Diagnostic accuracy of brief PTSD screening instruments in military veterans

A systematic review of validity of US survey measures for assessing substance use and substance use disorders

BACKGROUND

The steep rise in substance use and substance use disorder (SUD) shows an urgency to assess its prevalence using valid measures. This systematic review summarizes the validity of measures to assess the prevalence of substance use and SUD in the US estimated in population and sub-population-based surveys.

METHODS

A literature search was performed using nine online databases. Studies were included in the review if they were published in English and tested the validity of substance use and SUD measures among US adults at the general or sub-population level. Independent reviews were conducted by the authors to complete data synthesis and assess the risk of bias.

RESULTS

Overall, 46 studies validating substance use/SUD (n = 46) measures were included in this review, in which 63% were conducted in clinical settings and 89% assessed the validity of SUD measures. Among the studies that assessed SUD screening measures, 78% examined a generic SUD measure, and the rest screened for specific disorders. Almost every study used a different survey measure. Overall, sensitivity and specificity tests were conducted in over a third of the studies for validation, and 10 studies used receiver operating characteristics curve.

CONCLUSION

Findings suggest a lack of standardized methods in surveys measuring and reporting prevalence of substance use/SUD among US adults. It highlights a critical need to develop short measures for assessing SUD that do not require lengthy, time-consuming data collection that would be difficult to incorporate into population-based surveys assessing a multitude of health dimensions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022298280.

Posttraumatic stress disorder prevalence and childbirth: update meta-analysis after the introduction of the DSM-5 and COVID-19 pandemic

PURPOSE

Meta-analyses were previously performed to estimate PTSD prevalence in the postpartum period. Significant events that could impact this outcome occurred in the last decade, such as the publication of the DSM-5 in 2013 and the COVID-19 pandemic in 2020. This systematic literature review with a meta-analysis addressed studies published after 2014 to estimate PTSD prevalence after childbirth.

METHOD

The methodological guidelines recommended by PRISMA were followed. The meta-analysis estimate was the proportion of PTSD cases. The restricted maximum likelihood (REML) was the method adopted for estimation in addition to multilevel random effect models. Subgroup analyses were performed to assess the impact of interest variables.

RESULTS

The estimated prevalence was 0.10 (95%CI: 0.8-0.13; I2 = 98.5%). No significant differences were found regarding the introduction of the DSM-5 (p = 0.73) or COVID-19 (p = 0.97), but instead, between low- and middle-income countries, e.g., the Middle East presents a higher prevalence (p < 0.01) than European countries.

CONCLUSIONS

There is a potential increase in PTSD prevalence rates after childbirth in the last decade not associated with the pandemic or the current diagnostic classification. Most studies showed a methodological fragility that must be overcome to understand this phenomenon better and support preventive actions and treatment for puerperal women.

An Emotion-Driven Vocal Biomarker-Based PTSD Screening Tool

Goal: This paper introduces an automated post-traumatic stress disorder (PTSD) screening tool that could potentially be used as a self-assessment or inserted into routine medical visits to aid in PTSD diagnosis and treatment. Methods: With an emotion estimation algorithm providing arousal (excited to calm) and valence (pleasure to displeasure) levels through discourse, we select regions of the acoustic signal that are most salient for PTSD detection. Our algorithm was tested on a subset of data from the DVBIC-TBICoE TBI Study, which contains PTSD Check List Civilian (PCL-C) assessment scores. Results: Speech from low-arousal and positive-valence regions provide the highest discrimination for PTSD. Our model achieved an AUC (area under the curve) of 0.80 in detecting PCL-C ratings, outperforming models with no emotion filtering (AUC = 0.68). Conclusions: This result suggests that emotion drives the selection of the most salient temporal regions of an audio recording for PTSD detection.

Validating the primary care posttraumatic stress disorder screen for DSM-5 (PC-PTSD-5) in a substance misusing, trauma-exposed, socioeconomically vulnerable population

The co-occurrence of substance use disorder (SUD) and posttraumatic stress disorder (PTSD) is common, and is associated with greater severity of symptoms, poorer treatment prognosis, and increased risk of return to substance use following treatment. Screening for PTSD is not routinely implemented in substance use treatment programs, despite clinical relevance. Identifying screening tools that minimize patient burden and allow for comprehensive treatment in this patient population is critical. The current study examined the utility of the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) in identifying probable PTSD in a predominantly Black sample of 81 socioeconomically disadvantaged substance misusing hospital patients. The majority of the sample (75.3 %; n = 61) were found to meet criteria for probable PTSD using a suggested clinical cut score of 33 on the PTSD Checklist for DSM-5 (PCL-5). Diagnostic utility analyses were completed and determined a cut-score of 5 for the PC-PTSD-5 to demonstrate the best performance (SE = 0.62, κ(1) = 0.22; SP =.80, κ(0) = 0.61; EEF = 0.67, κ(0.5) = 0.32) in this sample. Results provide preliminary support for the use of the PC-PTSD-5 as a brief screening tool for probable PTSD in substance misusing patient populations. Routine use of the PC-PTSD-5 during assessment may be beneficial when treatment planning with those undergoing treatment for SUD because comprehensive assessment and treatment will provide a better chance of long-term recovery.

Diagnostic validity of the PC-PTSD screen in college students

Objective: The purpose of this study was to test the diagnostic validity of the Primary Care PTSD screen (PC-PTSD) in a generalizable college sample and to examine potential differences in its predictive efficacy according to sex and racial/ethnic identity. An exploratory aim was to determine whether PC-PTSD symptom items differentially predicted PTSD diagnostic status. Participants: Data from 475 undergraduates were analyzed. Methods: Logistic regressions were conducted to examine the relationship between different PC-PTSD endorsement thresholds and probable PTSD among various subsamples. Follow-up tests of diagnostic accuracy were performed. Results: Results of this study indicated that the PC-PTSD identified PTSD among college students with poor accuracy. Furthermore, the PC-PTSD did not demonstrate equal predictive validity across neither sex nor racial/ethnic identity. Endorsement of reexperiencing symptoms appeared to be the strongest predictor of PTSD. Conclusions: Results highlight the clear need for a validated PTSD screener effective for a diverse college population.

Internal entrapment and fearlessness about death as precipitants of suicidal thoughts and planning in the context of post-traumatic stress disorder

BACKGROUND

The relationship between post-traumatic stress disorder (PTSD) and suicidal thoughts and behaviors (STB) has been extensively studied but explanatory mechanisms remain inconclusive. Entrapment is one variable that evinces a mechanistic relationship with PTSD and STB. The current study examined the indirect effect of PTSD screen on suicide ideation (SI), planning, and likelihood of future suicide attempt through internal (IE) and external entrapment (EE), moderated by levels of fearlessness about death (FAD).

METHOD

The cross-sectional sample consisted of military service members and civilians recruited from primary care clinics across the United States (N = 2690).

RESULTS

Moderated mediation models indicated an indirect relationship between a positive PTSD screen, past-month SI, and past-month suicide planning through IE but not EE at low, moderate, and high levels of FAD. These relationships were replicated for the association between positive PTSD screen and concurrent self-rated likelihood of a future suicide attempt through both IE and EE at moderate and high levels of FAD.

CONCLUSIONS

Phenomenological implications are discussed, including IE as a mechanism of action in the PTSD/SI pathway and FAD as necessary to potentiate suicidal planning for those experiencing IE.

Treatment outcomes in individuals diagnosed with comorbid opioid use disorder and Posttraumatic stress disorder: A review

OBJECTIVES

Opioid use disorder (OUD) is a public health emergency. Evidence suggests that posttraumatic stress disorder (PTSD) is common among individuals with OUD; however, few studies evaluate whether concurrent diagnoses affect treatment outcomes. This review examines the impact of concurrent diagnoses of OUD and PTSD on treatment outcomes.

METHODS

A search was performed using articles identified through June 30, 2020 in PubMed, PsycINFO, and EMBASE. Included peer-reviewed articles evaluated individuals with OUD and a PTSD diagnosis via standardized assessment and/or medical record diagnoses, and reported relationships between diagnosis and treatment outcomes and/or other psychiatric conditions.

RESULTS

Out of 412 articles, 17 studies met inclusion criteria for this review (from 13 databases). Articles included had a total of n = 2190 with OUD, with n = 79 non-OUD comparison participants. Studies examining individuals with OUD revealed comorbid PTSD was associated with more severe addiction, higher rates of depression, attempted suicide, and psychosocial problems.

CONCLUSIONS

Among individuals with OUD, presence of PTSD is associated with multiple mental health problems. The impact of PTSD on drug use is inconclusive. Although only 5 studies examined psychosocial PTSD treatment, all found PTSD-focused treatment to be effective for those with comorbid OUD. Overall, results suggest the need to better identify PTSD among those with OUD, and to develop and evaluate interventions that are brief, integrative, and easy to implement in clinical settings.

Brief Mental Health Disorder Screening Questionnaires and Use with Public Safety Personnel: A Review

Brief mental health disorder screening questionnaires (SQs) are used by psychiatrists, physicians, researchers, psychologists, and other mental health professionals and may provide an efficient method to guide clinicians to query symptom areas requiring further assessment. For example, annual screening has been used to help identify military personnel who may need help. Nearly half (44.5%) of Canadian public safety personnel (PSP) screen positive for one or more mental health disorder(s); as such, regular mental health screenings for PSP may be a valuable way to support mental health. The following review was conducted to (1) identify existing brief mental health disorder SQs; (2) review empirical evidence of the validity of identified SQs; (3) identify SQs validated within PSP populations; and (4) recommend appropriately validated brief screening questionnaires for five common mental health disorders (i.e., generalized anxiety disorder (GAD), major depressive depression (MDD), panic disorder, posttraumatic stress disorder, alcohol use disorder). After reviewing the psychometric properties of the identified brief screening questionnaires, we recommend the following four brief screening tools for use with PSP: the Patient Health Questionnaire-4 (screening for MDD and GAD), the Brief Panic Disorder Symptom Screen—Self-Report, the Short-Form Posttraumatic Checklist-5, and the Alcohol Use Disorders Identification Test-Consumption.

Brief EcoMeditation Associated With Psychological Improvements: A Preliminary Study

BACKGROUND

A growing body of clinical research attests to the psychological and physiological benefits of meditation. EcoMeditation is a non-pharmacological therapeutic approach used to promote health and well-being, comprising four evidence-based techniques: The Quick Coherence Technique for regulating heart rate variability (HRV), Emotional Freedom Techniques (EFT), mindfulness, and neurofeedback.

OBJECTIVES

This study investigated changes in psychological symptoms of anxiety, depression, posttraumatic stress disorder (PTSD), pain, and happiness following a one-day EcoMeditation training workshop delivered in a large-group format and at 3-months post-intervention.

METHODS

A convenience sample of 208 participants (137 women, 71 men) aged between 21 and 87 years (M = 55.4 years; SD = 12.8 years) attended a one-day EcoMeditation training workshop. Participants completed a pen-and-paper survey pre-workshop and post-workshop, and an online survey three months following the EcoMeditation intervention.

RESULTS

Post-workshop results revealed significant reductions in anxiety (-23.4%, p < .001), depression (-15.8%, p = .011), PTSD (-11.8%, p < .001), and pain (-18.5%, p < .001), while happiness scores increased significantly (+8.9%, p < .001). At 3-month follow-up, one-way repeated-measures ANOVA (N = 65) found significant decreases in anxiety between pre-test and post-test, and pain between pre-intervention and 3-month follow-up. Differences in depression and PTSD scores were not significant over time. Happiness scores significantly increased from pre-test to 3-month follow-up. However, post-hoc analyses suggested that the final sample size was inadequate to detect significant differences between time points.

CONCLUSION

Findings provide preliminary support for EcoMeditation as a brief group-based stress reduction intervention with benefits for improved psychological functioning.

Association Between Positive Results on the Primary Care-Posttraumatic Stress Disorder Screen and Suicide Mortality Among US Veterans

IMPORTANCE

Suicide rates are higher among veterans compared with nonveterans, and the prevalence of posttraumatic stress disorder (PTSD) is higher among veterans compared with the general adult population in the US. To date, no study has examined the association between PTSD screening results and suicide mortality among veterans.

OBJECTIVE

To examine whether veterans receiving care in the US Veterans Health Administration (VHA) health system who had positive results on the Primary Care-Posttraumatic Stress Disorder Screen (PC-PTSD) had a greater risk of suicide mortality compared with those who had negative results and to assess whether such risk decreased over time.

DESIGN, SETTING, AND PARTICIPANTS

Multivariable proportional hazards regression models were used to evaluate suicide mortality risk through December 31, 2016, among a cohort of veterans who received the PC-PTSD in the VHA health system. The VHA administers the PC-PTSD to patients nationwide, and screening results are routinely documented in the VHA Corporate Data Warehouse. The PC-PTSD includes 4 questions regarding PTSD symptoms, to which patients respond with either a positive (yes) or negative (no) answer. All patients who completed the PC-PTSD in 2014 and who did not have a diagnosis of PTSD in the year before screening were included in the analysis. A score of 3 or 4 on the PC-PTSD indicated a positive result, and a score of 0, 1, or 2 indicated a negative result. Data collection and analyses were performed from November 13, 2018, to June 18, 2019.

EXPOSURES

Primary Care-Posttraumatic Stress Disorder Screen (PC-PTSD).

MAIN OUTCOMES AND MEASURES

Suicide mortality risk, as assessed through data obtained from the US Veterans Affairs/Department of Defense Mortality Data Repository.

RESULTS

A total of 1 693 449 PC-PTSDs were completed by 1 552 581 individual veteran patients in 2014. Most of the patients were White (73.9%), married (52.2%), male (91.1%), 55 years or older (62.5%), and had completed only 1 PC-PTSD (92.1%). In multivariable analyses, positive PC-PTSD results (ie, total scores of 3 or 4) were associated with a 58% increase in the risk of suicide mortality at 1 day after screening (hazard ratio [HR], 1.58; 95% CI, 1.19-2.10) and a 26% increase in the risk of suicide mortality at 1 year after screening (HR, 1.26; 95% CI, 1.07-1.48). A positive response on item 4 ("felt numb or detached from others, activities, or your surroundings") of the PC-PTSD was associated with a 70% increase in suicide mortality risk at 1 day after screening (HR, 1.70; 95% CI, 1.27-2.28).

CONCLUSIONS AND RELEVANCE

Positive PC-PTSD results, and specifically reports of feeling numb or detached, were associated with increases in the risk of suicide mortality. These associations decreased over time. The findings of this study can inform interpretation of PC-PTSD responses and suggest the importance of recent improvements made to the VHA suicide risk assessment.

Evaluation of three abbreviated versions of the PTSD Checklist in Canadian Armed Forces personnel

Introduction: Post-deployment screening within the Canadian Armed Forces (CAF) aims to identify individuals with mental health problems. However, as screening is a time-consuming process, it is important to consider ways to reduce the time required, including the use of shorter scales. The scale currently used to assess posttraumatic stress disorder (PTSD), the PTSD Checklist (PCL-C), is lengthy, although validated shorter versions have been developed that have not yet been evaluated in the CAF population. Methods: Three brief versions of the PCL-C were evaluated in this study: the PCL-2, PCL-4 and PCL-6. The operating characteristics of each scale were examined using the screening and diagnostic cut-offs of the full PCL, as well as clinician ratings of PTSD being of major concern, as the standards for comparison. Optimal cut-offs for each scale were determined based on a combination of sensitivity, specificity, area under the curve (AUC), and prevalence of disorder compared to the full scale. As well, correlations with other measures of health were examined. Results: Although all three scales demonstrated good psychometric properties, the PCL-6 showed the strongest properties of the three scales. Optimal cut-offs were similar to those found in past research when calibrated against the PCL-C screening cut-off for PTSD and to clinician ratings. As well, it exhibited high correlations with other measures of mental health. Discussion: This research provides evidence for the acceptability of brief measures in screening for PTSD in military members following deployment. In particular, it points to the advantages of using the PCL-6, with cut-offs in line with those recommended in past research.

Examination of a novel measure of trauma-related drinking to cope

OBJECTIVES

The present study sought to fill a gap in the current literature by developing a concise self-report questionnaire assessing drinking motives specific to coping with symptoms of posttraumatic stress disorder (PTSD). This new four-item questionnaire is called the Trauma Related Drinking questionnaire (TRD).

METHOD

Using structural equation modeling, the latent structure of the TRD items and how they relate to other variables of interest were explored among a sample of 1,896 college undergraduates from a large public university.

RESULTS

Broadly, we found evidence to suggest that TRD is a more specific measure of drinking to cope motives compared to the commonly used Drinking Motives Questionnaire coping subscale. Additionally, findings demonstrate support for the external validation of TRD, both with regard to PTSD and alcohol consumption and related problems.

CONCLUSIONS

Results support the use of TRD in future self-medication research and as a clinically useful screening tool.

Post-Traumatic Stress Disorder After Traumatic Brain Injury-A Systematic Review and Meta-Analysis

OBJECTIVE

To estimate the relative frequency and relative risk of post-traumatic stress disorder (PTSD) attributed to traumatic brain injury (TBI).

DATA SOURCES

PubMed and Embase were searched from database inception until January 26, 2019.

STUDY SELECTION

Two independent investigators screened titles, abstracts, and full texts. We selected studies that included subjects presenting with TBI, and where the number of subjects with TBI and PTSD could be extrapolated. There were no restrictions on study design.

DATA EXTRACTION AND SYNTHESIS

Data were extracted by two independent investigators and results were pooled using random-effects meta-analysis.

RESULTS

In civilian populations, relative frequency of PTSD following TBI was 12.2% after 3 months (CI-95 (7.6 to 16.8%) I² = 83.1%), 16.3% after 6 months (CI-95 (10.2 to 22.4%), I² = 88.4%), 18.6% after 12 months (CI-95 (10.2 to 26.9%), I² = 91.5%), and 11.0% after 24 months (CI-95 (0.0 to 25.8%), I² = 92.0%). Relative risk was 1.67 after 3 months (CI-95 (1.17 to 2.38), P = 0.011, I² = 49%), 1.36 after 6 months (CI-95 (0.81 to 2.30), P = 0.189, I² = 34%), and 1.70 after 12 months (CI-95 (1.16-2.50), P = 0.014, I² = 89%). In military populations, the relative frequency of associated PTSD was 48.2% (CI-95 (44.3 to 52.1%), I² = 100%) with a relative risk of 2.33 (CI-95 (2.00 to 2.72), P < 0.0001, I² = 99.9%).

CONCLUSIONS AND RELEVANCE

TBI is a risk factor for PTSD in clinic-based civilian populations. There are insufficient data to assess the relative frequency or relative risk of PTSD in moderate to severe TBI. Due to significant between-study heterogeneity, the findings of our study should be interpreted with caution.

Developing an optimal short-form of the PTSD Checklist for DSM-5 (PCL-5)

BACKGROUND

Although several short-forms of the posttraumatic stress disorder (PTSD) Checklist (PCL) exist, all were developed using heuristic methods. This report presents the results of analyses designed to create an optimal short-form PCL for DSM-5 (PCL-5) using both machine learning and conventional scale development methods.

METHODS

The short-form scales were developed using independent datasets collected by the Army Study to Assess Risk and Resilience among Service members. We began by using a training dataset (n = 8,917) to fit short-form scales with between 1 and 8 items using different statistical methods (exploratory factor analysis, stepwise logistic regression, and a new machine learning method to find an optimal integer-scored short-form scale) to predict dichotomous PTSD diagnoses determined using the full PCL-5. A smaller subset of best short-form scales was then evaluated in an independent validation sample (n = 11,728) to select one optimal short-form scale based on multiple operating characteristics (area under curve [AUC], calibration, sensitivity, specificity, net benefit).

RESULTS

Inspection of AUCs in the training sample and replication in the validation sample led to a focus on 4-item integer-scored short-form scales selected with stepwise regression. Brier scores in the validation sample showed that a number of these scales had comparable calibration (0.015-0.032) and AUC (0.984-0.994), but that one had consistently highest net benefit across a plausible range of decision thresholds.

CONCLUSIONS

The recommended 4-item integer-scored short-form PCL-5 generates diagnoses that closely parallel those of the full PCL-5, making it well-suited for screening.

Applications of the Chinese version of the primary care PTSD screen for DSM-5 (PC-PTSD-5) for children

BACKGROUND

Effective screening is important for public mental health services. Although the primary care PTSD screen for DSM-5 (PC-PTSD-5) is useful in screening for post-traumatic stress disorder (PTSD) in adults, its reliability and validity for use in children remain unclear. This study aimed to examine the performance characteristics of the Chinese PC-PTSD-5 for children in children aged 8 to 16 years.

METHODS

4,022 rural children from Grades 4 to 9 in China were included in this study. All participants were assessed for PTSD using the Chinese PC-PTSD-5 for children and the PTSD Checklist for DSM-5 (PCL-5), and assessed for anxiety using the Chinese version of the State Anxiety Scale for Children (CSAS-C), and for depression using the Children's Depression Inventory - Short Form (CDI-S). The performance characteristics of the PC-PTSD-5 for children were evaluated using receiver operating characteristic analyses.

RESULTS

The mean scores on the PCL-5 and the PC-PTSD-5 were 17.45 (SD = 14.78) and 1.78 (SD = 1.33), respectively. There was a significant correlation between the PC-PTSD-5 and PCL-5 (r = 0.54, p < 0.001), and small but significant correlations of the PC-PTSD-5 with the CSAS-C (r = 0.31, p < 0.001) and CDI-S (r = 0.27, p < 0.001). In this study, 2 and 3 were both found to be acceptable cutoff values. A cutoff value of 2 yielded a sensitivity of 0.87 and a specificity of 0.52, while a cutoff of 3 had sensitivity = 0.57, and specificity = 0.77.

LIMITATIONS

A clinical interview was not used to validated diagnostic findings.

CONCLUSIONS

The reliability and validity of the Chinese PC-PTSD-5 were statistically acceptable for screening for probable PTSD in children. Additionally, the Chinese PC-PTSD-5 had a favorable sensitivity at a cut off 2 and a favorable specificity at a cut off 3, based on PCL-5 results.

Validation of an Electronic Medical Record-Based Algorithm for Identifying Posttraumatic Stress Disorder in U.S. Veterans

We developed an algorithm for identifying U.S. veterans with a history of posttraumatic stress disorder (PTSD), using the Department of Veterans Affairs (VA) electronic medical record (EMR) system. This work was motivated by the need to create a valid EMR-based phenotype to identify thousands of cases and controls for a genome-wide association study of PTSD in veterans. We used manual chart review (n = 500) as the gold standard. For both the algorithm and chart review, three classifications were possible: likely PTSD, possible PTSD, and likely not PTSD. We used Lasso regression with cross-validation to select statistically significant predictors of PTSD from the EMR and then generate a predicted probability score of being a PTSD case for every participant in the study population (range: 0-1.00). Comparing the performance of our probabilistic approach (Lasso algorithm) to a rule-based approach (International Classification of Diseases [ICD] algorithm), the Lasso algorithm showed modestly higher overall percent agreement with chart review than the ICD algorithm (80% vs. 75%), higher sensitivity (0.95 vs. 0.84), and higher accuracy (AUC = 0.95 vs. 0.90). We applied a 0.7 probability cut-point to the Lasso results to determine final PTSD case-control status for the VA population. The final algorithm had a 0.99 sensitivity, 0.99 specificity, 0.95 positive predictive value, and 1.00 negative predictive value for PTSD classification (grouping possible PTSD and likely not PTSD) as determined by chart review. This algorithm may be useful for other research and quality improvement endeavors within the VA.

Training needs among nonmental health professionals working with service members: A qualitative investigation

Though many service members will not directly seek mental health care due to stigma and other factors, they may interact with the healthcare system in other ways including contact with first responders, nurses and allied health care professionals. However, little attention has been spent in this regard on the educational needs of these professionals whose contact with service members and veterans may provide the opportunity to assist veterans in need with overcoming barriers to accessing mental health care. This qualitative study investigates the educational training needs of first responders and health care professionals in contact with military families and trauma survivors to determine whether, and what type, of additional training is needed. A sample of 42 first responders and health care professionals including emergency medical technicians, police officers, fire fighters, speech language pathologists, occupational therapists, physical therapists, and nurses, were recruited to participate in one of six focus groups. Sessions were audio-taped and transcribed verbatim. Data analysis was guided by a thematic analysis approach. Thematic analyses suggest there is a significant knowledge gap with unmet educational needs of these professionals such as information on the invisible wounds of war, military culture, and screening and referring patients who present symptoms falling outside professionals' scope of practice. Findings point to a need and desire for more robust education for first responders and health care providers around mental health concerns of military populations, including topics such as trauma, military culture, and screening tools. Efforts to develop curricula addressing these concerns are warranted.

A new short version of the Posttraumatic Diagnostic Scale: validity among Japanese adults with and without PTSD

Background: Identifying high-risk groups for posttraumatic stress disorder (PTSD) during evacuation situations requires a valid short screening tool. The re-experiencing symptoms of PTSD are considered helpful for distinguishing those with PTSD from those without, as they are thought to be specific to PTSD, have less ambiguity for respondents, and are representative of all PTSD symptoms. Objective: To develop a new short version of the Posttraumatic Diagnostic Scale (PDS) comprising only re-experiencing symptom items. Method: We used existing data (N = 169) from our previous study on the Japanese version of the PDS and the Clinician-Administered PTSD Scale (CAPS). The sample included both clinical outpatients (n = 106) and university students (n = 63), all of whom reported one or more traumatic experiences. We created candidate 2- and 3-item versions of the PDS and compared their psychometric characteristics against the CAPS. Results: The best candidate (comprising items for 'intrusive images', 'nightmares', and 'physiological reactions when reminded of the trauma') demonstrated an area under the curve of .95, 94.8% sensitivity, 86.1% specificity for the best cut-off score of three. The candidate scale also showed a strong correlation with CAPS-evaluated severity score and internal consistency. Conclusions: The brief re-experiencing PDS had good psychometric properties among Japanese adults with and without PTSD.

A Socioecological Predication Model of Posttraumatic Stress Disorder in Low-Income, High-Risk Prenatal Native Hawaiian/Pacific Islander Women

INTRODUCTION

Only recently has perinatal posttraumatic stress disorder (PTSD) been researched in any depth; however, the causes and consequences of this serious illness remain unclear. Most commonly, childbirth trauma and interpersonal violence have been reported as contributing factors. However, not all Native Hawaiian/Pacific Islander (NHPI) women who experience these events experience PTSD. The factors affecting PTSD are many and complex, intertwining individual, family, and community contexts. Using a socioecological framework, 3 levels of contextual variables were incorporated in this study (individual, family, and social/community). The purpose of this study was to determine the socioecological predictors associated with prenatal PTSD among NHPI.

METHODS

A case-control design was used to collect retrospective data about socioecological variables from medical record data. The sample was low-income, high-risk NHPI women receiving perinatal health care at a rural community health center in Hawaii who screened positive (n = 55) or negative (n = 91) for PTSD.

RESULTS

Hierarchical logistic regression was conducted to determine socioecological predictors of positive PTSD screening. Although the majority of women (66.4%) experienced some form of interpersonal violence, a constellation of significant predictor variables from all 3 levels of the model were identified: depression (individual level), lack of family support and family stress (family level), and violence (social/community level).

DISCUSSION

Each of the predictor variables has been identified by other researchers as significantly affecting perinatal PTSD. However, it is because these variables occur together that a more complex picture emerges, suggesting the importance of considering multiple variables in context when identifying and caring for these women. Although additional research is needed, it is possible that the significant predictor variables could be useful in identifying women who are at higher risk for PTSD in other similar populations.

PTSD detection and symptom presentation: Racial/ethnic differences by gender among veterans with PTSD returning from Iraq and Afghanistan

BACKGROUND

To determine differences in positive PTSD screenings and symptom presentation by race/ethnicity and gender for Iraq and Afghanistan veterans diagnosed with PTSD.

METHOD

We conducted a retrospective analysis using existing records from Iraq and Afghanistan veterans who enrolled in VA care, received a post-deployment PTSD diagnosis, initiated mental health outpatient treatment between 10/01/07 and 12/31/11, and had a PTSD screen result at the start of treatment (N=79,938). PTSD outcomes were measured using the PC-PTSD and PCL.

RESULTS

At treatment initiation, differences in race/ethnicity and gender were found for PTSD screens and PTSD symptoms. Compared to their white counterparts, Asian/Pacific Islander (A/PI) women and black men were more likely to screen positive for PTSD (adjusted ORs=1.42 and 1.17, ps=.04 and <.0001, respectively) and endorse all measured symptoms (adjusted ORs=1.09 to 1.66, ps≤.000-.04) except avoidance for A/PI women and hyperarousal for black men; A/PI men were less likely to endorse hyperarousal (adjusted OR=.88, p=.04) and did not differ otherwise; and black women did not differ from their white counterparts. Additional differences in PTSD symptom presentation by race/ethnicity and gender were found.

LIMITATIONS

The current study utilized administrative data and was cross-sectional. The results may not be generalizable to veterans from other service eras.

CONCLUSIONS

PTSD screens differ by race/ethnicity and gender, and further by PTSD symptoms, which can influence initiation and planning of PTSD treatment. Awareness of such differences may aid in detecting PTSD to provide care for diverse veterans.