Exploring optimum cut-off scores to screen for probable posttraumatic stress disorder within a sample of UK treatment-seeking veterans.

Abstract:

:Background: Previous research exploring the psychometric properties of the scores of measures of posttraumatic stress disorder (PTSD) suggests there is variation in their functioning depending on the target population. To date, there has been little study of these properties within UK veteran populations. Objective: This study aimed to determine optimally efficient cut-off values for the Impact of Event Scale-Revised (IES-R) and the PTSD Checklist for DSM-5 (PCL-5) that can be used to assess for differential diagnosis of presumptive PTSD. Methods: Data from a sample of 242 UK veterans assessed for mental health difficulties were analysed. The criterion-related validity of the PCL-5 and IES-R were evaluated against the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Kappa statistics were used to assess the level of agreement between the DSM-IV and DSM-5 classification systems. Results: The optimal cut-off scores observed within this sample were 34 or above on the PCL-5 and 46 or above on the IES-R. The PCL-5 cut-off is similar to the previously reported values, but the IES-R cut-off identified in this study is higher than has previously been recommended. Overall, a moderate level of agreement was found between participants screened positive using the DSM-IV and DSM-5 classification systems of PTSD. Conclusions: Our findings suggest that the PCL-5 and IES-R can be used as brief measures within veteran populations presenting at secondary care to assess for PTSD. The use of a higher cut-off for the IES-R may be helpful for differentiating between veterans who present with PTSD and those who may have some sy`mptoms of PTSD but are sub-threshold for meeting a diagnosis. Further, the use of more accurate optimal cut-offs may aid clinicians to better monitor changes in PTSD symptoms during and after treatment. :Planteamiento: La investigación previa que exploró las propiedades psicométricas de las puntuaciones de las medidas del trastorno de estrés postraumático (TEPT) sugiere que existe una variación en su funcionamiento según la población objetivo. Hasta la fecha, ha habido pocos estudios sobre estas propiedades dentro de las poblaciones de veteranos del Reino Unido. Objetivo: Este estudio tuvo como objetivo determinar valores de corte óptimamente eficientes para la escala revisada del impacto de los eventos (IES-R, siglas en inglés de Impact of Event Scale-Revised) y la lista de TEPT para el DSM-5 (PCL-5, siglas en inglés de PTSD Checklist for DSM-5) que pueden utilizarse para evaluar el diagnóstico diferencial de TEPT presuntivo. Métodos: Se analizaron los datos de una muestra de 242 veteranos del Reino Unido evaluados por dificultades de salud mental. La validez relacionada con los criterios del PCL-5 y la IES-R se evaluó frente a la Escala de TEPT administrada por el clínico para el DSM-5 (CAPS-5, siglas en inglés de Clinician-Administered PTSD Scale for DSM-5). Se usaron estadísticas Kappa para evaluar el nivel de acuerdo entre los sistemas de clasificación del DSM-IV y DSM-5. Resultados: Las puntuaciones de corte óptimos observadas dentro de esta muestra fueron de 34 o más en la PCL-5 y de 46 o más en la IES-R. El límite de la PCL-5 es similar a los valores informados anteriormente, pero el punto de corte IES-R identificado en este estudio es más alto de lo que se había recomendado anteriormente. En general, se encontró un nivel moderado de acuerdo entre los participantes seleccionados con los sistemas de clasificación DSM-IV y DSM-5 para el TEPT. Conclusiones: Nuestros hallazgos sugieren que la PCL-5 y la IES-R pueden usarse como medidas breves en poblaciones de veteranos que se presentan en el sistema sanitario secundario para evaluar el TEPT. El uso de un punto de corte más alto para la IES-R puede ser útil para diferenciar entre los veteranos que presentan TEPT y aquellos que pueden presentar algunos síntomas de TEPT, pero que están por debajo del umbral y no cumplen con el diagnóstico. Además, el uso de puntos de corte óptimos más precisos puede ayudar a los clínios a controlar mejor los cambios en los síntomas de TEPT durante y después del tratamiento. :背景:探索创伤后应激障碍(PTSD)测量分数的心理测量特性的前人研究建议,根据不同目标群体测量分数的表现具有变异性。目前为止,很少有研究在英国老兵群体里考察这些特性。 目标:本研究目的是要决定事件影响量表修订版(IES-R)和DSM-5 PTSD检核表(PCL-5)的划界分,用来评估不同PTSD诊断。 方法:使用242名英国老兵评估精神健康的数据,将PCL-5和IES-R与CAPS-5对比得出诊断标准相关效度。使用Kappa系数来评估DSM-IV和DSM-5分类系统的一致性。 结果:本样本中PCL-5最好的划界分是34或以上,IES-R是46或以上。PCL-5划界分和之前报告值相近,但是IES-R则高于以往推荐的数值。总体上,使用DSM-IV和DSM-5的PTSD分类系统表现出中等一致性。 结论:我们的发现建议PCL-5和IES-R可以用在二级护理的老兵群体中作为评估PTSD的简要工具。使用更高的IES-R划界分可以有助于区分有PTSD和可能具有一些症状但还在达不到PTSD诊断阈值的老兵。进一步,使用更准备的最佳划界分可能帮助临床医生更好监控PTSD症状在治疗中和治疗后的改变。.

journal_name

Eur J Psychotraumatol

authors

Murphy D,Ross J,Ashwick R,Armour C,Busuttil W

doi

10.1080/20008198.2017.1398001

subject

Has Abstract

pub_date

2017-11-13 00:00:00

pages

1398001

issue

1

issn

2000-8066

pii

1398001

journal_volume

8

pub_type

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