Validation of the Brazilian-Portuguese version of the Clinician Administered Post Traumatic Stress Disorder Scale-5

Objectives: The aim of this study was to validate CAPS-5 for the Brazilian-Portuguese language on a sample of 128 individuals from two centers (from the cities of São Paulo and Porto Alegre) who have been recently exposed to a traumatic event. Methods: We performed a reliability analysis between interviewers (with a subset of 32 individuals), an internal consistency analysis, and a confirmatory factorial analysis for the validation study. Results: The inter-rater reliability of the total PTSD symptom severity score was high [intraclass correlation coefficient =0.994, 95% CI (0.987–0.997), p < 0.001]. Cohen’s Kappa for individual items ranged between 0.759 and 1. Cronbach’s alpha coefficients indicated high internal consistency for the CAPS-5 full scale (α = 0.826) and an acceptable level of internal consistency for the four symptom clusters. The confirmatory factorial analysis for the 20-item original CAPS-5 did not fit the data well. A 15-item model with better results was then established by excluding the following CAPS-5 items: dissociative amnesia, recklessness, distorted cognitions, irritability, and hypervigilance. Conclusion: Despite the limitation of the predominance of female victims, and the high number of sexually assaulted women in our sample, the model with only 15 items provided a good fit to the data with high internal consistency (α = 0.835)

Confiabilidade e consistência interna da escala Clinician-administered PTSD Scale 5 em português

Introdução: O transtorno de estresse pós traumático (TEPT) é uma doença altamente prevalente no mundo e no Brasil, o que traz grande impacto para a saúde pública. Por esse motivo, é importante a existência de instrumentos capazes de diagnosticar e avaliar o quadro de maneira eficiente e, o instrumento padrão-ouro para esse intuito, ainda não foi validado para o português do Brasil. Objetivo: avaliar a confiabilidade e consistência interna da escala CAPS-5 no português do Brasil. Métodos: Foram avaliadas 128 indivíduos, de 3 amostras distintas, coletadas em 2 diferentes centros. Foi realizada a adaptação transcultural da escala Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). A amostra foi posteriormente dividida entre 32 indíduos, que foram avaliados por 2 entrevistadores independentes e formaram a amostra para analise da confiabilidade entre entrevistadores, e 128 indivíduos na consistência interna da escala e análise fatorial confirmatória (AFC). Resultados: Houve uma alta confiabilidade entre entrevistadores, com valor de kappa > 0,80. A escala total teve uma alta consistência interna com alfa de Cronbach α=0,826 e um nível aceitável para cada grupo de sintomas. No entanto dois sintomas, D1/Amnesia dissociativa e E2/ Imprudência, tiveram baixa correlação item-total (0,025 e 0,095, respectivamente). A AFC demonstrou que apenas o modelo com 15 itens ajustou adequadamente os dados, com boa carga fatorial e boa consistência interna. Discussão: A escala apresenta boa confiabilidade entre entrevistadores, embora o estudo tenha sido realizado apenas por profissionais experientes. A consistência interna foi adequada, como ocorreu em estudos de validação para outros idiomas. Na AFC observou-se que o melhor modelo seria com 15 itens, sem comprometer o constructo da escala original. A maior parte da amostra constituiu-se de mulheres vítimas de violência sexual. Conclusão: em uma realidade de grande violência urbana, resultando em alta prevalência de TEPT, esse estudo é extremamente importante, pois possibilita a validação de um instrumento para corretamente avaliar sua sintomatologia.Introduction: The Post Traumatic Stress Disorder (PTSD) is a highly prevalent disease around the World and in Brazil, being a burden to public health. Due to this fact, the correct assessment and diagnosis of the PTSD is important. Despite of this, the gold-standard instrument for diagnosing this disorder is not yet validated to Brazilian Portuguese. Methods: 128 individuals were evaluated from 3 different samples, from two distinct centers. Initially, we performed a transcultural adaptation of the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Then, with the final version of the scale, the sample was divided: 32 individuals were assessed to evaluate the reliability between interviewers; the complete sample was assessed to evaluate the internal consistency and the CFA. Results: the reliability between interviewers was high, with kappa >.80. Although the full scale presents a high internal consistency, with Alpha Cronbach’s α=.826 and an acceptable level for each cluster, two symptoms had a low inter-item correlation (D1/Dissociative amnesia and E2/Recklessness). The CFA exhibited that only the 15-item model adequate fit the data, with good factor loads and internal consistency. Discussion: Though the scale has a good reliability between interviewers, the study was performed only by experienced professionals. The internal consistency was adequate as in previous validation studies performed in others countries. The CFA has demonstrated that the best model may be the 15-item model, without compromising the construct of the original scale. Despite the heterogeneous data from different sources, the majority of the sample was composed by sexually assaulted women. Conclusion: In a context of wide urban violence, which brings a high prevalence of PTSD, this study is extremely important because it completed the validation of an instrument to evaluate its symptomatology