As we saw in another article in this issue, clinicians who are usually focused on more obvious trauma or symptoms often miss PTSD in trauma patients. The authors of this study tested a short screening scale for PTSD. The goal of the questionnaire is to provide a quick and simple test that professionals can give to trauma patients to detect the presence of PTSD.
The authors used a shortened version of the Mental Health Diagnostic Interview Schedule (DIS) and World Health Organization Composite International Diagnostic Interview, which is a list of 19 potential traumatic events assessed by chronicity and severity.
1,957 subjects were surveyed, and the authors hoped to see which scales would predict PTSD with the same efficacy as the lengthened interview. Of the 1,957, 152 met the criteria for PTSD, using a seven-question scale. A score of four or more on the seven symptom scale, had the following characteristics: sensitivity 80%, specificity 97%, positive predictive value 71%, and negative predictive value 98%.
The questionnaire is reprinted below. The test is scored by giving one point for each "Yes" answer. The authors have found that a score of 4 or more is a reasonably accurate assessment of the existence of PTSD.
Although the authors are pleased at having created a shortened scale with moderate effectiveness, they do warn in their discussion that, "Clearly, the screening scale is not a substitute for psychiatric diagnosis." Any patient who does score four or more should be referred to the appropriate mental health professional for further assessment.
C2 Did you avoid being reminded of this experience by staying away from certain places, people or activities?
(REMIND RESPONDENT OF LIFE EVENT IF NECESSARY.)
C4 Did you lose interest in activities that were once important or enjoyable?
(REMIND RESPONDENT OF LIFE EVENT IF NECESSARY.)
C5 Did you begin to feel more isolated or distant from other people?
(REMIND RESPONDENT OF LIFE EVENT IF NECESSARY.)
C6 Did you find it hard to have love or affection for other people?
(REMIND RESPONDENT OF LIFE EVENT IF NECESSARY.)
C7 Did you begin to feel that there was no point in planning for the future?
(REMIND RESPONDENT OF LIFE EVENT IF NECESSARY.)
D1 After this experience were you having more trouble than usual falling asleep or staying asleep?
(REMIND RESPONDENT OF LIFE EVENT IF NECESSARY.)
D5 Did you become jumpy or get easily startled by ordinary noises or movements?
(REMIND RESPONDENT OF LIFE EVENT IF NECESSARY.)
Breslau N, Peterson E, Kessler R, Schultz L. Short screening scale for DSM-IV posttraumatic stress disorder. The American Journal of Psychiatry 1999;156:908-911.
