Development and Evaluation of the Thinking About Recovery Scale: Measure of Parent Posttraumatic Cognitions Following Children's Exposure to Trauma

Researchers have recently suggested that parent posttraumatic appraisals potentially contribute to the development of posttraumatic stress in both parents and children following children's exposure to trauma. However, a single‐instrument, multidimensional measure of parent posttraumatic cognitions as they relate to their child's recovery has yet to be operationalized. This study described the development and evaluation of a parent‐report questionnaire of parent posttraumatic cognitions, designed to be used after a child's exposure to trauma. We generated an initial pool of items in reference to existing theories and subjected this list to an iterative process of item writing and revision. Items were subjected to expert review to maximize construct validity. The 33‐item Thinking About Recovery Scale (TARS), which measures three domains (My child has been permanently damaged; The world is dangerous for my child; Parents should always promote avoidance) demonstrated good internal consistency (Cronbach's α = .74‐88) and convergent validity (r ² range = .08‐.40) when piloted in a sample of 116 parents of children who had been exposed to a serious accidental injury. The TARS augments the available literature by providing a brief measure of parent posttraumatic cognitions, an area which is currently understudied in childhood posttraumatic stress and could have broad clinical and research use.     

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.     

Examination of the Factor Structure and Correlates of the Perceived Military Healthcare Stressors Scale

The current study evaluated the factor structure, reliability estimates, correlates, and predictive utility of the Perceived Military Healthcare Stressor Scale (PMHSS) in a sample of active duty military medical personnel (N = 1,131) deployed to Joint Base Balad in Iraq. The sample was composed of an approximately even split of male (51.2%) and female (48.8%) participants who ranged in age from 18 to 60 years. The PMHSS is a 21‐item measure that was designed to assess the impact of specific medical stressors that military healthcare providers may encounter while deployed. An exploratory factor analysis of the PMHSS revealed the presence of two distinct factors: trainable and futility stressors. Confirmatory factor analysis showed that a bifactor model best represented the data, with all items loading higher on the general factor relative to their specific subscale factors. Evidence of partial scalar invariance by gender was found. The PMHSS was significantly correlated with several convergent measures, including assessments of posttraumatic stress disorder (PTSD), depression severity, distress due to both combat exposure and general deployment‐related concerns, and positive affect, rs = .30–.59. PMHSS scores were more strongly correlated with PTSD and depression in women than in men, and they provided incremental validity in predicting convergent measures over and above other related constructs. Healthcare–specific stressors are an understudied area, and this study provides new insights into how deployment‐related caregiving stress may impact deployed military medical personnel independently of the impact of combat experiences.     

A Parental Tool to Screen for Posttraumatic Stress in Children: First Psychometric Results

The Children's Revised Impact of Event Scale (CRIES‐13) is a brief self‐report measure designed to screen children for posttraumatic stress disorder (PTSD). This study investigates the psychometric properties of a Dutch version of the CRIES‐13–parent version and evaluates its correlation with the child version. A sample of 59 trauma‐exposed children (8 years–18 years) and their parents completed an assessment including the CRIES‐13 (child/parent version) along with the Anxiety Disorders Interview Schedule for DSM‐IV: Parent version. Results demonstrated good internal consistency (α = .87) with acceptable values for the 3 subscales. A strong correlation (r = .73) with another measure of PTSD and lower correlations with a behavioral measure (r = .15 to .38) were found, confirming the convergent/divergent validity. A cutoff score ≥ 31 emerged as the best balance between sensitivity and specificity, and correctly classified 83.6% of all children as having a diagnosis of PTSD. This study provides support for the reliability and validity of the CRIES‐13–parent version as a screening measure for posttraumatic stress in children.     

Psychometric properties of a Swedish translation of the Clinician-Administered PTSD Scale--Diagnostic Version

Internal consistency (N = 172) and convergent validity (N = 73) of a Swedish translation of the Clinician-Administered PTSD Scale-Diagnostic Version (CAPS-DX) were evaluated with violence victims with posttraumatic stress disorder (PTSD). The CAPS-DX evidenced a promising internal consistency, and significant correlations (Pearson product-moment) with the PTSD Symptom Scale Self-Report version (PSS-SR) and the Impact of Event Scale-Revised (IES-R). Additionally, each subscale of the CAPS-DX (intrusion, avoidance/numbing, and arousal) was significantly correlated with the corresponding subscales of the PSS-SR and the IES-R. Results of the present study are discussed in the context of internal consistencies and convergent validity coefficients of the CAPS with other PTSD symptom measures in previous studies.     

Psychometric Properties of the Child PTSD Symptom Scale in Latino Children

The Child PTSD Symptom Scale (Foa, Johnson, Feeny, & Treadwell, 2001 ) is a self‐report measure of posttraumatic stress disorder symptoms (PTSD) in children and adolescents. Despite widespread use of this measure, no study to our knowledge has examined its psychometric properties in Latino children. This study examined the factor structure, internal consistency, and convergent validity of the measure utilizing a sample of 161 Latino students (M = 11.42 years, SD = 0.70) at high risk of exposure to community violence. Confirmatory factor analyses suggested that a 3‐factor model consistent with the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM‐IV‐TR; American Psychiatric Association, 2000 ) provided the best fit to the data. Internal consistency of the total scale and subscales was high when completed in English or Spanish. All Child PTSD Symptom Scale scores were positively correlated with violence exposure. As additional evidence of convergent validity, scores evidenced stronger correlations with internalizing symptoms than with externalizing symptoms. Results supported the use of the Child PTSD Symptom Scale as a measure of PTSD severity in Latino children, but additional research is needed to determine appropriate clinical cutoffs for Latino youths exposed to chronic levels of violence. Implications for clinical practice and future research are discussed.     

Convergent Validity of Three Posttraumatic Symptoms Inventories Among Adult Sexual Abuse Survivors

We examined the convergent validity of three posttraumatic symptoms inventories, the civilian version of the Mississippi Scale for Combat-Related PTSD (CM-PTSD), the Trauma Symptom Checklist-40 (TSC-40), and the Response to Childhood Incest Questionnaire (RCIQ), in a sample of 52 adult sexual abuse survivors. The significant and moderate to strong correlations (r = .6 or higher) among these inventories supported their convergent validity. Comparison with other studies also suggests that these instruments can adequately discriminate clinical from nonclinical populations.     

Predictive Validity of ICD‐11 PTSD as Measured by the Impact of Event Scale‐Revised: A 15‐Year Prospective Study of Political Prisoners

The 11^th edition of the International Classification of Diseases (ICD‐11 ; World Health Organization, 2017) proposes a model of posttraumatic stress disorder (PTSD) that includes 6 symptoms. This study assessed the ability of a classification‐independent measure of posttraumatic stress symptoms, the Impact of Event Scale‐Revised (Weiss & Marmar, 1996), to capture the ICD‐11 model of PTSD. The current study also provided the first assessment of the predictive validity of ICD‐11 PTSD. Former East German political prisoners were assessed in 1994 (N = 144) and in 2008‐2009 (N = 88) on numerous psychological variables using self‐report measures. Of the participants, 48.2% and 36.8% met probable diagnosis for ICD‐11 PTSD at the first and second assessments, respectively. Confirmatory factor analysis supported the factorial validity of the 3‐factor ICD‐11 model of PTSD, as represented by items selected from the Impact of Event Scale‐Revised. Hierarchical multiple regression analysis demonstrated that, controlling for sex, the symptom clusters of ICD‐11 PTSD (reexperiencing, avoidance, and sense of threat) significantly contributed to the explanation of depression (R ² = .17), quality of life (R ² = .21), internalized anger (R ² = .10), externalized anger (R ² = .12), hatred of perpetrators (R ² = .15), dysfunctional disclosure (R ² = .27), and social acknowledgment as a victim (R ² = .12) across the 15‐year study period. Current findings add support for the factorial and predictive validity of ICD‐11 PTSD within a unique cohort of political prisoners.     

The Child Trauma Screen: A Follow‐Up Validation

Although the prevalence of exposure to potentially traumatic events and associated outcomes among children is well documented, widespread trauma screening remains limited. This study provides additional data supporting the psychometrics of the Child Trauma Screen (CTS), a free, brief, empirically derived measure that was intended as a trauma screen for use across child‐serving systems. Participants were an ethnically diverse sample of 187 children aged 6–18 years recruited from an urban children's community mental health clinic. At intake, children and their caregivers completed the CTS and other standardized measures of posttraumatic stress disorder, externalizing behavior, anxiety, and depression. Results indicated that the CTS had strong properties on both child and caregiver reports, including internal consistency (Cronbach's α = .78 for both), convergent validity (r = .83 and r = .86), divergent validity (mean across measures and reporters, r = .31; range r = .01–.70), and criterion validity (sensitivity = 0.83 and 0.76; specificity = 0.95 and 0.79, correct classification 89.3% and 81.4%). Suggested cut points and recommendations for using the CTS as a trauma screen are provided. This study provides further empirical support for the use of the CTS as a brief trauma screening measure and provides recommendations for further research.     

Disgusted by Sexual Abuse: Exploring the Association Between Disgust Sensitivity and Posttraumatic Stress Symptoms Among Mothers of Sexually Abused Children

Nonoffending mothers of sexually abused children often exhibit high levels of posttraumatic stress (PTS) symptoms. Emerging evidence suggests that trait‐like individual differences in sensitivity to disgust play a role in the development of PTS symptoms. One such individual difference, disgust sensitivity, has not been examined as far as we are aware among victims of secondary traumatic stress. The current study examined associations between disgust sensitivity and PTS symptoms among mothers of sexually abused children (N = 72). Mothers completed the Impact of Event Scale‐Revised and the Three Domain Disgust Scale (Tybur, Lieberman, & Griskevicius, 2009). More than one third of mothers scored above a suggested cutoff (mean score = 1.5) for high levels of PTS symptoms. Hierarchical linear regression analysis results indicated that sexual disgust sensitivity (β = .39, p = .002) was associated with PTS symptoms (R² = .18). An interaction analysis showed that sexual disgust sensitivity was associated with maternal PTS symptoms only when the perpetrator was not biologically related to the child (β = ?.32, p = .047; R² = .28). Our findings suggested that sexual disgust sensitivity may be a risk factor for developing PTS symptoms among mothers of sexually abused children.     

German version of Clinician-Administered PTSD Scale

This study assessed the reliability of a German translation of the Clinician-Administered PTSD Scale (CAPS) by using data from 45 survivors of accidents who were hospitalized at the department of traumatology of a university hospital. Assessments were carried out 5 days (Time 1) and 6 months (Time 2) after the accident. Internal consistency proved to be comparable to that of the original English version: Cronbach's alpha was .88 at T1 and .92 at T2 for the CAPS total score. The CAPS correlated significantly with the validated German version of the Impact of Event Scale (IES) (T1: r = .56, T2: r = .78). The data suggest that the German version of the CAPS is a reliable instrument for the assessment of posttraumatic stress disorder symptomatology in accident victims. Further studies are necessary to validate further the questionnaire.     

Association of PTSD Symptoms With Asthma Attacks Among Hurricane Katrina Survivors

The relationship between posttraumatic stress disorder (PTSD) and asthma in the wake of natural disasters is poorly understood. Using pre‐ and postdisaster data (N = 405) from the Resilience in Survivors of Katrina (RISK) project, we examined associations between PTSD symptoms, measured by the Impact of Event Scale‐Revised (IES‐R), and self‐reported postdisaster asthma attacks. A 1‐point increase in the IES‐R avoidance score, which corresponded to one standard deviation change in this sample, was associated with double the odds of reporting an asthma attack or episode since the hurricane, 95% CI Revise spacing among characters: [1.22, 4.16]. Association with hyperarousal and intrusion symptoms was null. Further research using objective measures of asthma morbidity is needed; nevertheless, these findings may help inform postdisaster health services delivery and predisaster mitigation planning.     

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.     

Validation of the Persistent Complex Bereavement Disorder (PCBD) Checklist: A Developmentally Informed Assessment Tool for Bereaved Youth

The inclusion of Persistent Complex Bereavement Disorder (PCBD) in the DSM‐5 appendix signifies a call for research regarding the distinguishing features and clinical utility of proposed PCBD criteria. Rigorously constructed tools for assessing PCBD are lacking, especially for youth. This study evaluated the validity and clinical utility of the PCBD Checklist, a 39‐item measure designed to assess PCBD criteria in youth aged 8 to18 years. Test construction procedures involved: (a) reviewing the literature regarding developmental manifestations of proposed criteria, (b) creating a developmentally informed item pool, (c) surveying an expert panel to evaluate the clarity and developmental appropriateness of candidate items, (d) conducting focus groups to evaluate the comprehensibility and acceptability of items, and (e) evaluating psychometric properties in 367 bereaved youth (M_age = 13.49, 55.0% female). The panel, clinicians, and youth provided favorable content validity and comprehensibility ratings for candidate items. As hypothesized, youth who met full PCBD criteria, Criterion B (e.g., preoccupation with the deceased and/or circumstances of the death), or Criterion C (e.g., reactive distress and/or social/identity disruption) reported higher posttraumatic stress and depressive symptoms than youth who did not meet these criteria, η_p² = .07–.16. Youth who met Criterion C reported greater functional impairment than youth who did not, η_p² = .08–.12. Youth who qualified for the “traumatic bereavement specifier” reported more frequent posttraumatic stress symptoms than youth who did not, η_p² = .04. Findings support the convergent, discriminant, and discriminant‐groups validity, developmental appropriateness, and clinical utility of the PCBD Checklist.     

Convergent validity of measures of Post-Traumatic Stress Disorder in a mixed military and civilian population

The authors evaluated the validity of the Post-Traumatic Stress Disorder (PTSD) subscale of the Minnesota Multiphasic Personality Inventory (MMPI), the Impact of Event Scale (IES) and the Symptom Check List 90 (SCL-90) as continuous and dichotomous measures of PTSD in a mixed military and civilian group of 70 subjects in the United Kingdom. The MMPI-PTSD and the IES are designed specifically as measures of PTSD and the Global Symptom Index of the SCL-90 is a general measure of neurosis. All measures produced significant positive correlations with scores from the Clinician Administered Post-Traumatic Stress Disorder Scale (CAPS-1) and with each other. The IES was the most useful dichotomous measure. The optimum cut-off score for the IES producing the highest Positive Predictive Value and the lowest Apparent Total Misclassification Error Rate has been determined.     

Validation of the Pittsburgh Sleep Quality Index Addendum for Posttraumatic Stress Disorder (PSQI‐A) in U.S. Male Military Veterans

Sleep disturbances are core symptoms of posttraumatic‐stress disorder (PTSD), yet they bear less stigma than other PTSD symptoms. Given the growing number of returning military veterans, brief, valid assessments that identify PTSD in a minimally stigmatizing way may be useful in research and clinical practice. The study purpose was to evaluate the psychometric properties of the Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI‐A), and to examine its ability to identify PTSD cases among U.S. male military veterans. Male military veterans (N = 119) completed the PSQI‐A, as well as measures of sleep quality, combat exposure, posttraumatic stress, depression, and anxiety. Veterans with PTSD had higher PSQI‐A identified disruptive nocturnal behaviors than veterans without PTSD. The PSQI‐A had good internal consistency and convergent validity with sleep quality, combat exposure, PTSD symptoms, depression, and anxiety. A cutoff score ≥ 4 provided an area under the curve = .81, with 71% sensitivity, 82% specificity, and 60% positive and 83% negative predictive value for a clinical diagnosis of PTSD; correct classification was 74%. The PSQI‐A is a valid measure to possibly detect PTSD among male military veterans. Assessment of disruptive nocturnal behaviors may provide a cost‐effective, nonstigmatizing approach to PTSD screening without directly probing for trauma exposure(s).     

Screening for PTSD in a Substance Abuse Sample: Psychometric Properties of a Modified Version of the PTSD Symptom Scale Self-Report

The high rate of posttraumatic stress disorder (PTSD) among substance use disorder (SUD) patients has been documented in research protocols, but there is evidence that it is markedly under-diagnosed in clinical settings. To address the need for a brief self-report measure to identify SUD patients who may benefit from further assessment and/or treatment for PTSD, the psychometric properties of a modified version of the PTSD Symptom Scale Self-Report (PSSSR) were examined in a treatment-seeking SUD sample (N = 118). The modified version of the PSS-SR, which measures both frequency and severity of PTSD symptoms, demonstrated good internal consistency reliability and was correlated with other self-report measures of trauma-related symptomatology. Comparisons between a structured PTSD diagnostic interview and the modified PSS-SR indicated that 89% of the PTSD positive patients were correctly classified by the modified PSS-SR. The clinical relevance of these findings was discussed.     

A diagnostic interview for acute stress disorder for children and adolescents

The goal of this study was to develop a semistructured clinical interview for assessing acute stress disorder (ASD) in youth and test its psychometric properties. Youth (N = 168) with an acute burn or injury were administered the acute stress disorder module of the Diagnostic Interview for Children and Adolescents (DICA‐ASD). The DICA‐ASD demonstrated strong psychometric properties, including high internal consistency (α = .97) and perfect diagnostic interrater agreement (κ = 1.00). Participants diagnosed with ASD scored significantly higher than those not diagnosed on validated traumatic stress symptomatology measures but not on other symptomatology measures, providing evidence of convergent and discriminant validity. Preliminary evidence supports the reliability and validity of the first semistructured clinical interview for diagnosing ASD in youth.     

The Perceived Stress Scale for Kids (PeSSKi): Initial development of a brief measure for children aged 7–11 years

Perceived stress, a known risk factor for poor health, has been extensively assessed in adult populations. Yet an equivalent assessment tool for measurement of global perceived stress in children is lacking. This study aimed to develop and provide initial validation of a scale to measure perceived stress in children aged 7–11 years. Using a two-phase design, we conducted semi-structured interviews with thirteen child-parent dyads for development of items. In a sample of 123 children (age range 7–11 years, Mage = 9 years 7 months, 54.5% male) we administered the resulting Perceived Stress Scale for Kids (PeSSKi). Exploratory factor analysis of the 10-item PeSSKi yielded support for both a one-factor and a two-factor solution (negative, positive item wording). The PeSSKi was associated positively with the Penn-State Worry Questionnaire for Children (r = 0.748, p < 0.001) and negatively with the Students' Life Satisfaction Scale (r = 0.381, p < 0.001) indicating strong convergent/divergent validity respectively. Girls showed higher scores on the PeSSKi than boys with no effects observed by age. Initial psychometrics suggest the PeSSKi provides a robust scale for assessment of perceived stress in children. Further validation is needed across different child populations, over time and with physical measures of stress and health outcomes.     

PRISM (Pictorial Representation of Illness and Self Measure): a new method for the assessment of suffering after trauma

This pilot study tested the validity of a 1-item visual assessment method originally developed to evaluate suffering in chronic illness that has been adapted for use with patients who have been exposed to traumatic events. The Pictorial Representation of Illness and Self Measure (PRISM) was administered 5 times during the course of a posttraumatic stress disorder (PTSD) treatment outcome study (N = 29). The PRISM scores declined significantly under trauma-focused psychotherapy and differentiated between participants with and without PTSD diagnoses. Test-retest reliability over a 6-month period was high (r = .85). PRISM showed significant correlations with measures of PTSD, depression, and psychopathology symptom load (r = -.38 to r = -.81; convergent validity). At the same time, PRISM was not significantly related to trauma history (discriminant validity). Illustrations of symptom time courses indicated that PRISM was more closely related to trauma-specific psychopathology than to nontrauma-specific psychopathology (discriminant validity) and sensitive to change. In summary, PRISM appears to be a valid tool for the assessment of trauma-related suffering and adds to multimethod approaches in trauma research.