operating in war contexts may develop posttraumatic stress disorder (PTSD) following exposure to traumatic events. Impact of trauma must be accurately assessed by researchers via robust models of measurement. In this article, measurement models for the 13-item Children’s Revised Impact of Event scale (CRIES-13), Arabic version were assessed in an adult population operating in a war context. Method: A sample ( N = 218) of in-service adult Palestinian helpers was evaluated using confirmatory factor analysis. Results: Findings supported adoption of a bidimensional model comprising two normally distributed measures labeled intrusion and avoidance as a quantitative screening tool for PTSD in contexts of military violence. Conclusion: The solid psychometric properties of CRIES in an adult population suggest its use as a short version of the Impact of Event scale–Revised (IES), Arabic version (IES-R-13).

Post-traumatic stress disorder in trainee doctors with previous needlestick injuries

Doctors are at particular risk of occupational needlestick injuries (NSI), and these may result in considerable acute anxiety and fear of disease transmission. To measure the prevalence of post-traumatic stress disorder (PTSD) among trainee doctors who had experienced an NSI. A questionnaire was distributed to trainee doctors starting work in a large university hospital in the UK. The survey gathered demographic information and experience of previous NSI and included questions designed to assess the presence of PTSD via the Impact of Event Scale (IES), a widely used screening tool for PTSD. The six-item version of this tool (IES-6) was used in this study. Among the 147 doctors who participated, 80 (54%) had sustained at least one NSI during their training and 77 of these completed the IES-6 survey. Of note, 38% of injuries (30/80) were not reported to the occupational health or emergency departments. Using a cut-off level of 10 in the IES-6, 12% (9/77) of the doctors who suffered NSI during their training showed evidence of PTSD. Since the prevalence of PTSD in the general population is estimated at 3%, the odds ratio of PTSD in doctors who had NSI was 4.28 (95% confidence interval: 2.16-8.47). NSI injury is common among doctors in training. As 12% of doctors with experience of NSI had post-traumatic stress reactions, special attention should be paid to psychological impacts of NSIs. We would recommend further prospective studies.

Adaptação transcultural da versão brasileira da Escala do Impacto do Evento - Revisada (IES-R)

The Impact of Events Scale-Revised (IES-R) is used to screen for post-traumatic stress disorder (PTSD). The aim of this study was to assess the cross-cultural adaptation of the IES-R. The scale was translated into Brazilian Portuguese and culturally adapted. Reliability and validity were evaluated in 45 individuals divided into three groups of 15 (without PTSD, with PTSD, and treated for PTSD). Reliability was evaluated using intraclass correlation coefficient - ICC and Cronbach's alfa. Discriminant validity was evaluated by comparing mean IES-R scores in the three groups. The area under the ROC curve (AUC) was evaluated to determine cut-offs with higher sensitivity (s) and specificity (e) using the clinical interview (DSM-IV) as reference. The IES-R showed good reliability (ICC = 1; alfa from 0.75 to 0.93). The mean IES-R scores (p < 0.05) and ROC curve had good discriminant validity for a cut-off of 5.6 (s = 0.80, e = 0.70 and AUC = 0.81). The Brazilian version of IES-R showed good properties and can be a useful screening tool for PTSD.

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.

Emotional consequences of intensive care unit delirium and delusional memories after intensive care unit admission: A systematic review

PurposeThe aim of this study was to review literature exploring the emotional consequences of delirium and delusional memories in intensive care unit patients. MethodsA systematic review was performed using PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and PsychINFO. ResultsFourteen articles were eligible for this review. Five of them assessed delirium during intensive care unit admission, and the remainder assessed delusional memories during or after admission. No association was found for delirium and adverse emotional outcome. Data regarding delusional memories and emotional outcome were heterogenic. Some studies presented worse scores on posttraumatic stress disorder screening tools in patients with delusional memories, whereas other studies found better scores in patients with delirium or delusional memories. ConclusionsBased on current literature, no relationship could be shown for delirium and emotional outcome. Regarding delusional memories and adverse emotional outcome, results were in contradiction.

The child behavior checklist PTSD scale: Screening for PTSD in young children with high exposure to trauma

The objective of this study was to examine the validity of the Child Behavior Checklist (CBCL) Posttraumatic Stress Disorder (PTSD) subscale to screen for PTSD in children attending an inner-city early childhood mental health center. Using various measures, we assessed 51 preschool-age children with high exposure to trauma receiving outpatient child-parent psychotherapy for PTSD. We compared 15 items on the CBCL, a proposed subscale indicative of PTSD, to the UCLA-PTSD Index and to clinical diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) and the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (rev. ed.; DC:0-3; Zero to Three, 2005). Using the DC:0-3 criteria, 24% of the children were diagnosed with PTSD, but only 4% using the DSM-IV. The CBCL-PTSD subscale did not reach significant sensitivity or specificity to be a valuable screening tool for PTSD in this population.

The relationship between substance use and posttraumatic stress disorder in a methadone maintenance treatment program

Introduction and Aims Posttraumatic stress disorder (PTSD) is frequently linked with substance abuse. The self-medication hypothesis suggests that some people may use illicit substances in an attempt to self-treat psychiatric symptoms. This study explores the relationship between substance abuse and PTSD symptom clusters in a methadone maintenance population. Design and Methods Clients of a methadone maintenance program at a public Drug and Alcohol Service were invited to complete the PTSD Checklist–Civilian Version, a screening tool for PTSD. Information about their history of substance use was also collected. Results Eighty clients (43 female, 37 male), aged 35 ± 8.0 years (mean ± SD), participated in the study, of which 52.7% screened positive for PTSD. Severity of marijuana use was significantly associated with a number of reexperiencing and hyperarousal symptoms and with overall severity of PTSD symptoms. Opiate, amphetamine, and benzodiazepine use did not appear to be related to PTSD symptoms. Discussion and Conclusions In this sample, marijuana may be used to self-treat certain PTSD symptoms, supporting the self-medication hypothesis. Further research is required to confirm the association between a diagnosis of PTSD and substance use. Given the high prevalence of PTSD in the substance-using population, routine PTSD screening in the substance abuse treatment setting may be justified.

Die posttraumatische Stressskala-14 (PTSS-14) – Validierung der richtlinienkonformen Übersetzung für den deutschsprachigen Raum

Hospitalization may represent a stressor that can lead to Posttraumatic stress disorder (PTSD). Translation of the UK-PTSS-14, conducted in accordance with ISPOR principles and validation with the PDS (86 patients). The ROC analysis showed that the German version of PTSS-14 is a valid instrument with high sensitivity (82%) and specificity (92%) with the optimum cut-off point at 40 points. The translation process was authorized by the author of the UK-PTSS-14. The validated German version of PTSS-14 is now ready for use as an efficient and reliable screening-tool for PTSD in a clinical setting.

Validation of a Swedish version of the Impact of Event Scale-Revised (IES-R) in patients with burns

The Impact of Event Scale (IES) and the Impact of Event Scale-Revised (IES-R) are often used as self-report instruments for symptoms of post-traumatic stress disorder (PTSD). However, there are few validations of the IES and the IES-R against structured clinical interviews. In this study the two scales, together with the three subscales of the IES-R, were assessed for their agreement with a diagnosis of PTSD in patients with burns 1 year after injury. Sixty patients with burns were evaluated 1 year after injury using the Structured Clinical Interview for the DSM-IV Axis I (SCID-I) psychiatric disorders and a Swedish version of the IES-R. The total score of the IES-R had the best discriminant ability (0.89) with a sensitivity of 1.0 and a specificity of 0.78. In conclusion, the total IES-R had good properties as a screening tool for PTSD and subsyndromal PTSD 1 year after burn injury.

Psychometric properties of the IES-R in traumatized substance dependent individuals with and without PTSD

Posttraumatic stress disorder (PTSD) is common among treatment-seeking substance abusers. Despite the high prevalence of these co-occurring conditions, few PTSD screening tools have been evaluated for their utility in identifying PTSD in substance use disorder (SUD) populations. The present study evaluated the psychometric properties of the Impact of Event Scale—Revised (IES-R) in a sample of 124 substance dependent individuals. All participants had a history of a DSM-IV Criterion A traumatic event, and 71 individuals met diagnostic criteria for PTSD. Participants with comorbid PTSD reported significantly more symptoms of anxiety, depression, and PTSD compared to substance dependent individuals without PTSD. Acceptable internal consistency and convergent validity of the IES-R were established among a substance dependent sample. Examination of diagnostic effectiveness suggested a cutoff value of 22 as optimal for a substance using population, resulting in adequate classification accuracy, sensitivity, and specificity.