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Forkus SR, Raudales AM, Rafiuddin HS, Weiss NH, Messman BA, Contractor AA. The Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5: A Systematic Review of Existing Psychometric Evidence. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2023; 30:110-121. [PMID: 37378352 PMCID: PMC10292741 DOI: 10.1037/cps0000111] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
The PTSD Checklist for DSM-5 (PCL-5) is a widely used self-rated measure of DSM-5 PTSD symptoms. The goal of this systematic review was to synthesize research on the psychometric properties of the PCL-5 to guide clinical and research applications. We focused on reliability, validity, factor structure, optimal cutoff scores, and sensitivity to clinical change indices. A systematic review of the literature following PRISMA guidelines was conducted using PubMed, PsycINFO, CINAHL, and PTSDpubs with search terms capturing selected psychometric indices of the PCL-5. The inclusion criteria were: peer-reviewed publication in English; primary focus on the PCL-5 psychometrics; empirical study; and study with adult samples. The search yielded 265 studies; 56 papers (amounting to 64 studies) met inclusion criteria and were reviewed. Findings generally indicated evidence for: acceptable internal consistency and test-retest reliability; construct validity; a 7-factor Hybrid Model; recommended cutoff scores between 31-33; and ability to index sensitivity to clinical change. To further advance knowledge and applications of the PCL-5, we need more research on abbreviated versions of the PCL-5, bifactor modeling as applied to the PCL-5, as well as on PCL-5 item difficulty estimates, discrimination parameters, and clinical change score estimates.
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Affiliation(s)
| | | | | | - Nicole H. Weiss
- Department of Psychology, University of Rhode Island, RI, USA
| | - Brett A. Messman
- Department of Psychology, University of North Texas, Denton, TX, USA
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Williamson MLC, Stickley MM, Armstrong TW, Jackson K, Console K. Diagnostic accuracy of the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) within a civilian primary care sample. J Clin Psychol 2022; 78:2299-2308. [PMID: 35763419 DOI: 10.1002/jclp.23405] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 05/24/2022] [Accepted: 06/09/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study aims to evaluate the diagnostic accuracy of the Primary Care Posttraumatic Stress Disorder (PTSD) Screen for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) (PC-PTSD-5) as a screening tool for the identification of PTSD among a civilian sample receiving behavioral health treatment within a primary care setting. Validation within a civilian sample will increase the generalizability of the PC-PTSD-5 as a brief screening measure to identify PTSD within primary care practices. METHOD The present study is a retrospective review of data (N = 198) collected as part of a patient registry for an integrated behavioral health consultation service within a primary care clinic. The PC-PTSD-5 was administered as part of a standardized set of brief screening measures and a standard clinical interview. Diagnostic validation was accomplished via a consensus model between a board-certified family medicine physician and a licensed psychologist along with medical/psychology trainees. RESULTS Fifty-two participants (26.26%) out of 198 who completed the PC-PTSD-5 were diagnosed with PTSD. The PC-PTSD-5 demonstrated excellent diagnostic accuracy (area under the curve = 0.933, 95% confidence interval [CI]: 0.901-0.965). A cutoff score of 4 maximized sensitivity (sensitivity% = 100) while maintaining acceptable specificity (specificity% = 85.2). This score also maximized efficiency (κ[0.5] = 0.77, SE = 0.05, 95% CI: 0.67-0.86) and maintained a good (≥0.60) quality index for specificity (κ[0] = 0.61). CONCLUSION The PC-PTSD-5 maintained strong diagnostic accuracy within a civilian primary care sample.
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Affiliation(s)
- Meredith L C Williamson
- Department of Primary Care & Population Health, Texas A&M Health Science Center, College of Medicine, Bryan, Texas, USA
| | - Mariah M Stickley
- Department of Psychiatry & Behavioral Sciences, Texas A&M Health Science Center, College of Medicine, Bryan, Texas, USA
| | - Trey W Armstrong
- Department of Psychiatry & Behavioral Sciences, Texas A&M Health Science Center, College of Medicine, Bryan, Texas, USA
| | - Kaylee Jackson
- Department of Psychiatry & Behavioral Sciences, Texas A&M Health Science Center, College of Medicine, Bryan, Texas, USA
| | - Katie Console
- Department of Psychiatry & Behavioral Sciences, Texas A&M Health Science Center, College of Medicine, Bryan, Texas, USA
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Golfenshtein N, Hanlon AL, Lozano AJ, Srulovici E, Lisanti AJ, Cui N, Medoff-Cooper B. Parental Post-traumatic Stress and Healthcare Use in Infants with Complex Cardiac Defects. J Pediatr 2021; 238:241-248. [PMID: 34216630 PMCID: PMC8551052 DOI: 10.1016/j.jpeds.2021.06.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/08/2021] [Accepted: 06/25/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the associations between post-traumatic stress of parents of infants with complex congenital heart defects and their healthcare use for their infants during the early months of life. STUDY DESIGN The current study is a secondary data analysis from a randomized controlled trial in which 216 parent-infant dyads were recruited from 3 cardiac intensive care units of large pediatric centers in Northeastern America. The current sample included 153 dyads with post-traumatic stress data at hospital discharge and at 4-months' follow-up. Poisson regressions were used to estimate the effect of post-traumatic stress change scores on number of emergency department (ED) visits, unscheduled cardiologist visits, and unscheduled pediatrician visits outcomes. RESULTS Infants whose parents gained post-traumatic stress disorder over the study period were at increased risk for ED visits and unscheduled cardiologist visits. Increased symptom severity predicted more unscheduled cardiologist visits and more unscheduled pediatrician visits. Increased symptom clusters (avoidance, arousal, re-experiencing) predicted more ED visits, more unscheduled cardiologist visits, and more unscheduled pediatrician visits. CONCLUSIONS Parents of infants with cardiac conditions may experience post-traumatic stress following cardiac surgery, which can be linked to greater healthcare use. Findings highlight the importance of screening and treating post-traumatic stress to preserve parental mental health and prevent adverse outcomes.
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Affiliation(s)
| | - Alexandra L Hanlon
- Center for Biostatistics and Health Data Science, Virginia Tech, Roanoke, VA
| | - Alicia J Lozano
- Center for Biostatistics and Health Data Science, Virginia Tech, Roanoke, VA
| | | | - Amy J Lisanti
- Center for Pediatric Nursing Research & Evidence-Based Practice, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Naixue Cui
- School of Nursing & Rehabilitation, Shandong University, Jinan, Shandong Province, China
| | - Barbara Medoff-Cooper
- University of Pennsylvania, School of Nursing, Philadelphia, PA; Children’s Hospital of Philadelphia, Philadelphia, PA
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Affiliation(s)
- Stephanie Streb
- Stephanie Streb is an assistant professor at the University of Maryland School of Nursing, Department of Family and Community Health, Baltimore, Md
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Menta C, Bisol LW, Nogueira EL, Engroff P, Cataldo Neto A. Prevalence and correlates of generalized anxiety disorder among elderly people in primary health care. JORNAL BRASILEIRO DE PSIQUIATRIA 2020. [DOI: 10.1590/0047-2085000000267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective To examine the prevalence of generalized anxiety disorder (GAD) and its associations with sociodemographic and health factors. Methods A cross-sectional study with a population-based sample of 578 individuals aged 60 years or older from the Family Health Strategy (FHS) program of Porto Alegre, RS, Brazil. Home visit screening and general data collection were made by trained Community Health Workers (CHWs). Diagnoses of psychiatric disorders were made by board-certified psychiatrists using the Mini International Neuropsychiatric Interview plus (MINIplus) in the Hospital São Lucas of the Pontifical University of Rio Grande do Sul (PUCRS). Results GAD was found in 9% of the sample (n = 52; CI 95% = 6.9-11.6). The main results of the multivariate analysis show associations between GAD and retirement (PR: 0.43, CI: 0.25-0.76), history of falls (PR: 2.52, CI: 1.42-4.49), cohabitation with four or more people (PR: 1.80, CI: 1.04-3.13), having more than one hospitalization in the last year (PR: 2.53, CI: 1.17-5.48) and self-perception of health as regular (PR: 2.75, CI: 1.02-7.47). Retirement in the elderly shows 2.32x less risk of GAD, although confounding factors may have overestimated this finding and underestimated the association with female gender (PR: 1.61, CI: 0.83-3.10). Conclusions We estimate a high prevalence of GAD in this population. Associations were found between GAD and health self-perceived as regular, cohabitation with four or more people, history of falls and more than one hospitalization in the last year. These epidemiological data from the Family Health Strategy are important to develop further strategies for this age group that could improve the health care practice.
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Affiliation(s)
- Caroline Menta
- Pontifical Catholic University of Rio Grande do Sul, Brazil; Pontifical Catholic University of Rio Grande do Sul, Brazil
| | | | - Eduardo Lopes Nogueira
- Pontifical Catholic University of Rio Grande do Sul, Brazil; Pontifical Catholic University of Rio Grande do Sul, Brazil
| | - Paula Engroff
- Pontifical Catholic University of Rio Grande do Sul, Brazil; Pontifical Catholic University of Rio Grande do Sul, Brazil
| | - Alfredo Cataldo Neto
- Pontifical Catholic University of Rio Grande do Sul, Brazil; Pontifical Catholic University of Rio Grande do Sul, Brazil
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Cook JM, Zeber JE, Simiola V, Rossom R, Scherrer JF, Owen-Smith AA, Ahmedani BK, Zolfaghari K, Copeland LA. Comparisons Between Patients Diagnosed with PTSD in Primary Care Versus Mental Health Care in Five Large Civilian Health Care Systems. J Clin Psychol Med Settings 2020; 28:221-228. [PMID: 32048114 DOI: 10.1007/s10880-020-09706-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a serious mental health disorder that may not be adequately detected or treated in primary care (PC). The purpose of this study was to compare the clinical characteristics and health care utilization of PTSD patients diagnosed in PC versus in specialty mental health care (MHC) across five large, civilian, not-for-profit healthcare systems. Electronic claims and medical record data on patients treated during 2014 were analyzed. Treatment was considered in terms of initiation and dose (i.e., psychotherapy sessions; pharmacotherapy-prescription psychotropics). Of 5256 patients aged 15-88 with a diagnosis of PTSD, 84.4% were diagnosed by a MHC provider. Patients diagnosed by MHC providers had 4 times the rate of and more enduring psychotherapy than those diagnosed by PC providers. Receipt of psychotropics varied by provider type, with generally higher prescription fill levels for patients in MHC. Strategies to better align patient needs with access and treatment modality in PC settings are needed.
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Affiliation(s)
- Joan M Cook
- Yale School of Medicine, New Haven, CT, USA. .,Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT, 06511, USA.
| | - John E Zeber
- University of Massachusetts, Amherst, MA, USA.,Central Texas Veterans Health Care System, Tempe, TX, USA
| | - Vanessa Simiola
- Kaiser Permanente, Center for Integrated Health Care Research, Honolulu, HI, USA
| | | | | | - Ashli A Owen-Smith
- Kaiser Permanente Center for Research and Evaluation, Atlanta, GA, USA.,Georgia State University School of Public Health, Atlanta, GA, USA
| | | | - Kiumars Zolfaghari
- Center for Applied Health Research, Baylor Scott & White Health, Dallas, TX, USA
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Substance Use Issues Among the Underserved. PHYSICIAN ASSISTANT CLINICS 2019. [DOI: 10.1016/j.cpha.2018.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Remes O, Wainwright N, Surtees P, Lafortune L, Khaw KT, Brayne C. Generalised anxiety disorder and hospital admissions: findings from a large, population cohort study. BMJ Open 2018; 8:e018539. [PMID: 30368445 PMCID: PMC6224748 DOI: 10.1136/bmjopen-2017-018539] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/18/2017] [Accepted: 10/19/2017] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Generalised anxiety disorder (GAD) is the most common anxiety disorder in the general population and has been associated with high economic and human burden. However, it has been neglected in the health services literature. The objective of this study is to assess whether GAD leads to hospital admissions using data from the European Prospective Investigation of Cancer-Norfolk. Other aims include determining whether early-onset or late-onset forms of the disorder, episode chronicity and frequency, and comorbidity with major depressive disorder (MDD) contribute to hospital admissions. DESIGN Large, population study. SETTING UK population-based cohort. PARTICIPANTS 30 445 British participants were recruited through general practice registers in England. Of these, 20 919 completed a structured psychosocial questionnaire used to identify presence of GAD. Anxiety was assessed in 1996-2000, and health service use was captured between 1999/2000 and 2009 through record linkage with large, administrative health databases. 17 939 participants had complete data on covariates. MAIN OUTCOME MEASURE Past-year GAD defined according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. RESULTS In this study, there were 2.2% (393/17 939) of respondents with GAD. Anxiety was not independently associated with hospital admissions (incidence rate ratio (IRR)=1.04, 95% CI 0.90 to 1.20) over 9 years. However, those whose anxiety was comorbid with depression showed a statistically significantly increased risk for hospital admissions (IRR=1.23, 95% CI 1.02 to 1.49). CONCLUSION People with GAD and MDD comorbidity were at an increased risk for hospital admissions. Clinicians should consider that meeting criteria for a pure or individual disorder at one point in time, such as past-year GAD, does not necessarily predict deleterious health outcomes; rather different forms of the disorder, such as comorbid cases, might be of greater importance.
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Affiliation(s)
- Olivia Remes
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Nicholas Wainwright
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Paul Surtees
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Louise Lafortune
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Comorbid Pain and PTSD: Integrating Research and Practice with MVC Survivors. PSYCHOLOGICAL INJURY & LAW 2018. [DOI: 10.1007/s12207-018-9316-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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The Prevalence and Mental and Physical Health Correlates of Posttraumatic Stress Disorder Symptoms in Vulnerable and Underresourced Primary Care Patients Referred to a Behavioral Health Provider. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 23 Suppl 6 Suppl, Gulf Region Health Outreach Program:S32-S39. [DOI: 10.1097/phh.0000000000000654] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Kowalchuk AA, Gonzalez SJ, Zoorob RJ. Substance Use Issues Among the Underserved: United States and International Perspectives. Prim Care 2017; 44:113-125. [PMID: 28164811 DOI: 10.1016/j.pop.2016.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Substance use affects people of all ages, cultures, and socioeconomic levels. Most underserved populations have lower rates of substance use than the general population in a given society, excluding tobacco use. The impact of substance use is more severe, however, in the underserved, with higher rates of incarceration, job loss, morbidity, and mortality. Innovative solutions are being developed to address these differences. Working together, underserved patients with substance use problems can be helped on their journeys toward health and wholeness.
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Affiliation(s)
- Alicia Ann Kowalchuk
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston, TX 77098, USA.
| | - Sandra J Gonzalez
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston, TX 77098, USA
| | - Roger J Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston, TX 77098, USA
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