Sensitivity and specificity of the Posttraumatic Stress Disorder Checklist for DSM-5 in a Canadian psychiatric outpatient sample

Adult refugees' perspectives on the impact of trauma and post-migration hardships on learning

Background: Research shows that adult refugees' well-being and future in the reception country heavily depend on successfully learning the host language. However, we know little about how adult learners from refugee backgrounds experience the impact of trauma and adversity on their learning.Objective: The current study aims to investigate the perspectives of adult refugee learners on whether and how trauma and other adversity affect their learning.Methods: We conducted in-depth interviews with 22 adult refugees (10 women) attending the Norwegian Introduction Programme (NIP). The participants came from six Middle Eastern, Central Asian, and African countries. Two questionnaires were included, one about past stressful life events (SLESQ-Revised), and one about mental health symptoms and current psychological distress following potentially traumatic experiences (PCL-5).Results: Participants held varying beliefs about trauma's impact on learning: that it had a constant impact, that it was situational, or that it had no impact. Other aspects they brought up as having an essential effect on learning and school attendance include psychological burdens from past and present school experiences, and post-migration hardships such as loneliness, depression, ongoing violence, and negative social control. Post-migration trauma and hardships exacerbated the burden of previous trauma and were frequently associated with a greater negative influence on learning.Conclusion: This study adds new insights from adult refugee learners themselves into how post-migration hardships as well as trauma can impact their learning, and the importance of recognising their struggles. A safe space is required for refugees to open up about their difficulties in life and with learning. This knowledge can be used to enhance teaching practices, foster better teacher-student relationships, and inform policy-making decisions, ultimately benefiting both individuals and society.

Assessment of PTSD and Trauma Symptoms With the MMPI-3 in College Students: Validity and Incremental Utility of the Anxiety Related Experiences (ARX) Scale

Post Traumatic Stress Disorder (PTSD) is heterogeneous in nature, which complicates diagnostic efforts and makes accurate assessment tools critical. The MMPI family of instruments are widely used broadband measures of psychopathology, including trauma symptomology. The MMPI-3's Anxiety Related Experiences scale (ARX) is an expansion of the MMPI-2-RF Anxiety (AXY) scale which has historically represented the MMPI family's best measure of trauma symptoms. This study expands research on ARX in 2 samples of college students (n = 332 [PCL-5 Criterion] & n = 58 [CAPS-5 Criterion]) by examining ARX's incremental, criterion, and classification validity. ARX incrementally predicted PCL-5 total and cluster scores beyond that accounted for by AXY (R2Δ = .01-.09). ARX accounted for the most unique variance, beyond RCd and RC7, in CAPS-5 interview ratings of intrusion symptoms (R2Δ = .16). ARX was strongly related to trauma symptomology broadly (r = .42-.58) and demonstrated strong screening ability at T65 (sensitivity = .37-.40; specificity = .91-.92) and stronger diagnostic screening at T75 (sensitivity = .31; specificity = .93). We discuss clinical considerations when using ARX for assessing PTSD.

A diagnostic questionnaire for childbirth related posttraumatic stress disorder: a validation study

BACKGROUND

Labor and delivery can entail complications and severe maternal morbidities that threaten a woman's life or cause her to believe that her life is in danger. Women with these experiences are at risk for developing posttraumatic stress disorder. Postpartum posttraumatic stress disorder, or childbirth-related posttraumatic stress disorder, can become an enduring and debilitating condition. At present, validated tools for a rapid and efficient screen for childbirth-related posttraumatic stress disorder are lacking.

OBJECTIVE

We examined the diagnostic validity of the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, for detecting posttraumatic stress disorder among women who have had a traumatic childbirth. This Checklist assesses the 20 Diagnostic and Statistical Manual of Mental Disorders, posttraumatic stress disorder symptoms and is a commonly used patient-administrated screening instrument. Its diagnostic accuracy for detecting childbirth-related posttraumatic stress disorder is unknown.

STUDY DESIGN

The sample included 59 patients who reported a traumatic childbirth experience determined in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, posttraumatic stress disorder criterion A for exposure involving a threat or potential threat to the life of the mother or infant, experienced or perceived, or physical injury. The majority (66%) of the participants were less than 1 year postpartum (for full sample: median, 4.67 months; mean, 1.5 years) and were recruited via the Mass General Brigham's online platform, during the postpartum unit hospitalization or after discharge. Patients were instructed to complete the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, concerning posttraumatic stress disorder symptoms related to childbirth. Other comorbid conditions (ie, depression and anxiety) were also assessed. They also underwent a clinician interview for posttraumatic stress disorder using the gold-standard Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. A second administration of the Checklist was performed in a subgroup (n=43), altogether allowing an assessment of internal consistency, test-retest reliability, and convergent and diagnostic validity of the Checklist. The diagnostic accuracy of the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, in reference to the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, was determined using the area under the receiver operating characteristic curve; an optimal cutoff score was identified using the Youden's J index.

RESULTS

One-third of the sample (35.59%) met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria for a posttraumatic stress disorder diagnosis stemming from childbirth. The Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, symptom severity score was strongly correlated with the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, total score (ρ=0.82; P<.001). The area under the receiver operating characteristic curve was 0.93 (95% confidence interval, 0.87-0.99), indicating excellent diagnostic performance of the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. A cutoff value of 28 optimized the sensitivity (0.81) and specificity (0.90) and correctly diagnosed 86% of women. A higher value (32) identified individuals with more severe posttraumatic stress disorder symptoms (specificity, 0.95), but with lower sensitivity (0.62). Checklist scores were also stable over time (intraclass correlation coefficient, 0.73), indicating good test-retest reliability. Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, scores were moderately correlated with the depression and anxiety symptom scores (Edinburgh Postnatal Depression Scale: ρ=0.58; P<.001 and the Brief Symptom Inventory, anxiety subscale: ρ=0.51; P<.001).

CONCLUSION

This study demonstrates the validity of the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, as a screening tool for posttraumatic stress disorder among women who had a traumatic childbirth experience. The instrument may facilitate screening for childbirth-related posttraumatic stress disorder on a large scale and help identify women who might benefit from further diagnostics and services. Replication of the findings in larger, postpartum samples is needed.

Navigating into the unknown: exploring the experience of exposure to prehospital emergency stressors: a sequential explanatory mixed-methods

INTRODUCTION

The unpredictability of prehospital emergencies combined with constantly changing circumstances can lead to increased stress and mental health issues among Emergency Medical Technicians (EMTs). To accurately determine the stress-inducing factors in the prehospital environment, it is important to first identify the stressful events that occur in this environment. Therefore, this study strives to provide a thorough analysis of the stressors in the prehospital environment.

METHODS

Sequential explanatory mixed methods were conducted in Hamadan prehospital emergency centers in 2022. The study included 251 EMTs, who were selected through a method in the quantitative phase. The quantitative part used a questionnaire consisting of basic information and the Posttraumatic Stress Questionnaire (PCL-5). In the qualitative phase, 17 with extensive experience in dealing with prehospital stressors were selected based on their PCL-5 scores (above 33). The qualitative phase analysis was carried out using the contractual content method using the Graneheim and Ladman's approach. Statistical analyzes for the quantitative and qualitative phases were performed using SPSS 21 and maxqda 10, respectively.

RESULTS

The study revealed that the EMTs had an average PTSD score of 21. 60 ± 11. 45. Multivariate linear regression analysis showed that the number of shifts had a statistically significant relationship with PTSD scores (t = 26.38, P < 0.001). The qualitative phase of the study included 17 interviews, resulting in 14 subcategories, which consisted of four categories: "the overall impact of the stress crisis on technicians," "missing links in the communication network in incident management," "professional shortcomings in pre-hospital care," and "the complex and multifaceted context of stressful pre-hospital emergencies." Additionally, the study's theme was centered around "surveying the experiences of EMTs in stressful environments."

CONCLUSION

As the number of shifts increased, the primary cause of the high prevalence of PTSD in EMTs was revealed. Prehospital emergency stress can be reduced and managed more skillfully by adjusting various factors such as shortening workdays, offering continuous training, augmenting workforce, supplying ambulance equipment insurance, refraining from hiring personnel devoid of clinical training, hiring psychologists, hiring midwives in an emergency, updating prehospital protocols and guidelines, encouraging cooperation between EMTs and other relief groups, and utilizing cutting-edge technologies.

Do trauma cue exposure and/or PTSD symptom severity intensify selective approach bias toward cannabis cues in regular cannabis users with trauma histories?

Trauma cue-elicited activation of automatic cannabis-related cognitive biases are theorized to contribute to comorbid posttraumatic stress disorder and cannabis use disorder. This phenomenon can be studied experimentally by combining the trauma cue reactivity paradigm (CRP) with cannabis-related cognitive processing tasks. In this study, we used a computerized cannabis approach-avoidance task (AAT) to assess automatic cannabis (vs. neutral) approach bias following personalized trauma (vs. neutral) CRP exposure. We hypothesized that selective cannabis (vs. neutral) approach biases on the AAT would be larger among participants with higher PTSD symptom severity, particularly following trauma (vs. neutral) cue exposure. We used a within-subjects experimental design with a continuous between-subjects moderator (PTSD symptom severity). Participants were exposed to both a trauma and neutral CRP in random order, completing a cannabis AAT (cannabis vs. neutral stimuli) following each cue exposure. Current cannabis users with histories of psychological trauma (n = 50; 34% male; mean age = 37.8 years) described their most traumatic lifetime event, and a similarly-detailed neutral event, according to an established interview protocol that served as the CRP. As hypothesized, an AAT stimulus type x PTSD symptom severity interaction emerged (p = .042) with approach bias greater to cannabis than neutral stimuli for participants with higher (p = .006), but not lower (p = .36), PTSD symptom severity. Contrasting expectations, the stimulus type x PTSD symptoms effect was not intensified by trauma cue exposure (p = .19). Selective cannabis approach bias may be chronically activated in cannabis users with higher PTSD symptom severity and may serve as an automatic cognitive mechanism to help explain PTSD-CUD co-morbidity.

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

BACKGROUND

Stroke 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.

METHODS

This 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.

RESULTS

PCL-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.

CONCLUSIONS

Our findings supported the use of PCL-5 as a psychometrically adequate measure of post-stroke PTSD in the Chinese patients.