Traumatic events such as combat, serious accidents, physical and sexual abuse, and sudden death of loved ones are disturbingly common. Exposure to traumatic stressors often produces posttraumatic stress disorder (PTSD), a debilitating, often long-lasting psychiatric disorder that is a risk factor for clinical depression, other mental health problems, serious medical conditions, and over utilization of health care. For these reasons and because patients rarely disclose traumatic experiences unless asked, authorities have urged health providers to conduct routine trauma history/PTSD screening. Still, trauma history screening in health settings is rare, due in part to time constraints and competing demands. Thus, untreated PTSD and other effects of trauma are an enormous cost and health care burden. There is a dire need for a cost-effective, efficient tool that reliably assesses for trauma history and PTSD symptoms, as a basis for making appropriate referrals. As a major service provider, the VA would benefit from a fast, easy, and accurate means of identifying those in need of mental health care.
The objectives of this study are to develop and validate: 1) standard; and 2) abbreviated versions of a low-cost, computerized, self-administered trauma history/PTSD screening protocol, which is self-scoring, report-generating, and requires minimal clinician involvement. These abbreviated versions are for clinical and research applications where time is at a premium.
Six studies are being conducted among active duty military personnel, adult family members, and retirees (n=350). Study 1 refined a preliminary version of a Computerized Trauma History/PTSD Screen (CTS). The CTS was constructed by converting into a computerized format two brief questionnaires which have been shown to possess strong psychometric properties: 1) a broad-spectrum measure of trauma exposure; and 2) a measure of PTSD shown to have strong discriminative validity in classifying the PTSD status of combat veterans and abused women. Study 2 evaluates: 1) agreement between the computerized and paper-and-pencil versions of the assessment protocol when administered on the same day: and 2) the convergent and criterion validity of the computerized questionnaires, judged against structured interview assessment of trauma history and PTSD. Study 3 evaluates short-term (1-week) temporal stability of the two computerized questionnaires. Study 4 evaluates agreement between the computerized and paper-and-pencil versions of the questionnaire administered one week apart. It is hypothesized that both of the computerized questionnaires will possess strong temporal stability. Study 5 seeks to verify the occurrence of the participants’ self-report of their most traumatic experience. To establish the generalizability or clinical utility of the findings across health settings and patient subgroups, the protocol is being validated with: primary medical care patients; psychiatric patients; individuals receiving substance abuse treatment; and individuals referred for advocacy services related to domestic violence and child abuse. Study 6 evaluates the agreement between the standard computerized screen and the abbreviated computerized screen, as well as the agreement between the standard paper-and-pencil screen and the abbreviated paper-and-pencil screen.
Study 1 is complete and has established that the CTS is "user friendly" and easy to administer. We anticipate that the CTS will: 1) be equivalent to paper-and-pencil administration of these measures; 2) yield high rates of agreement with structured interview assessments of trauma history and PTSD; and 3) yield high rates of agreement on PTSD status (present/absent), judged against interview assessments. We also anticipate high rates of agreement between the abbreviated and standard versions of the Trauma History/PTSD screens.
This study will address the need for a cost-effective, efficient, and reliable method to assess for trauma history and PTSD, as a basis for making appropriate referrals.
- Kubany ES, Haynes SN, Leisen MB, Owens JA, Kaplan AS, Watson SB, Burns K. Development and preliminary validation of a brief broad-spectrum measure of trauma exposure: the Traumatic Life Events Questionnaire. Psychological assessment. 2000 Jun 1; 12(2):210-24.
- Kubany ES, Leisen MB, Kaplan AS, Kelly MP. Validation of a brief measure of posttraumatic stress disorder: the Distressing Event Questionnaire (DEQ). Psychological assessment. 2000 Jun 1; 12(2):197-209.