Development of a crime-related post-traumatic stress disorder scale for women within the symptom checklist-90-revised

A community sample of 355 adult women were administered the Symptom Checklist-90-Revised and were assessed with structured interviews for a life-time history of criminal victimization and Crime-Related Post-Traumatic Stress Disorder. Using a criterion group classification approach, a 28-item scale within the SCL-90-R was developed that successfully discriminated between the CR-PTSD positive and negative respondents. Though replication and further research is needed, the developed scale may be of use for initial screening for CR-PTSD as well as for ongoing clinical assessment and research purposes.     

A comparison of four PTSD measures' convergent validities in Vietnam veterans

We compared the convergent validities of four commonly used post-traumatic stress disorder (PTSD) measures in 80 help-seeking Vietnam veterans by contrasting their intercorrelations. When scored as continuous severity or frequency measures, the Mississippi Scale for Combat-related PTSD's and the Post-Traumatic Stress Disorder Interview's (PTSD-I's) concordances with other measures were similar to one anothers' and generally larger than those of either the Diagnostic Interview Schedule (DIS) PTSD module or the MMPI PTSD scale. However, when used only to identify stress disorder's presence or absence, the four techniques' concordances were nearly identical. This suggested that the four measures have similar convergent validities when used simply to identify PTSD, but that the PTSD-I and Mississippi scale offer better convergent validity than the MMPI or DIS instruments when used as severity measures.     

Sleep of chronic post-traumatic patients

The purpose of the present study was to investigate the sleep of people diagnosed as suffering from chronic Post-Traumatic Stress Disorder (PTSD). The sleep of seven chronic post-traumatic patients with no known physical injuries was compared with that of seven matched control subjects. The post-traumatic patients had poorer sleep: decreased sleep efficiency, increase in number of awakenings, and decreased SWS, as well as longer REM latency. It was also found that their complaints correlated with relevant sleep-monitored measures. The findings add further support for the inclusion of sleep difficulties in the definition of the Post-Traumatic Stress Disorder.     

Use of a screening questionnaire for post-traumatic stress disorder (PTSD) on a sample of UK ICU patients

Background: Although rates vary across studies, research in recent years shows that prevalence of post-traumatic stress disorder (PTSD) following intensive care unit (ICU) can be high. Presently no screening tool assessing all three PTSD symptom categories has been validated in ICU patients. The aim of the study was to conduct a preliminary validation of such a measure, the UK- Post-Traumatic Stress Syndrome 14-Questions Inventory (UK-PTSS-14).
Methods: A case series cohort study performed at two ICUs in two UK district general hospitals. The UK-PTSS-14 was administered at three time-points (4–14 days, 2 months and 3 months post-ICU discharge). At time-point three participants also completed the Post-traumatic Stress Diagnostic Scale (PDS) and the Impact of Events Scale (IES).
Results: Forty-four patients completed the 3-month follow up. The UK-PTSS-14 was internally reliable at all three time-points (Cronbach's α=0.89, 0.86 and 0.84, respectively). Test–retest reliability was highest between time-points two and three (ICC=0.90). Concurrent validity at time-point three was high against the PDS ( r =0.86) and the IES ( r =0.71). Predictive validity was highest at time-point two ( r =0.85 with the PDS and r =0.71 with the IES). Receiver operator characteristic curve analysis suggested the highest levels of sensitivity (86%) and specificity (97%) for diagnosis of PTSD were at time-point two, with an optimum decision threshold of 45 points.
Conclusion: This preliminary validation study suggests that the UK-PTSS-14 could be reliably used as a screening instrument at 2 months post-discharge from the ICU to identify those patients in need of referral to specialist psychological services.     

MMPI profiles and post-traumatic symptomatology in former prisoners of war

Results of this study found that prisoners of war (POWs) tend to produce a basic 1, 2, 3 (Hs, D, Hy) configuration on the MMPI which has also been found in other studies. Significant differences were found for different subgroupings on specific scales, but the same basic, 1, 2, 3 configuration was maintained for all groups. Subjects were found to display considerable PTSD symptomatology as depicted by independent psychiatric interviews and performance on an Impact of Events Scale (IES). Post-Traumatic Stress Disorder (PTSD) symptoms were also found to dissipate over time. Results are discussed in reference to the possible use of somatization as a means of handling stress and how the manifestation of PTSD in this population differ from that seen in Vietnam combat veterans suffering from PTSD.     

Which instruments are most commonly used to assess traumatic event exposure and posttraumatic effects?: A survey of traumatic stress professionals

We report findings from a Web-based survey of the International Society for Traumatic Stress Studies' members (n = 227) regarding use of trauma exposure and posttraumatic assessment instruments. Across clinical and research settings, the most widely used tests included the Posttraumatic Stress Diagnostic Scale, Trauma Symptom Inventory, Life Events Checklist, Clinician-Administered Post-traumatic Stress Disorder (PTSD) Scale, PTSD Checklist, Impact of Event Scale-Revised, and Trauma Symptom Checklist for Children. Highest professional degree, time since degree award, and student status yielded no differences in extent of reported trauma assessment test use.     

Convergent and Discriminant Validity of the Perinatal PTSD Questionnaire (PPQ): A Preliminary Study

We evaluated the validity of the Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) as a measure of posttraumatic stress symptomatology. Mothers of high-risk infants (N = 91) and healthy, full-term infants (N = 51) answered the PPQ and two other convergent measures of posttraumatic stress disorder symptoms, the Impact of Event Scale (IES) and the Penn Inventory (PI). The Need for Cognition Scale (NCS) was used as a divergent measure. Correlations among the convergent measures were significantly greater than the correlation between the PPQ and NCS. High-risk mothers also scored higher than normal mothers on the PPQ and IES. The results support the validity of the PPQ.     

Screening for PTSD in motor vehicle accident survivors using the PSS-SR and IES

The current study compares the total scores of two potential posttraumatic stress disorder (PTSD) screening tools, the Impact of Event Scale (IES) and the PTSD Symptom Scale, Self-Report (PSS-SR), to the Clinician-Administered PTSD Scale (CAPS) in a large sample of motor vehicle accident (MVA) survivors (N = 229, of whom 43% met criteria for PTSD). For the IES using a cutoff score of 27, sensitivity was .91, specificity was .72, and overall correct classification was .80. For the PSS-SR using a cutoff score of 14, sensitivity was .91, specificity was .62, and overall correct classification was .74. Compared to those in studies of other trauma populations, the identified IES cutoff score is somewhat lower for this population of MVA survivors and the identified PSS-SR cutoff score is consistent with previous findings. These data support the use of the IES and the PSS-SR as PTSD screening tools in MVA samples.     

Psychometric Evaluation of Horowitz's Impact of Event Scale: A Review

Despite being developed before the formal introduction of posttraumatic stress disorder (PTSD) within the diagnostic literature, the Impact of Event Scale (Horowitz, Wilner, & Alvarez, 1979) remains one of the most widely used self-report measures of posttraumatic stress. This paper presents an overview of research using the IES in an attempt to assess its psychometric status. It is concluded that the psychometric properties of the IES are satisfactory (although not as a PTSD diagnostic measure) and that continued use of the IES as a measure of intrusive and avoidant processes is warranted.     

Assessing the effects of violence on women in battering relationships with the Keane MMPI-PTSD Scale

The Minnesota Multiphasic Personality Inventory (MMPI)-Keane Posttraumatic Stress Disorder (PTSD) Scale (PK) has proven to be a reliable and valid measure of PTSD in combat veterans. However, few studies have examined the scale's validity in battered women, who often present with PTSD. Using empirically derived cutoff scores for the PK Scale, 69 battered women were assigned to PTSD-Positive and PTSD-Negative groups and then compared on measures of PTSD, distress, social support, and history of abuse in and out of the battering relationship. The PTSD-Positive group scored significantly higher across all measures of PTSD and distress, supporting the concurrent validity of the PK Scale in this population. However, the two groups differed only for the frequency of death threats, suggesting that the PK Scale is only mildly sensitive to the level of trauma exposure. Finally, lower levels of perceived social support were found in the PTSD-Positive than the PTSD-Negative group. Implications of these findings for the assessment of PTSD in battered women are discussed.     

Psychological distress and physical disability in patients sustaining severe injuries in road traffic crashes: Results from a one-year cohort study from three European countries

The current study aimed to follow-up a group of road crash survivors for one year and assesses the impact of injury on their psychological and physical condition. All crash survivors that were admitted to the intensive or sub-intensive care units of selected hospitals in Greece, Germany and Italy over one year period (2013–2014), were invited to participate in the study and were interviewed at three different time-points as follows: (a) at one month (baseline data), (b) at six months, and (c) at twelve months. The study used widely recommended classifications for injury severity (AIS, MAIS) and standardized health outcome measures such as the Disability Assessment Schedule II (WHODAS 2.0) to measure disability, “Impact of Event Scale” (IES-R) to measure Post-Traumatic Stress Disorder (PTSD), Center for Epidemiological Studies Depression Scale (CES-D Scale) to measure depression. A total of 120 patients were enrolled in the study in all the partner countries and 93 completed all follow up questionnaires. The risk of physical disability was 4.57 times higher [CI 1.98–2.27] at the first follow up and 3.43 times higher [CI 1.43–9.42] at the second follow up as compared with the time before the injury. There was a 79% and an 88% lower risk of depression at the first and the second follow up respectively, as compared with the baseline time. There was also a 72% lower risk of Post-Traumatic Stress at the second follow up as compared with the baseline time. A number of factors relevant to the individuals, the road crash and the injury, were shown to distinguish those at higher risk of long-lasting disability and psychological distress including age, marital status, type of road user, severity and type of the injury, past emotional reaction to distress. The study highlights the importance of a comprehensive and holistic understanding of the impact of injury on an individual and further underlines the importance of screening and treating psychological comorbidities in injury in a timely manner.     

The Keane PTSD Scale extracted from the MMPI: Sensitivity and specificity with Vietnam veterans

A study was conducted to further investigate whether the Keane Posttraumatic Stress Disorder (PTSD) Scale of the Minnesota Multiphasic Personality Inventory (MMPI) can be employed as a separate instrument administered outside the context of the full MMPI. A group of Vietnam combat veterans with diagnosed PTSD and two comparison groups of veterans without PTSD (Vietnam combat and era veterans) were diagnosed by clinical interviews. Over 84% of the 64 veterans in the study were accurately classified by the Keane PTSD Scale into their original diagnostic groups. Excellent test sensitivity was demonstrated, with 90% of combat veterans with PTSD being properly classified by the Keane PTSD Scale when the recommended cutoff score of 30 was utilized. The clinical and research implications are discussed.     

Cognitive functioning in Post-Traumatic Stress Disorder

Twelve Post-Traumatic Stress Disorder (PTSD) patients, 12 psychiatric patients matched for severity of psychopathology, and 12 normal controls were assessed for cognitive functioning by means of a comprehensive test battery. Both patient groups felt subjectively more impaired than normals. Performance on measures of intelligence, organicity, verbal fluency, memory, and attention was significantly poorer in patients than in normals. The performance of the PTSD patients and that of the psychiatric controls was, however, very similar. The premorbid intelligence of both the PTSD patients and the psychiatric controls was average and had deteriorated significantly by the time of current testing. These cognitive problems were not secondary to alcohol, drug abuse, or head injury. The results suggest a cognitive impairment in post-traumatic patients.     

Sleep disturbance in post-traumatic stress disorder: A comparison with non-PTSD insomnia

Sleep disturbances, including repetitive nightmares and insomnia, are central and long-lasting aspects of Post-Traumatic Stress Disorder (PTSD). This study utilized a questionnaire to compare sleep disturbance in Vietnam War combat veterans having PTSD with non-PTSD patients having insomnia without other PTSD symptoms. The PTSD group reported symptoms of anxiety, agitation and concurrent body movement which were associated with insomnia. Nightmares of this group were more repetitive and more disruptive of a return to sleep than the non-PTSD insomnia group. The PTSD group also reported more fatigue during daytime functioning and more anxiety during waking hours than the non-PTSD insomnia group.     

The relationship between traumatic exposure,family dysfunction,and post-traumatic stress symptoms in male juvenile offenders

This study examined some chronic, stressful conditions and some acute, traumatic events which may place youths at risk for specific types of psychopathology. Ninety one delinquent adolescents with histories of serious and repeated crimes were assessed for their exposure to 11 different types of trauma. The subjects were also tested using measures which assess family functioning, and frequency and intensity of Post-Traumatic Stress Disorder (PTSD) symptoms. Results indicated that 24% of the subjects tested met full DSM III-R criteria for PTSD. Both exposure to violence and family dysfunction were significantly associated with PTSD symptomatology. These findings suggest that juvenile offenders may constitute a high risk group for exposure to multiple types of trauma and the development of post-traumatic stress symptoms related to such exposure. This study provides a rationale for future cross-trauma research both within the juvenile offender population and between it and other identified trauma groups.     

Familial abuse and post-traumatic stress disorder

Previous study of a sample of 149 adolescent runaways showed that youths who left home because of familial physical abuse were more likely than youths who left home for other reasons to report symptomatology consistent with the diagnostic criteria of Post-Traumatic Stress Disorder (PTSD). The literature suggests that stress reactions, such as PTSD, are not direct responses to stressors, such as familial abuse. Rather, these relationships are mediated by factors which influence a person's ability to cope with stressors. This paper reports the results of exploring two factors which influence coping ability: (1) perceptions of control over the stressor, and (2) the availability of intrafamilial social support. Using information from the same sample of 149 adolescent runaways, we compared youth who left home because of familial physical abuse to youth who did not on the basis of these two coping resources. Results show that victims of familial physical abuse are significantly more likely than are other runaways to believe that they could not have changed or controlled the events that led to their running. Further, the intrafamilial social support systems of these young victims are highly dysfunctional. Study findings support the contention that factors which decreased the coping ability of runaway victims of familial abuse heightened the probability of their developing Post-Traumatic Stress Disorder.     

Lithium for irritability in Post-Traumatic stress disorder

Irritability is often a problem for patients with Post-Traumatic Stress Disorder (PTSD). We describe two cases that illustrate the use of lithium in the treatment of veterans with PTSD who complained of serious problems with irritability or angry outbursts. These cases are discussed in the context of evidence that lithium may be useful in other patients with disorders of impulse control. The evidence linking disorders of anger and impulse control to a dysregulation in neurotransmitter regulation, particularly in serotonergic pathways, supports a psychopharmacologic approach to treatment. These findings should lead to further study of the role of lithium in the treatment of this symptom complex in patients with PTSD.     

Incidence of and risk factors for acute stress disorder in children with injuries

BACKGROUND: To assess the incidence of and risk factors for Acute Stress Disorder (ASD) in children with injuries. Numerous studies have documented the increased incidence of PTSD in those initially diagnosed with ASD. PTSD symptoms cause tremendous morbidity and may persist for many years in some children. METHODS: Children hospitalized with one or more injuries were interviewed and assessed with the following: Child Stress Disorders Checklist (CSDC), Family Strains Scale, Brief Symptom Inventory (BSI) and Facial Pain Scale. RESULTS: Participants included sixty-five children (ages 7-18 years). The mechanisms of injury varied (e.g. MVC, penetrating). The mean injury severity score was 8.9 +/- 7. The mean length of hospital stay was 4.6 +/- 4.6 days. Altogether, 18 (27.7%) of participants met DSM IV criteria for ASD during their acute hospital stay. Risk factors such as level of family stress, caregiver stress, child's experience of pain, and child's age were predictive of acute stress symptoms. CONCLUSION: We have identified four risk factors of ASD that have implications for the treatment, and possibly, preventative intervention for PTSD. Further investigation and greater understanding of risk factors for ASD in children with injuries may facilitate the design of acute interventions to prevent the long-term negative outcomes of traumatic events.     

Psychological and physical abuse in the schools: A paradigm for understanding post-traumatic stress disorder in children and youth

The literature on Post-Traumatic Stress Disorder (PTSD) in children is rather sparse. Most accounts describe only the aftereffects of horrendous traumas. Yet there is evidence that children are also vulnerable to a wider range of stressor than adults. Since the nosology for PTSD is based upon adult psychopathology, there is a need to examine the syndrome in light of current knowledge about development, psychopathology, and ecological factors in children's lives. The purpose of this paper is to present evidence that the pattern of symptoms of PTSD in children is different from those in adults. The paradigm presented was generated by work with children and youth who were the victims of excessively punitive disciplinary practices in schools. An updated overview of the literature on PTSD in children is presented. Case studies and retrospective data are offered in support of the need to differentiate child/adolescent PTSD from adult nosology and to understand the nature of PTSD when it occurs as a result of school related abuse.     

Post-traumatic stress disorder in child sexual abuse survivors: A literature review

Research to date has failed to identify a unique syndrome describing the sequelae of child sexual abuse (CSA). Recently, however, some researchers have suggested Post-Traumatic Stress Disorder as the diagnosis which best fits the syndrome commonly seen in CSA survivors. Research examining the consequences of CSA in terms of the applicability of a PTSD diagnosis is reviewed. Additionally, based on findings of significant relationships between PTSD and traumatic exposure in other trauma groups, this review also examines studies which have investigated relationships between exposure and symptom development among CSA survivors. Finally, conclusions regarding the applicability of PTSD to CSA survivors and suggestions for future research are offered.This article was accepted for publication under the Editorship of Charles R. Figley.