A brief report on the Penn Inventory for posttraumatic stress disorder

Burnout, compassion fatigue, compassion satisfaction, and secondary traumatic stress in trauma nurses

The relationship of burnout (BO), compassion fatigue (CF), compassion satisfaction (CS), and secondary traumatic stress (STS) to personal/environmental characteristics, coping mechanisms, and exposure to traumatic events was explored in 128 trauma nurses. Of this sample, 35.9% had scores consistent with BO, 27.3% reported CF, 7% reported STS, and 78.9% had high CS scores. High BO and high CF scores predicted STS. Common characteristics correlating with BO, CF, and STS were negative coworker relationships, use of medicinals, and higher number of hours worked per shift. High CS correlated with greater strength of supports, higher participation in exercise, use of meditation, and positive coworker relationships. Caring for trauma patients may lead to BO, CF, and STS; identifying predictors of these can inform the development of interventions to mitigate or minimize BO, CF, and STS in trauma nurses.

Randomized clinical trial comparing affect regulation and supportive group therapies for victimization-related PTSD with incarcerated women

Traumatic victimization and associated problems with posttraumatic stress disorder (PTSD) and affect dysregulation are prevalent among incarcerated women, but there is limited evidence to support psychotherapeutic interventions for these problems in this underserved population. A group psychotherapy designed to enhance affect regulation without trauma memory processing-Trauma Affect Regulation: Guide for Education and Therapy (TARGET)-was compared to a supportive group therapy (SGT) in a randomized clinical trial with 72 incarcerated women with full or partial PTSD. Both interventions achieved statistically significant reductions in PTSD and associated symptom severity and increased self-efficacy. Dropout rates for both interventions were low (<5%). TARGET was more effective than SGT in increasing sense of forgiveness toward others who have caused harm in the past. Group therapy that teaches affect regulation may enhance incarcerated women's ability to achieve affective resolution (forgiveness) while also reducing their victimization-related PTSD and associated symptoms. Experiential-focused supportive group therapy also may reduce victimization-related PTSD and associated symptoms. Both group therapy approaches warrant further study with this vulnerable population.

A randomized clinical trial comparing affect regulation and social problem-solving psychotherapies for mothers with victimization-related PTSD

Addressing affect dysregulation may provide a complementary alternative or adjunctive approach to the empirically supported trauma memory processing models of cognitive behavior therapy (CBT) for posttraumatic stress disorder (PTSD). A CBT designed to enhance affect regulation without trauma memory processing--trauma affect regulation: guide for education and therapy (TARGET)--was compared to present centered therapy (PCT) and wait-list (WL) conditions in a randomized clinical trial with 146 primarily low-income and ethnoracial minority mothers with PTSD. TARGET achieved statistically and clinically significant improvement on PTSD and affect regulation measures compared to WL, with more consistent and sustained (over a 6-month follow-up period) evidence of improvement than PCT. Drop-out rates (~25%) were comparable in TARGET and PCT, similar to those previously reported for trauma memory processing CBTs. Symptom worsening was rare (2-8%) and transient. Affect regulation-based CBT without trauma memory processing warrants further research as a potentially efficacious therapy for victimization-related PTSD.

The psychometric utility of two self-report measures of PTSD among women substance users

Given the high rates of posttraumatic stress disorder (PTSD) among substance users, integrated programs that target PTSD and substance use are recommended as best practice. To effectively implement such treatments, accurate and reliable PTSD screening instruments are needed. Unfortunately, no standardized PTSD measure has been validated among women substance abusers. Therefore, the goal of this investigation was to examine the psychometric utility of two PTSD measures to optimize the number of women clients correctly identified as meeting diagnostic criterion for PTSD. Forty-four women in residential substance use treatment were administered diagnostic interviews for PTSD (Clinician-Administered PTSD Scale) and then completed questionnaires regarding trauma exposure and related symptoms. In this group, 38.6% of the participants met diagnostic criteria for current PTSD. A score of 38 and above on the PTSD Checklist Civilian Version and a Penn Inventory score of 25 and above optimally maximized the number of women with PTSD identified and minimized false negative and false positive rates.

Systematic review of screening instruments for adults at risk of PTSD

The development of effective methods of screening for posttraumatic stress disorder (PTSD) is important in the context of mass trauma, the geographical dispersion of victims, and the restricted availability of specialists in psychological trauma. The review focused on published English-language screening instruments for civilian PTSD consisting of 30 items or fewer and validated against structured clinical interviews. Thirteen instruments were identified meeting these criteria, all consisting of symptoms of traumatic stress. The review concluded that the performance of some currently available instruments is near to their maximal potential effectiveness, and that instruments with fewer items, simpler response scales, and simpler scoring methods perform as well as if not better than longer and more complex measures.

The Centre for Addiction and Mental Health Concurrent Disorders Screener

OBJECTIVES

To review the characteristics of psychiatric screening tools currently available in addiction treatment services for rapid assessment of comorbid pathology and to introduce the Centre for Addictions and Mental Health Concurrent Disorders Screener (CAMH-CDS), a computer-administered questionnaire that screens for the occurrence of 11 Axis I disorders plus all substance use disorders, as well as for a history of conduct disorder.

METHODS

We describe the structure, contents, and application of the CAMH-CDS. We undertook a sensitivity and specificity trial involving 171 subjects, a test-retest reliability study with 301 participants, and an open-label concordance study with 656 respondents. All subjects were regular clients of a major addiction treatment facility.

RESULTS

The CAMH-CDS was easily and effectively used by addiction counsellors with limited or no mental health training. It has a low rate of false-negative responses, and it yields excellent test-retest reliability figures. It is highly sensitive to identifying persons with psychiatric disturbances; however, its ability to discriminate among specific disorders appears to be more limited.

CONCLUSIONS

The CAMH-CDS can be reliably used to rule out the presence of psychiatric comorbidity in addiction service populations. As with other psychiatric screening instruments, its sensitivity values are stronger than its specificity values. The use of nonstructured clinical evaluations as the gold standard for diagnosis and a likely variance in the patients' symptom reports between the 2 examinations may have contributed to the latter finding.