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IIR 15-103 – HSR&D Study

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IIR 15-103
Validation of the PTSD Primary Care Screen
Michelle Jeri Bovin PhD
VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
Boston, MA
Funding Period: January 2017 - May 2019

BACKGROUND/RATIONALE:
Given the high prevalence of posttraumatic stress disorder (PTSD) in Veterans, VA mandates that all Veterans be screened for PTSD annually for the first five years after military separation and every five years thereafter, unless the Veteran has had a PTSD diagnosis entered in his/her medical record in the past year (Vista Clinical Reminder User Manual, 2007). Screening typically takes place in primary care because the majority of patients who have received mental health diagnoses are seen there.

Currently, VA uses the Primary Care PTSD screen (PC-PTSD) to identify Veterans with probable PTSD. This 4-item questionnaire is based on the PTSD diagnostic criteria included in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). In 2013, the DSM-5 was introduced, which included a number of significant revisions to the PTSD diagnosis. In response, the PC-PTSD was updated to add (1) a trauma-specific stem that reflects changes made to PTSD Criterion A and (2) a new item that reflects the revisions made to the PTSD symptom criteria. The new instrument, the PC-PTSD-5, therefore reflects the new knowledge the field possesses about PTSD.

Despite this, VA continues to use the old version of the measure until a valid cutoff for the PC-PTSD-5 is established. Although initial pilot data for the PC-PTSD-5 indicate it is psychometrically sound, it has not yet been compared with a gold standard PTSD diagnostic interview, such as the Clinician Administered PTSD Scale for DSM-5 (CAPS-5), in a VA primary care setting.

OBJECTIVE(S):
The objectives of the study are to: (a) establish a cutpoint for the PC-PTSD-5 in a primary care Veteran sample by validating it against the CAPS-5; (b) explore whether the optimally sensitive cutpoint for the PC-PTSD-5 varies by gender, race, ethnicity, age, military sexual trauma (MST) status, traumatic brain injury (TBI), and psychiatric comorbidity; and (c) gather initial data on the acceptability of the PC-PTSD-5 to Veterans.

METHODS:
To achieve these objectives, we will conduct a two-session psychometric study of the PC-PTSD-5 using a sample of primary care treatment seeking Veterans, oversampling women to allow for group comparisons. Across two sites (Boston and Palo Alto [PA]), 405 Veterans will complete the PC-PTSD-5 and will be interviewed by a doctoral-level clinician, blind to the screening results, using the CAPS-5. Signal detection analyses, conducted on a weighted dataset to ensure generalizability, will allow us to determine the optimally sensitive cutpoint for the PC-PTSD-5 and examine its performance overall and in key subgroups.

FINDINGS/RESULTS:
We expect that this project will yield an optimally sensitive cutpoint for the PC-PTSD-5 that can be used across VA primary care clinics. In addition, we expect that we will determine whether subgroups of interest require unique cut scores on the instrument, and gain a better understanding of the acceptability of the measure.

IMPACT:
Study results will have both immediate and long-term implications for VA. By identifying a valid cutpoint for the PC-PTSD-5, this study will have an immediate impact on VA's ability to accurately identify and treat Veterans with PTSD. In addition, the data obtained will provide the necessary foundation for future research on implementation and how to optimize PTSD screening in VA. By improving our PTSD screening efforts, the results of this study ultimately will enhance both PTSD research and clinical care for all individuals with PTSD.

PUBLICATIONS:

Journal Articles

  1. Lee DJ, Bovin MJ, Weathers FW, Palmieri PA, Schnurr PP, Sloan DM, Keane TM, Marx BP. Latent factor structure of DSM-5 posttraumatic stress disorder: Evaluation of method variance and construct validity of novel symptom clusters. Psychological assessment. 2019 Jan 1; 31(1):46-58.
  2. Kimerling R. Sexual Assault and Women's Health: Universal Screening or Universal Precautions?. Medical care. 2018 Aug 1; 56(8):645-648.
  3. Moshier SJ, Bovin MJ, Gay NG, Wisco BE, Mitchell KS, Lee DJ, Sloan DM, Weathers FW, Schnurr PP, Keane TM, Marx BP. Examination of posttraumatic stress disorder symptom networks using clinician-rated and patient-rated data. Journal of abnormal psychology. 2018 Aug 1; 127(6):541-547.
  4. Babson KA, Wong AC, Morabito D, Kimerling R. Insomnia Symptoms Among Female Veterans: Prevalence, Risk Factors, and the Impact on Psychosocial Functioning and Health Care Utilization. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. 2018 Jun 15; 14(6):931-939.
  5. Kilbourne AM, Schumacher K, Frayne SM, Cypel Y, Barbaresso MM, Nord KM, Perzhinsky J, Lai Z, Prenovost K, Spiro A, Gleason TC, Kimerling R, Huang GD, Serpi TB, Magruder KM. Physical Health Conditions Among a Population-Based Cohort of Vietnam-Era Women Veterans: Agreement Between Self-Report and Medical Records. Journal of women's health (2002). 2017 Nov 1; 26(11):1244-1251.
  6. Kimerling R. No Mission Too Difficult: Responding to Military Sexual Assault. American journal of public health. 2017 May 1; 107(5):642-644.
  7. Shaw JG, Asch SM, Katon JG, Shaw KA, Kimerling R, Frayne SM, Phibbs CS. Post-traumatic Stress Disorder and Antepartum Complications: a Novel Risk Factor for Gestational Diabetes and Preeclampsia. Paediatric and perinatal epidemiology. 2017 May 1; 31(3):185-194.
  8. Sternke LM, Serpi T, Spiro A, Kimerling R, Kilbourne AM, Cypel Y, Frayne SM, Furey J, Huang GD, Reinhard MJ, Magruder K. Assessment of a Revised Wartime Experiences Scale for Vietnam-Era Women: The Health of Vietnam-Era Women's Study (HealthViEWS). Women's health issues : official publication of the Jacobs Institute of Women's Health. 2017 Jul 1; 27(4):471-477.
  9. Bovin MJ, Wolf EJ, Resick PA. Longitudinal Associations between Posttraumatic Stress Disorder Severity and Personality Disorder Features among Female Rape Survivors. Frontiers in psychiatry. 2017 Feb 2; 8(1):6.
  10. Zimmerman L, Lounsbury DW, Rosen CS, Kimerling R, Trafton JA, Lindley SE. Participatory System Dynamics Modeling: Increasing Stakeholder Engagement and Precision to Improve Implementation Planning in Systems. Administration and policy in mental health. 2016 Nov 1; 43(6):834-849.
  11. Gutner CA, Galovski T, Bovin MJ, Schnurr PP. Emergence of Transdiagnostic Treatments for PTSD and Posttraumatic Distress. Current psychiatry reports. 2016 Oct 1; 18(10):95.
  12. Rosenbaum DL, Kimerling R, Pomernacki A, Goldstein KM, Yano EM, Sadler AG, Carney D, Bastian LA, Bean-Mayberry BA, Frayne SM. Binge Eating among Women Veterans in Primary Care: Comorbidities and Treatment Priorities. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2016 Jul 1; 26(4):420-8.


DRA: Mental, Cognitive and Behavioral Disorders
DRE: Diagnosis, TRL - Applied/Translational
Keywords: Clinical Diagnosis and Screening, Ethnicity/Race, Gender Differences, PTSD
MeSH Terms: none