Effects of varying scoring rules of the Clinician-Administered PTSD Scale (CAPS) for the diagnosis of post-traumatic stress disorder in motor vehicle accident victims

doi:10.1016/0005-7967(94)00064-Q

Behaviour Research and Therapy

Volume 33, Issue 4, May 1995, Pages 471-475

https://doi.org/10.1016/0005-7967(94)00064-Q Get rights and content

Abstract

We examined the effects of varying the scoring rules for the CAPS (Clinician Administered PTSD Scale) on the diagnosis of PTSD in a sample of 100 victims of recent motor vehicle accidents. This was done by assessing, for each scoring rule, the rate of categorical diagnosis and the effect on group mean scores on measures of subjective distress and role impairment. Changing from the most liberal to the most conservative scoring rule results in a change in diagnosis of PTSD from 44% to 29% of the sample. Comparisons of those included as PTSD under the most conservative scoring criteria vs those excluded (who had previously been included) reveal significantly greater subjective distress and role impairment among those who continue to be included in the PTSD category. Thus, changes in scoring rules have clinically significant effects on the incidence and severity of diagnosed PTSD. This indicates that the selection of scoring rules has important implications for epidemiological estimates of the prevalence of PTSD, and that PTSD studies using different scoring rules as inclusion criteria may be using somewhat different samples.

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The American College of Surgeons Committee on Trauma (ACS-CoT) mandated that trauma centers have mental health screening and referral protocols in place by 2023. This study compares the Injured Trauma Survivor Screen (ITSS) and the Automated Electronic Medical Record (EMR) Screen to assess their performance in predicting risk for posttraumatic stress disorder (PTSD) within the same sample of trauma patients to inform trauma centers’ decision when selecting a tool to best fit their current clinical practice.
This was a secondary analysis of three prospective cohort studies of traumatically injured patients (N = 255). The ITSS and Automated EMR Screen were compared using receiver operating characteristic curves to predict risk of subsequent PTSD development. PTSD diagnosis at 6-month follow-up was assessed using the Clinician Administered PTSD Scale for DSM-5.
Just over half the sample screened positive on the ITSS (57.7%), while 67.8% screened positive on the Automated EMR Screen. The area under the curve (AUC) for the two screens was not significantly different (ITSS AUC = 0.745 versus Automated EMR Screen AUC = 0.694, p = 0.21), similar performance in PTSD risk predication within the same general trauma population. The ITSS and Automated EMR Screen had similar sensitivities (86.5%, 89.2%), and specificities (52.5%, 40.9%) respectively at their recommended cut-off points.
Both screens are psychometrically comparable. Therefore, trauma centers considering screening tools for PTSD risk to comply with the ACS-CoT 2023 mandate should consider their local resources and patient population. Regardless of screen selection, screening must be accompanied by a referral process to address the identified risk.
Trauma cue-elicited emotional response profiles influence acute experiences of alcohol urge
2022, Journal of Behavior Therapy and Experimental Psychiatry
Citation Excerpt :
The interview procedures were identical for individuals with and without Criterion A trauma. Symptoms were scored using the conservative “rule of 2” for both intensity and frequency ratings (i.e., at least “moderate” severity; Blanchard et al., 1995). These procedures resulted in three sub-groups within our sample: individuals with no Criterion A trauma (“No Trauma”; n = 127), individuals with at least one Criterion A trauma, but did not report symptoms consistent with a diagnosis of PTSD (“Trauma Only”; n = 106) and individuals with Criterion A trauma and clinically significant PTSD (“PTSD” n = 71).
Affective responses to trauma cues in individuals with posttraumatic stress (PTS) can evoke a desire to drink and may shed light on novel mechanisms of PTS-drinking. The present study aimed to (1) identify and characterize patterns of acute emotional responses (ER) to trauma cues and (2) examine how these patterns influence drinking urge.
University students (N = 304; M_age = 19; 52.3% female) completed a structured clinical interview to confirm trauma history and PTS. At an experimental session one week later, participants completed a series of three trauma cue exposures. Affect and drinking urge were measured at baseline, after each cue exposure, and at experiment's end.
Latent profile analysis of ER yielded a five-profile solution: (1) Nonresponders (2) Low Responders (3) Moderate Responders (4) Resilient Responders and (5) High Responders. Profiles differed by trait neuroticism, PTS, and emotion dysregulation, with High Responders as the most severe group. In latent growth curve models, profiles significantly predicted alcohol urge trajectories in a graded pattern. High Responders, with the greatest affective intensity, showed the strongest urge. Duration of affect was also implicated with Resilient Responders, who had similar intensity but faster overall affective recovery time compared to High Responders, demonstrating lower mean levels of urge.
External validity is limited.
Individual differences in ER to trauma cues are important for understanding alcohol urge. Findings can inform integrative treatments for PTS-drinking by targeting ER to shorten affective recovery to trauma reminders and reduce the need for alcohol use as a regulation strategy.
Utility of Psychophysiological Metrics in Guiding Treatment of Trauma Symptoms: A Systematic Review
2021, Journal of Behavioral and Cognitive Therapy
The reliability of gold standard symptom assessments of post-traumatic stress disorder (PTSD) can be compromised by memory, emotional or cultural bias. The use of psychophysiological measures may complement psychometrics in tracking changes during treatment in physiological response and emotion regulation. In this systematic review, we integrate knowledge about the correlation between psychometric and psychophysiological measures in 22 prospective studies with trauma-focused cognitive, exposure, pharmacological and other interventions. Our objective was to determine how physiological resting states and reactivity pre- vs. post-intervention correspond to the effect of intervention on PTSD symptoms. Trends towards normalizing physiological resting states and arousal, as measured before and after treatment, were seen to correlate with a psychometric recovery. In patients with significant changes in trauma symptoms, pre- vs. post-treatment resting heart rate, heart rate reactivity to trauma cues and skin conductance decreased, and heart rate variability increased. Electromyography could measure adaptive decreases in startle responses to exposure content. Both blood pressure raw values and reactivity decreased post-treatment following cognitive therapy. Additional longitudinal studies are needed to explore standard testing paradigms that can be used for psychophysiological measures, and the corresponding cut-off levels that can indicate healthy and abnormal treatment response levels. The current findings stress a need for the development of a psychophysiological methodology that is feasible and reliable during experimental and clinical procedures to elucidate the effects of trauma intervention on emotional processing. Systematic review PROSPERO registration ID:CRD42021227774.
Family emotional climate in childhood and risk of PTSD in adult children of Australian Vietnam veterans
2020, Psychiatry Research
The mechanisms of intergenerational transmission of posttraumatic stress disorder (PTSD) from parent to child are not yet known. We hypothesised that the mechanisms involved in trauma transmission may be dependent upon sex specific caregiver-child dyads and these dyads may have a differential impact on post-traumatic stress disorder (PTSD). A non-clinical sample of adult offspring (N = 306) of Australian Vietnam veterans was interviewed in-person to assess the relationship between family emotional climate and caregiver attachment with the offspring's adult experience of post-traumatic stress disorder (PTSD). Attachment to the veteran father was not associated with sons’ PTSD, but was for daughters. Attachment to mother was associated with PTSD and depression for both sons and daughters, with positive and warm attachment related to reduced PTSD diagnosis and its symptom clusters. A less positive family emotional environment was related to increased PTSD symptoms in daughters, while for sons a negative relationship style with their mother was related to increased frequency and severity of numbing/avoidance behaviours and hyperarousal symptoms. The findings suggest that sex-related differences in caregiver-child dyads do have a differential impact on PTSD symptom domains and may be one environmental mechanism by which trauma is transmitted across generations.
Posttraumatic stress disorder after minor trauma – A prospective cohort study
2020, Medical Hypotheses
Citation Excerpt :
The symptoms have to last longer than one month, cause significant functional impairment and develop within the first 6 months after trauma [2]. Many studies investigated possible influencing factors for developing a PTSD [3–7]. The results showed that injury severity is not a good predictor of psychosocial outcome, whereas the subjective impact of trauma is much more important in this context [7].
Posttraumatic stress disorder (PTSD) can arise as a reaction to a traumatic experience. While many data concerning PTSD in severely injured patients are available, little is known about this disease in slightly injured patients after road traffic accidents. It is rather assumed that PTSD does not exist after objectively slight injuries.
In total, 36 patients (Injury Severity Score < 16) after road traffic accidents were included in this prospective cohort study. Next to demographic and accident-specific data, the PDI (Peritraumatic Distress Inventory: individual experienced distress directly during or immediately after the traumatic event), THQ (Trauma History Questionnaire) and the BDI-II (Beck Depression Inventory-II: self-report measurement tool to examine the severity of depression) were assessed immediately after trauma (t0). Six weeks (t1) and 3 months (t2) after trauma the Impact of Event Scale – Revised (IES-R), a screening instrument for PTSD, and the BDI-II were collected.
Overall 2 patients showed critical measurement values in IES-R after 6 weeks. A strong correlation between PDI and IES-R at t1 and t2 could be detected (p < 0.05). Furthermore, a significant correlation of BDI-II and IES-R after 6 weeks and 3 months was found (p < 0.05). Neither age or sex showed a significant correlation to IES-R (p ≥ 0.05).
The present study showed that symptoms of PTSD can also occur after minor trauma. Especially high peritraumatic distress is associated with developing a PTSD. The occurrence of PTSD should be considered not only in severely injured patients, but also in slightly injured patients after road traffic accidents.
Cardiovascular risks in relation to posttraumatic stress severity among young trauma-exposed women
2018, Journal of Affective Disorders
Posttraumatic stress is associated with elevated risk for cardiovascular disease (CVD). Relatively little research, particularly among women, has documented mechanisms by which PTSD might confer CVD risk during early adulthood. The purpose of the present study was to examine whether the number and relative levels of CVD risk factors are associated with posttraumatic stress symptom severity among young, trauma-exposed women.
Participants were premenopausal women ages 19–49 with varying levels of posttraumatic stress and no history of chronic medical illness (n = 54), and were recruited from mental health clinics and the general community. Posttraumatic stress severity was assessed with a structured clinical interview (Clinician-Administered PTSD Scale). The CVD risk factors assessed were lipids (total cholesterol, triglycerides, high- and low-density lipoproteins), resting blood pressure (BP), body mass index (BMI), no exercise in typical week, and cigarette smoking.
Posttraumatic stress severity was associated with lower high-density lipoprotein levels and higher triglycerides, greater systolic and diastolic BP, greater BMI, and a greater number of total CVD risk factors.
The main limitation is the limited number of participants who displayed clinical levels on some of the CVD risk factors (e.g., BP). Nonetheless, most participants exhibited more than one CVD risk factor, indicating the potential for many of the women in this relatively young sample to progress toward greater risk later in life.
The present results support the contention that, in the absence of medical illness, posttraumatic stress symptom severity among young women is associated with several CVD risk factors early in life.

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Behavioral assessmentEffects of varying scoring rules of the Clinician-Administered PTSD Scale (CAPS) for the diagnosis of post-traumatic stress disorder in motor vehicle accident victims

Abstract

Diagnostic and Statistical Manual of Mental Disorders

An inventory for measuring depression

Archives of General Psychiatry

Clinician Administered PTSD Scale (CAPS)

Post-traumatic stress disorder and motor vehicle accidents

Journal of Anxiety Disorders

Lifetime and current prevalence of specific psychiatric disorders among Vietnam veterans and controls

Archives of General Psychiatry

A longitudinal interval follow-up evaluation: A comprehensive method for assessing outcome and prospective longitudinal studies

Archives of General Psychiatry

Behavioral assessment
Effects of varying scoring rules of the Clinician-Administered PTSD Scale (CAPS) for the diagnosis of post-traumatic stress disorder in motor vehicle accident victims