Diagnostic Accuracy and Acceptability of the Primary Care Posttraumatic Stress Disorder Screen for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) among US Veterans

Importance: Posttraumatic stress disorder (PTSD) is a serious mental health disorder that can be effectively treated with empirically based practices. PTSD screening is essential for identifying undetected cases and providing patients with appropriate care. Objective: To determine whether the Primary Care PTSD screen for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PC-PTSD-5) is a diagnostically accurate and acceptable measure for use in Veterans Affairs (VA) primary care clinics. Design, Setting, and Participants: This cross-sectional, diagnostic accuracy study enrolled participants from May 19, 2017, to September 26, 2018. Participants were recruited from primary care clinics across 2 VA Medical Centers. Session 1 was conducted in person, and session 2 was completed within 30 days via telephone. A consecutive sample of 1594 veterans, aged 18 years or older, who were scheduled for a primary care visit was recruited. Data analysis was performed from March 2019 to August 2020. Exposures: In session 1, participants completed a battery of questionnaires. In session 2, a research assistant administered the PC-PTSD-5 to participants, and then a clinician assessor blind to PC-PTSD-5 results conducted a structured diagnostic interview for PTSD. Main Outcomes and Measures: The range of PC-PTSD-5 cut points overall and across gender was assessed, and diagnostic performance was evaluated by calculating weighted κ values. Results: In total, 495 of 1594 veterans (31%) participated, and 396 completed all measures and were included in the analyses. Participants were demographically similar to the VA primary care population (mean [SD] age, 61.4 [15.5] years; age range, 21-93 years) and were predominantly male (333 participants [84.1%]) and White (296 of 394 participants [75.1%]). The PC-PTSD-5 had high levels of diagnostic accuracy for the overall sample (area under the receiver operating characteristic curve [AUC], 0.927; 95% CI, 0.896-0.959), men (AUC, 0.932; 95% CI, 0.894-0.969), and women (AUC, 0.899, 95% CI, 0.824-0.974). A cut point of 4 ideally balanced false negatives and false positives for the overall sample and for men. However, for women, this cut point resulted in high numbers of false negatives (6 veterans [33.3%]). A cut point of 3 fit better for women, despite increasing the number of false positives. Participants rated the PC-PTSD-5 as highly acceptable. Conclusions and Relevance: The PC-PTSD-5 is an accurate and acceptable screening tool for use in VA primary care settings. Because performance parameters will change according to sample, clinicians should consider sample characteristics and screening purposes when selecting a cut point

The use of the trauma symptom inventory in the assessment of PTSD symptoms

This study examined the Trauma Symptom Inventory (TSI; Briere, 1995) in a sample of 62 trauma-exposed community residents (80% Caucasian, 89% women), including 16 who had posttraumatic stress disorder (PTSD). PTSD and non-PTSD groups differed on seven TSI clinical scales and one validity scale, with effect sizes (r) ranging from 0.26 to 0.53. The largest effect sizes and best diagnostic utility were found for the Defensive Avoidance and Anxious Arousal scales. Diagnostic utility analyses suggest that TSI subscales in isolation are not superior to existing measures of PTSD. A logistic regression using the five most discriminating TSI scales produced a correct classification rate of 85.5%. TSI scales also demonstrated good convergent validity with other measures of PTSD. Overall, the results provide preliminary support for the use of the TSI in the assessment of PTSD. © 2005 International Society for Traumatic Stress Studies

Psychometric properties of seven self-report measures of posttraumatic stress disorder in college students with mixed civilian trauma exposure

In this study psychometric properties of seven self-report measures of posttraumatic stress disorder (PTSD) were compared. The seven scales evaluated were the Davidson Trauma Scale (DTS), the PTSD Checklist (PCL), the Posttraumatic Stress Diagnostic Scale (PDS), the Civilian Mississippi Scale (CMS), the Impact of Event Scale-Revised (IES-R), the Penn Inventory for Posttraumatic Stress Disorder (Penn), and the PK scale of the MMPI-2 (PK). Participants were 239 (79 male and 160 female) trauma-exposed undergraduates. All seven measures exhibited good test-retest reliability and internal consistency. The PDS, PCL and DTS demonstrated the best convergent validity; the IES-R, PDS, and PCL demonstrated the best discriminant validity; and the PDS, PCL, and IES-R demonstrated the best diagnostic utility. Overall, results most strongly support the use of the PDS and the PCL for the assessment of PTSD in this population. © 2008 Elsevier Ltd. All rights reserved

Use of the personality assessment inventory in assessment of posttraumatic stress disorder in women

This study investigated the utility of the Personality Assessment Inventory (PAI) for the assessment of posttraumatic stress disorder (PTSD). Participants were 55 community-residing adult women who were administered a comprehensive battery that included the PAI and the Clinician-Administered PTSD Scale (CAPS). Participants were classified as either PTSD or non-PTSD based on the CAPS, and PAI profiles were compared between the two groups. Significant group differences were found for seven PAI clinical scales (Anxiety, Depression, Anxiety-Related Disorders, Somatic Complaints, Paranoia, Borderline Features, and Schizophrenia), one validity scale (Negative Impression), and two treatment scales (Nonsupport and Treatment Rejection). When all PAI scales and component subscales are considered, the largest group differences were found for the physiological subscale of the Depression scale (DEP-P) and the Traumatic Stress subscale of the Anxiety-Related Disorders scale (ARD-T). ARD-T and DEP-P also demonstrated excellent diagnostic utility. Finally, correlations between PAI scales and four CAPS symptom clusters provided additional validity evidence, in particular supporting a distinction between effortful avoidance and numbing. Taken together, these results support the use of the PAI in the assessment of PTSD. © 2005 Springer Science+Business Media, Inc

Consistency of Retrospective Reporting About Exposure to Traumatic Events 1

Lifetime exposure to traumatic events was assessed by means of a multimethod protocol applied to 76 male military veterans. Consistency of retrospective reporting was determined for physical and sexual assault and abuse, accidents, disasters, combat and warzone experiences, serious illness or injury, and hazardous duty. Findings demonstrate that respondents are generally consistent in reporting traumatic events, although the majority report more events upon reevaluation. Reporting about traumatic events shows some variation as a function of the life epoch in which events occurred, whether they were directly or indirectly experienced, and the type of trauma involved. Discussion addresses memory-related processes triggered by trauma evaluation or tied to characteristics of events themselves as potential sources of inconsistency