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Pinto R, Albuquerque S, de Castro MV, Levendosky AA, Fonseca M, Jongenelen I, Maia Â, Gamito P. A Virtual Reality Simulation to Examine the Relationship Between Post-Traumatic Stress Symptoms and Decision-Making in First Responders. J Trauma Dissociation 2024:1-16. [PMID: 38978229 DOI: 10.1080/15299732.2024.2374370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/21/2024] [Indexed: 07/10/2024]
Abstract
First responders (FRs) are continuously exposed to critical incidents, considered traumatic events (TEs). This cumulative exposure increases the risk for post-traumatic stress disorder (PTSD). However, there is no evidence about the relationship between PTSD symptoms and emergency decision-making (EDM). The objective of this study was to examine the EDM of FRs during a virtual reality through the simulation of two emergency scenarios to collect data on the reaction time and the number of incorrect decisions. We also assessed PTSD symptoms, TE, and sociodemographics. The sample included 368 Portuguese FRs, were 295 (80.20%) males and 73 (19.80%) females, with a mean age of 33.96 (SD = 9.38). Considering the probable PTSD diagnosis according to the DSM-5, 85 (23.10%) of the FRs met the criteria. These individuals who meet the criteria exhibited higher EDM scores (M = 19.60, SD = 5.99) compared to those without probable PTSD (M = 17.87, SD = .5.66) (F(1, 360) = 5.32, p = .02, partial η2 = .015). We found that TEs had a direct effect on EDM, β = -.16, Z = -3.74, p < .001), and the pathway of trauma-PTSD symptoms-decision-making an indirect effect, β = .02, Z = 3.10, p = .002). Individuals exposed to more TEs demonstrated faster and more accurate decision-making in the context of EDM. However, when these individuals developed PTSD symptoms, their decision-making became slower and less accurate. The inclusion of a trauma-informed approach for FRs to prevent individual and job-related consequences is discussed.
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Affiliation(s)
- Ricardo Pinto
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisbon, Portugal
| | - Sara Albuquerque
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisbon, Portugal
| | - Maria Vieira de Castro
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisbon, Portugal
| | - Alytia A Levendosky
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Micaela Fonseca
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisbon, Portugal
| | - Inês Jongenelen
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisbon, Portugal
| | - Ângela Maia
- School of Psychology, University of Minho, Braga, Portugal
| | - Pedro Gamito
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisbon, Portugal
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2
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Georgescu T, Nedelcea C, Gorbănescu A, Papasteri C, Cosmoiu AM, Vasile DL, Letzner RD. Psychometric evaluation of the PCL-5: assessing validity, diagnostic utility, and bifactor structures. Eur J Psychotraumatol 2024; 15:2333222. [PMID: 38699832 PMCID: PMC11073431 DOI: 10.1080/20008066.2024.2333222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/11/2024] [Indexed: 05/05/2024] Open
Abstract
Background: The changes DSM-5 brought to the diagnostic criteria for posttraumatic stress disorder (PTSD) resulted in revising the most widely used instrument in assessing PTSD, namely the Posttraumatic Checklist for DSM-5 (PCL-5).Objective: This study examined the psychometric properties of the Romanian version of the PCL-5, tested its diagnostic utility against the Structured Clinical Interview for DSM-5 (SCID-5), and investigated the latent structure of PTSD symptoms through correlated symptom models and bifactor modelling.Method: A total sample of 727 participants was used to test the psychometric properties and underlying structure of the PCL-5 and 101 individuals underwent clinical interviews using SCID-5. Receiver operating characteristic curve (ROC) analyses were performed to test the diagnostic utility of the PCL-5 and identify optimal cut-off scores based on Youden's J index. Confirmatory Factor Analyses (CFAs) and bifactor modelling were performed to investigate the latent structure of PTSD symptoms.Results: Estimates revealed that the PCL-5 is a valuable tool with acceptable diagnostic accuracy compared to SCID-5 diagnoses, indicating a cut-off score of >47. The CFAs provide empirical support for Anhedonia, Hybrid, and bifactor models. The findings are limited by using retrospective, self-report data and the high percentage of female participants.Conclusions: The PCL-5 is a psychometrically sound instrument that can be useful in making provisional diagnoses within community samples and improving trauma-informed practices.
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Affiliation(s)
- Teodora Georgescu
- Department of Psychology and Cognitive Sciences, University of Bucharest, Bucharest, Romania
| | - Cătălin Nedelcea
- Department of Psychology and Cognitive Sciences, University of Bucharest, Bucharest, Romania
| | - Adrian Gorbănescu
- Department of Psychology and Cognitive Sciences, University of Bucharest, Bucharest, Romania
| | - Claudiu Papasteri
- Department of Psychology and Cognitive Sciences, University of Bucharest, Bucharest, Romania
| | - Ana Maria Cosmoiu
- Department of Psychology and Cognitive Sciences, University of Bucharest, Bucharest, Romania
| | - Diana Lucia Vasile
- Department of Psychology and Cognitive Sciences, University of Bucharest, Bucharest, Romania
| | - Ramona Daniela Letzner
- Department of Psychology and Cognitive Sciences, University of Bucharest, Bucharest, Romania
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Alexandrov A, Román N, Kovács P, Ritz A, Viszket MK, Kaló Z. Posttraumatic stress disorder symptomology as measured by PCL-5 and its relationships to resilience, hostility and stress among paramedics and social professionals. Stress Health 2024:e3409. [PMID: 38690633 DOI: 10.1002/smi.3409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/12/2024] [Accepted: 04/11/2024] [Indexed: 05/02/2024]
Abstract
This survey study aimed to contribute to the extensive debate on the dimensionality of the Posttraumatic Stress Disorder Checklist for the DSM-5 (PCL-5) questionnaire by examining the psychometric properties and construct validity of its Hungarian version and relying on the inspection of a conceptual network of related variables, that is, perceived stress, hostility, and resilience. Confirmatory factor analysis (CFA), exploratory structural equation modelling (ESEM) and path analysis were applied on data collected from 177 paramedics and 66 professionals from the social field (58.4% male; Mage = 43.5 ± 9.96 years). Despite the acceptable fit indices gained with CFA when testing the original four-factor DSM-5 model of PCL-5, strong associations (r = 0.69-0.90) between subscales were found. Thus, ESEM was applied and as a result a new, three-factor version of the DSM-5 model of PCL-5 was proposed due to significant crossloadings that was theoretically also supported. The Reexperiencing and Avoidance subscales were merged and named Difficulty with Assimilation of Experience (DAE). In the path analysis only two of the tested associations were not significant using the new factor structure, in which stress fully mediated the relationship between resilience and DAE, and resilience and Hyperarousal. Overall, the hypothesised pathways between variables fit the collected data well. (weighted least squares mean-and variance-adjusted χ2 = 503.750 (df = 270), comparative fit index = 0.948, Tucker-Lewis index = 0.939, root mean square error of approximation (90% confidence interval) = 0.064 (0.055-0.073), weighted root mean square residual = 1.024). Our analysis of the Hungarian version of PCL-5 contributes to the testing of a DSM-5-based questionnaire measuring posttraumatic stress disorder symptomology.
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Affiliation(s)
- Anna Alexandrov
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Nóra Román
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Petra Kovács
- National Ambulance Service, Psychological and Mental Health Group, Budapest, Hungary
- Doctoral School of Psychology, University of Pécs, Pécs, Hungary
| | - Anna Ritz
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | | | - Zsuzsa Kaló
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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4
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Bovin MJ, Mahoney CT, Klein AB, Keane TM, Marx BP. Comparing the Prevalence of Probable DSM-IV and DSM-5 Posttraumatic Stress Disorder in a Sample of U.S. Military Veterans Using the PTSD Checklist. Assessment 2023; 30:2050-2057. [PMID: 36382778 DOI: 10.1177/10731911221133483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Posttraumatic stress disorder (PTSD) changed substantially when Diagnostic and Statistical Manual of Mental Disorders transitioned from fourth (DSM-IV) to fifth (DSM-5) edition. Hoge et al. found that although diagnostic prevalence remained consistent across nomenclatures, diagnostic concordance was low (55%). Study goals were to examine both the generalizability of these findings and whether either diagnosis systematically excluded patients. U.S. veterans (N = 1,171) who completed the PTSD Checklist for DSM-IV (PCL-S) and DSM-5 (PCL-5) were classified as: probable PTSD on both measures; probable PTSD on PCL-S only; probable PTSD on PCL-5 only; or no PTSD on either measure. Diagnostic prevalence was equivalent. Unlike Hoge et al.'s findings, diagnostic concordance was high (91.3%). Furthermore, observed demographic and severity differences were driven by disparities between veterans in the no PTSD versus the probable PTSD groups, not diagnostic changes. Findings suggest translatability across measures and that diagnostic changes do not systematically exclude patients.
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Affiliation(s)
- Michelle J Bovin
- National Center for PTSD at VA Boston Healthcare System, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, MA, USA
| | - Colin T Mahoney
- University of Colorado at Colorado Springs, USA
- Lyda Hill Institute for Human Resilience, Colorado Springs, CO, USA
| | | | - Terence M Keane
- National Center for PTSD at VA Boston Healthcare System, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, MA, USA
| | - Brian P Marx
- National Center for PTSD at VA Boston Healthcare System, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, MA, USA
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Cunha O, Castro Rodrigues AD, Caridade S, Dias AR, Almeida TC, Cruz AR, Peixoto MM. The impact of imprisonment on individuals' mental health and society reintegration: study protocol. BMC Psychol 2023; 11:215. [PMID: 37491401 PMCID: PMC10369709 DOI: 10.1186/s40359-023-01252-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 07/18/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Prison sentences are a particular type of penalty that aim to reintegrate individuals into society. Nonetheless, research suggests that prison sentences have a null or a criminogenic effect on recidivism and a critical impact on inmates' mental health, negatively interfering with their successful reintegration into society and recidivism. Prevalence rates of mental health disorders among individuals who commit crimes are high, but little is known about how incarceration perpetuates and/or worsens mental health symptoms. In the Portuguese context, no studies focused on understanding the impact of imprisonment on prisoners' mental health. Thus, this project aims to understand incarceration's mental health and well-being impact on male and female individuals convicted to prison, both while incarcerated and after release. METHODS The study will follow a quantitative cross-sectional design of male and female individuals in prison and parole, aiming to assess different samples at different moments of the prison sentence. It will also follow a longitudinal design in a subsample of male and female individuals sentenced to prison and on parole who will be followed for one year. DISCUSSION This study intends to have a meaningful impact on the understanding of imprisonment effects, giving important clues for developing and implementing evidence-based prevention and intervention strategies to address prisoners' and ex-prisoners' mental health and improve their ability to successfully reintegrate into society and reduce recidivism.
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Affiliation(s)
- Olga Cunha
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Porto, Portugal.
- Faculty of Psychology, Education, and Sports, Lusófona University of Porto, Rua Augusto Rosa, 24, Porto, 4000-098, Portugal.
| | - Andreia de Castro Rodrigues
- William James Center for Research, ISPA - Instituto Universitário de Ciências Psicológicas, Sociais e da Vida, Lisbon, Portugal
| | - Sónia Caridade
- Research Center of Psychology, School of Psychology, Minho University, Braga, Portugal
| | - Ana Rita Dias
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Porto, Portugal
| | - Telma Catarina Almeida
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, LabPSI - Laboratório de Psicologia Egas Moniz, Almada, Portugal
| | - Ana Rita Cruz
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisbon, Portugal
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Mendes DCG, Fonseca A, Cameirão MS. The psychological impact of Early Pregnancy Loss in Portugal: incidence and the effect on psychological morbidity. Front Public Health 2023; 11:1188060. [PMID: 37427267 PMCID: PMC10325666 DOI: 10.3389/fpubh.2023.1188060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Worldwide, up to a quarter of all recognized pregnancies result in Early Pregnancy Loss (EPL), also known as miscarriage. For many women, this is a traumatic experience that leads to persistent negative mental health responses. The most common morbidity reported in studies from different countries is complicated grief, usually comorbid with depression, anxiety, and Post-Traumatic Stress Disorder (PTSD). To our best knowledge, no studies characterizing the psychological impact of EPL have been made in Portugal. Methods An online survey was conducted to evaluate clinical symptoms of perinatal grief, anxiety, depression, and PTSD in women who suffered a spontaneous loss within 20 weeks of gestation. Out of 1,015 women who answered this survey, 873 were considered eligible, and subsequently distributed in 7 groups according to the time passed between their loss and their participation in the study. Results The proportion of women showing symptoms of all comorbidities was greater in those whose loss had happened within a month, and there was a significant gradual decrease over time in scores and proportions of clinical perinatal grief and PTSD. In terms of depression symptoms, scores dropped significantly in the group whose loss occurred 13-24 months before their participation but proportions oscillated without great changes in the other groups. Regarding anxiety, there were small oscillations, but there was no significant decrease of symptoms over time. Discussion Overall, despite a general drop in scores for most morbidities over time, substantial proportions of women showed persistent symptoms of clinical morbidities 3 years or more after the loss. Therefore, it is essential to promote monitoring of possible complicated responses to the event, to provide appropriate and timely intervention to those women in need.
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Affiliation(s)
- Diana C. Gonçalves Mendes
- Faculdade de Ciências Exatas e da Engenharia & NOVA LINCS, Universidade da Madeira, Funchal, Portugal
- Agência Regional para o Desenvolvimento de Investigação, Tecnologia e Inovação (ARDITI), Funchal, Portugal
| | - Ana Fonseca
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Coimbra, Portugal
| | - Mónica S. Cameirão
- Faculdade de Ciências Exatas e da Engenharia & NOVA LINCS, Universidade da Madeira, Funchal, Portugal
- Agência Regional para o Desenvolvimento de Investigação, Tecnologia e Inovação (ARDITI), Funchal, Portugal
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7
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Forkus SR, Raudales AM, Rafiuddin HS, Weiss NH, Messman BA, Contractor AA. The Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5: A Systematic Review of Existing Psychometric Evidence. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2023; 30:110-121. [PMID: 37378352 PMCID: PMC10292741 DOI: 10.1037/cps0000111] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
The PTSD Checklist for DSM-5 (PCL-5) is a widely used self-rated measure of DSM-5 PTSD symptoms. The goal of this systematic review was to synthesize research on the psychometric properties of the PCL-5 to guide clinical and research applications. We focused on reliability, validity, factor structure, optimal cutoff scores, and sensitivity to clinical change indices. A systematic review of the literature following PRISMA guidelines was conducted using PubMed, PsycINFO, CINAHL, and PTSDpubs with search terms capturing selected psychometric indices of the PCL-5. The inclusion criteria were: peer-reviewed publication in English; primary focus on the PCL-5 psychometrics; empirical study; and study with adult samples. The search yielded 265 studies; 56 papers (amounting to 64 studies) met inclusion criteria and were reviewed. Findings generally indicated evidence for: acceptable internal consistency and test-retest reliability; construct validity; a 7-factor Hybrid Model; recommended cutoff scores between 31-33; and ability to index sensitivity to clinical change. To further advance knowledge and applications of the PCL-5, we need more research on abbreviated versions of the PCL-5, bifactor modeling as applied to the PCL-5, as well as on PCL-5 item difficulty estimates, discrimination parameters, and clinical change score estimates.
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Affiliation(s)
| | | | | | - Nicole H. Weiss
- Department of Psychology, University of Rhode Island, RI, USA
| | - Brett A. Messman
- Department of Psychology, University of North Texas, Denton, TX, USA
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8
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Maly EG, Grower PL, Robertson KE, Haran NJ, Graham-Bermann SA. The Mental Health of Emerging Adults: Hostile Home Environments and COVID-19. JOURNAL OF FAMILY VIOLENCE 2022; 38:1-13. [PMID: 36530538 PMCID: PMC9735161 DOI: 10.1007/s10896-022-00478-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
Purpose Due to shifts in societal and educational expectations alongside the COVID-19 pandemic, many emerging adults live with their family of origin for extended periods of time. Little is known about patterns of parent-perpetrated maltreatment in emerging adulthood. Therefore, this study evaluates the relation between forms of parent-perpetrated maltreatment, including economic abuse, and COVID stress, on symptoms of depression, anxiety, and traumatic stress. Method 423 emerging adults who were enrolled in college in the United States in March of 2020 were recruited via MTurk to complete an online survey. An age-related COVID questionnaire and six empirically validated measures assess levels of COVID-19 exposure, lifetime maltreatment, economic abuse, and mental health status. Results 13.0% of participants reported maltreatment that most recently occurred over the age of 18 in their household of origin. Mean COVID stress level was found to be significantly higher in the Maltreated Over 18 group compared to the Never Maltreated group (t(345) = -3.03, p = 0.003), and in the Maltreated Under 18 group compared to the Never Maltreated group (t(346) = -3.20, p = 0.002). In accounting for the contribution of demographic variables, maltreatment chronicity, economic abuse, and COVID stress, our model predicted 38.6% of variance in depression symptoms, 37.2% of variance in anxiety symptoms, and 42.9% of variance in traumatic stress. Conclusions Findings indicate need for increased maltreatment screenings within the emerging adult population and calls for age-specific interventions to address the mental health disparities experienced by emerging adults with maltreatment histories.
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Affiliation(s)
- Ellie G. Maly
- Department of Psychology, University of Michigan, 530 Church St., Ann Arbor, MI 48109 USA
| | - Petal L. Grower
- Department of Psychology, University of Michigan, 530 Church St., Ann Arbor, MI 48109 USA
| | - Katherine E. Robertson
- Department of Psychology, University of Michigan, 530 Church St., Ann Arbor, MI 48109 USA
| | - Neil J. Haran
- Department of Psychology, University of Michigan, 530 Church St., Ann Arbor, MI 48109 USA
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9
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Hoffman J, Ben-Zion Z, Arévalo A, Duek O, Greene T, Hall BJ, Harpaz-Rotem I, Liddell B, Locher C, Morina N, Nickerson A, Pfaltz MC, Schick M, Schnyder U, Seedat S, Shatri F, Sit HF, von Känel R, Spiller TR. Mapping the availability of translated versions of posttraumatic stress disorder screening questionnaires for adults: A scoping review. Eur J Psychotraumatol 2022; 13:2143019. [PMID: 38872602 PMCID: PMC9724641 DOI: 10.1080/20008066.2022.2143019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 10/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background: The most used questionnaires for PTSD screening in adults were developed in English. Although many of these questionnaires were translated into other languages, the procedures used to translate them and to evaluate their reliability and validity have not been consistently documented. This comprehensive scoping review aimed to compile the currently available translated and evaluated questionnaires used for PTSD screening, and highlight important gaps in the literature.Objective: This review aimed to map the availability of translated and evaluated screening questionnaires for posttraumatic stress disorder (PTSD) for adults.Methods: All peer-reviewed studies in which a PTSD screening questionnaire for adults was translated, and which reported at least one result of a qualitative and /or quantitative evaluation procedure were included. The literature was searched using Embase, MEDLINE, and APA PsycInfo, citation searches and contributions from study team members. There were no restrictions regarding the target languages of the translations. Data on the translation procedure, the qualitative evaluation, the quantitative evaluation (dimensionality of the questionnaire, reliability, and performance), and open access were extracted.Results: A total of 866 studies were screened, of which 126 were included. Collectively, 128 translations of 12 different questionnaires were found. Out of these, 105 (83.3%) studies used a forward and backward translation procedure, 120 (95.2%) assessed the reliability of the translated questionnaire, 60 (47.6%) the dimensionality, 49 (38.9%) the performance, and 42 (33.3%) used qualitative evaluation procedures. Thirty-four questionnaires (27.0%) were either freely available or accessible on request.Conclusions: The analyses conducted and the description of the methods and results varied substantially, making a quality assessment impractical. Translations into languages spoken in middle- or low-income countries were underrepresented. In addition, only a small proportion of all translated questionnaires were available. Given the need for freely accessible translations, an online repository was developed.HIGHLIGHTS We mapped the availability of translated PTSD screening questionnaires.The quality of the translation and validation processes is very heterogenous.We created a repository for translated, validated PTSD screening questionnaires.
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Affiliation(s)
- Joel Hoffman
- School of Psychology, UNSW Australia, Sydney, Australia
| | - Ziv Ben-Zion
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- US Department of Veterans Affairs National Center for PTSD, VA Connecticut, Healthcare System, West Haven, CT, USA
| | - Adrián Arévalo
- Facultad de Medicina & Neuron Research Group Lima, Universidad de Piura, Lima, Perú
- Facultad de Medicina "San Fernando", Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Or Duek
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- US Department of Veterans Affairs National Center for PTSD, VA Connecticut, Healthcare System, West Haven, CT, USA
| | - Talya Greene
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Brian J Hall
- Center for Global Health equity, New York University (Shanghai), Shanghai, People's Republic of China
- School of Global Public Health, New York University, New York, NY, USA
| | - Ilan Harpaz-Rotem
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- US Department of Veterans Affairs National Center for PTSD, VA Connecticut, Healthcare System, West Haven, CT, USA
| | | | - Cosima Locher
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Monique C Pfaltz
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Matthis Schick
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Soraya Seedat
- Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Fatlinda Shatri
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hao Fong Sit
- Department of Psychology, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tobias R Spiller
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- US Department of Veterans Affairs National Center for PTSD, VA Connecticut, Healthcare System, West Haven, CT, USA
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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10
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Boyd JE, Cameron DH, Shnaider P, McCabe RE, Rowa K. Sensitivity and specificity of the Posttraumatic Stress Disorder Checklist for DSM-5 in a Canadian psychiatric outpatient sample. J Trauma Stress 2022; 35:424-433. [PMID: 34791713 DOI: 10.1002/jts.22753] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/02/2021] [Accepted: 07/28/2021] [Indexed: 11/07/2022]
Abstract
The Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5) is a widely used, self-report measure that is employed to assess PTSD symptom severity and determine the presence of probable PTSD in various trauma-exposed populations. The PCL-5 is often administered in clinical settings as a screening tool for PTSD, with a suggested cutoff score of 33 indicating a probable PTSD diagnosis. Recent research indicates that a higher cutoff may be required in psychiatric samples. In the present study, we aimed to determine the sensitivity and specificity of the PCL-5 in a Canadian outpatient psychiatric sample and establish an optimal cutoff score for detecting probable PTSD in this sample. Participants were 673 individuals who reported a history of trauma exposure and were assessed using a semistructured interview and self-report measures. Individuals diagnosed with PTSD (N = 193) reported a mean PCL-5 score of 56.57, whereas individuals without PTSD (N = 480) reported a mean score of 33.56. A score of 45 was determined to be the optimal cutoff score in this sample, balancing sensitivity and specificity while detecting a probable diagnosis of PTSD. Consistent with findings in other psychiatric samples, these findings indicate that in an outpatient psychiatric sample with a history of exposure to a variety of trauma types, a higher cutoff score is required to determine probable PTSD. In addition, given the estimated rate of false positives even with a higher cutoff, follow-up diagnostic assessments are recommended.
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Affiliation(s)
- Jenna E Boyd
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Duncan H Cameron
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Philippe Shnaider
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Karen Rowa
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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11
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Seybert C, Cotovio G, Grácio J, Oliveira-Maia AJ. Future Perspectives From a Case Report of Transcranial Magnetic Stimulation, Cognitive Behavioral Therapy, and Psychopharmacological Treatment for Post-traumatic Stress Disorder. Front Psychol 2021; 12:728130. [PMID: 34589030 PMCID: PMC8473870 DOI: 10.3389/fpsyg.2021.728130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/18/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Carolina Seybert
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Gonçalo Cotovio
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Jaime Grácio
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Albino J Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal
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Roberts NP, Kitchiner NJ, Lewis CE, Downes AJ, Bisson JI. Psychometric properties of the PTSD Checklist for DSM-5 in a sample of trauma exposed mental health service users. Eur J Psychotraumatol 2021; 12:1863578. [PMID: 34992744 PMCID: PMC8725778 DOI: 10.1080/20008198.2020.1863578] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 11/09/2020] [Indexed: 11/25/2022] Open
Abstract
Background: PTSD self-report measures are frequently used in mental health services but very few have been evaluated in clinical samples that include civilians. The PCL-5 was developed to assess for DSM-5 PTSD. Objective: The aim of this study was to evaluate the psychometric properties of the PCL-5 in a sample of trauma-exposed mental health service users who were evidencing symptoms of PTSD. Method: Reliability and validity of the PCL-5 were investigated in a sample of 273 participants who reported past diagnosis for PTSD or who had screened positively for traumatic stress symptoms. Diagnostic utility was evaluated in comparison to the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Results: The PCL-5 demonstrated high internal consistency, good convergent and divergent validity, acceptable stability and good diagnostic utility. However, operating characteristics differed from those found in other samples. Scores of 43-44 provided optimal efficiency for diagnosing PTSD. A post hoc regression analysis showed that depression explained more of the variance in PCL-5 total score than the CAPS-5. Conclusion: Whilst the PCL-5 is psychometrically sound it appears to have difficulty differentiating self-reported depression and anxiety symptoms from PTSD in trauma-exposed mental health service users and clinicians should take care to assess full symptomatology when individuals screen positively on the PCL-5. Clinicians and researchers should also take care not to assume that operating characteristics of self-report PTSD measures are valid for mental health service users, when these have been established in other populations.
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Affiliation(s)
- Neil P. Roberts
- Psychology and Psychological Therapies Directorate, Cardiff & Vale University Health Board, Cardiff, UK
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Neil J. Kitchiner
- Psychology and Psychological Therapies Directorate, Cardiff & Vale University Health Board, Cardiff, UK
- Veterans’ NHS Wales, Cardiff & Vale University Health Board, Cardiff, UK
| | - Catrin E. Lewis
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Anthony J. Downes
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Jonathan I. Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
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Fresno A, Arias V, Núñez D, Spencer R, Ramos N, Espinoza C, Bravo P, Arriagada J, Brunet A. Using Exploratory Structural Equation Modeling (ESEM) to Examine the Internal Structure of Posttraumatic Stress Disorder Symptoms. THE SPANISH JOURNAL OF PSYCHOLOGY 2020; 23:e48. [PMID: 33176894 DOI: 10.1017/sjp.2020.46] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Several studies have reported the factor structure of posttraumatic stress disorder (PTSD) using confirmatory factor analysis (CFA). The results show models with different number of factors, high correlations between factors, and symptoms that belong to different factors in different models without affecting the fit index. These elements could suppose the existence of considerable item cross-loading, the overlap of different factors or even the presence of a general factor that explains the items common source of variance. The aim is to provide new evidence regarding the factor structure of PTSD using CFA and exploratory structural equation modeling (ESEM). In a sample of 1,372 undergraduate students, we tested six different models using CFA and two models using ESEM and ESEM bifactor analysis. Trauma event and past-month PTSD symptoms were assessed with Life Events Checklist for DSM-5 (LEC-5) and PTSD Checklist for DSM-5 (PCL-5). All six tested CFA models showed good fit indexes (RMSEA = .051-.056, CFI = .969-.977, TLI = .965-.970), with high correlations between factors (M = .77, SD = .09 to M = .80, SD = .09). The ESEM models showed good fit indexes (RMSEA = .027-.036, CFI = .991-.996, TLI = .985-.992). These models confirmed the presence of cross-loadings on several items as well as loads on a general factor that explained 76.3% of the common variance. The results showed that most of the items do not meet the assumption of dimensional exclusivity, showing the need to expand the analysis strategies to study the symptomatic organization of PTSD.
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