Posttraumatic stress disorder among mothers of pediatric cancer survivors: diagnosis, comorbidity, and utility of the PTSD checklist as a screening instrument. Sensitivity and Specificity of the PTSD Checklist in Detecting PTSD in Female Veterans in Primary Care Psychometric Properties of the PTSD Checklist—Civilian Version Validation of the PTSD checklist in an HMO sample of women. The impact of PTSD on pain experience in persons with HIV/AIDS Randomized Effectiveness Trial of a Brief Course of Acupuncture for Posttraumatic Stress Disorder A Randomized Stepped Care Intervention Trial Targeting Posttraumatic Stress Disorder for Surgically Hospitalized Injury Survivors CAM and energy psychology techniques remediate PTSD symptoms in veterans and spouses.
OBJECTIVE To examine posttraumatic stress disorder ( PTSD ) in mothers of survivors of childhood cancer . Comorbidity of anxiety and depressive disorders , prevalence of sub clinical PTSD , and the utility of a self-report measure as a screening instrument for PTSD were also investigated . METHOD Mothers ( n = 65 ) completed a question naire self-report PTSD checklist ( PCL-C ) .  Mothers were administered several modules of the SCID : nonpatient edition by telephone , including the PTSD , Generalized Anxiety , and Major Depressive Disorder modules . RESULTS We diagnosed 6.2 % of the sample with current PTSD . An additional 20 % had sub clinical PTSD . One of four mothers with PTSD diagnoses had a comorbid diagnosis of an anxiety and depressive disorder . The PCL-C evidence d diagnostic utility as a screening instrument . However , a moderate number of false-positives would result if the recommended cut-off on the instrument was used . CONCLUSIONS The PCL-C had diagnostic utility in screening mothers of childhood cancer survivors . The presence of comorbid diagnoses such as anxiety and depression should be examined PTSD affects a substantial number of women in medical setting s and is associated with significant distress and impairment . There are effective methods of treating trauma-related distress , but a minority seek such care . Thus , primary care is an important setting in which to identify individuals with PTSD . We sent question naires , including the  PTSD Checklist — Civilian Version ( PCL-C )  , to 419 female veterans who were seen in our primary care clinic in 1998 ; 56 % ( N = 221 ) returned the measures . A r and om subset ( n = 49 ) was interviewed to establish psychiatric diagnoses . The results provide qualified support for the use of the PCL-C total score with a lowered cutoff score as a screening measure for PTSD in female veterans in primary care We examined the psychometric properties of the  PTSD Checklist ( PCL ) , a self-report instrument design ed to assess symptoms of posttraumatic stress disorder . Three hundred ninety-two participants recruited in a university setting completed the PCL in addition to several well-established self-report instruments design ed to assess various forms of psychopathology ( e.g. , depression , general anxiety , PTSD ) . Ninety participants returned for readministration of selected measures . Findings provided support for psychometric properties of the PCL  , including internal consistency , test – retest reliability , convergent validity , and discriminant validity . Additional strengths of the PCL are discussed Although Post-traumatic Stress Disorder ( PTSD ) is common among patients seeking care at medical clinics , little is known about the performance of screening instruments for this disorder in these setting s. Previous studies of acute trauma population s using the  PTSD Checklist ( PCL )  have suggested that scores of 45 - 50 provide the best discrimination between cases and noncases . We gave the PCL  to 1,225 r and omly selected women enrolled in an HMO . After interviewing a sample of 261 of these women using a structured , clinician-administered PTSD interview , we compared the results of the PCL to the clinician interviews over a range of possible cut scores using Receiver Operating Characteristic analysis . The optimum balance of sensitivity and specificity for this population was a score of 30 , yielding a sensitivity of.82 and specificity of.76 . The positive and negative likelihood ratios for this cut score were 3.40 and 0.24 , respectively . By comparison , the use of 45 as a cut score would result in very low sensitivity ( .36 ) in this setting . The lower cut score found in this study may indicate that the use of previously published cut scores of 45 - 50 may not optimize the function of the PCL as a screening tool outside of acute trauma setting s due to an unacceptably high number of false negative cases & NA ; Pain is a common and pervasive symptom for persons infected with the human immunodeficiency virus ( HIV ) . Individuals with persistent pain are known to be at heightened risk for posttraumatic stress disorder ( PTSD ) , an anxiety disorder that manifests itself following exposure to a traumatic event . Moreover , research suggests that patients with persistent pain who develop PTSD often experience greater pain intensity and pain‐related disability than those who do not develop PTSD . The purpose of this study was to assess the relation of PTSD to pain intensity and pain‐related interference in HIV‐infected persons suffering from persistent pain . Study participants included 145 ambulatory persons living with HIV/AIDS ( PWHAs ) who were enrolled in a r and omized clinical trial assessing the impact of a pain communication intervention .  Participants completed a series of self‐report measures including the Stressful Life Events Checklist ( SLE ) , the Posttraumatic Stress Disorder Checklist‐Civilian ( PCL‐C ) , the Mental Health Inventory ( MHI ) , and the Brief Pain Inventory ( BPI ) . On average , participants reported being exposed to 6.3 different types of trauma over the course of their lifetime , of which receiving an HIV diagnosis was rated as being among the most stressful . Over half ( 53.8 % ) merited a PTSD diagnosis according to the PCL‐C. Those with PTSD reported having significantly higher pain intensity and greater pain‐related interference in performance of daily activities ( i.e. , working , sleeping , walking ability and general activity ) , and affect ( i.e. , mood , relations with other people , enjoyment of life ) over time than those who did not meet the diagnostic criteria . Possible explanations for these findings are discussed along with implication s for clinical care Background : Initial posttraumatic stress disorder ( PTSD ) care is often delayed and many with PTSD go untreated . Acupuncture appears to be a safe , potentially nonstigmatizing treatment that reduces symptoms of anxiety , depression , and chronic pain , but little is known about its effect on PTSD . Methods : Fifty-five service members meeting research diagnostic criteria for PTSD were r and omized to  usual PTSD care ( UPC ) plus eight 60-minute sessions of acupuncture conducted twice weekly or to UPC alone . Outcomes were assessed at baseline and 4 , 8 , and 12 weeks postr and omization . The primary study outcomes were difference in PTSD symptom improvement on the PTSD Checklist ( PCL ) and the Clinician-administered PTSD Scale ( CAPS ) from baseline to 12-week follow-up between the 2 treatment groups . Secondary outcomes were depression , pain severity , and mental and physical health functioning . Mixed model regression and t test analyses were applied to the data . Results : Mean improvement in PTSD severity was significantly greater among those receiving acupuncture than in those receiving UPC ( PCL&Dgr;=19.8±13.3 vs. 9.7±12.9 , P<0.001 ; CAPS&Dgr;=35.0±20.26 vs. 10.9±20.8 , P<0.0001 ) . Acupuncture was also associated with significantly greater improvements in depression , pain , and physical and mental health functioning . Pre-post effect-sizes for these outcomes were large and robust . Conclusions : Acupuncture was effective for reducing PTSD symptoms . Limitations included small sample size and inability to parse specific treatment mechanisms . Larger multisite trials with longer follow-up , comparisons to st and ard PTSD treatments , and assessment s of treatment acceptability are needed . Acupuncture is a novel therapeutic option that may help to improve population reach of PTSD treatment Objective : To test the effectiveness of a stepped care intervention model targeting posttraumatic stress disorder ( PTSD ) symptoms after injury . Background : Few investigations have evaluated interventions for injured patients with PTSD and related impairments that can be feasibly implemented in trauma surgical setting s. Methods : The investigation was a pragmatic effectiveness trial in which 207 acutely injured hospitalized trauma survivors were screened for high PTSD symptom levels and then r and omized to a stepped combined care management , psychopharmacology , and cognitive behavioral psychotherapy intervention ( n = 104 ) or usual care control ( n = 103 ) conditions . The symptoms of PTSD and functional limitations were reassessed at 1 , 3 , 6 , 9 , and 12 months after the index injury admission . Results : Regression analyses demonstrated that over the course of the year after injury , intervention patients had significantly reduced PTSD symptoms when compared with controls [ group by time effect , CAPS ( Clinician-Administered PTSD Scale ) : F(2 , 185 ) = 5.50 , P < 0.01 ; PCL-C ( PTSD Checklist Civilian Version ) : F(4 , 185 ) = 5.45 , P < 0.001 ] . Clinical ly and statistically significant PTSD treatment effects were observed at the 6- , 9- , and 12-month postinjury assessment s. Over the course of the year after injury , intervention patients also demonstrated significant improvements in physical function [ MOS SF-36 PCS ( Medical Outcomes Study Short Form 36 Physical Component Summary ) main effect : F(1 , 172 ) = 9.87 , P < 0.01 ] . Conclusions : Stepped care interventions can reduce PTSD symptoms and improve functioning over the course of the year after surgical injury hospitalization . Orchestrated investigative and policy efforts could systematic ally introduce and evaluate screening and intervention procedures for PTSD at US trauma centers . ( Trial Registration : clinical trials.gov identifier : NCT00270959 Male veterans and their spouses ( N = 218 ) attending one of six-week-long retreats were assessed for  posttraumatic stress disorder ( PTSD ) symptoms pre- and postintervention . Participants were evaluated using the PTSD checklist ( PCL ) , on which , a score of > 49 indicates clinical symptom levels . The mean pretest score was 61.1 ( SD ± 12.5 ) for veterans and 42.6 ( SD ± 16.5 ) for spouses ; 83 % of veterans and 29 % of spouses met clinical criteria . The multimodal intervention used Emotional Freedom Techniques and other energy psychology ( EP ) methods to address PTSD symptoms and a variety of complementary and alternative medicine ( CAM ) modalities for stress reduction and re source building . Interventions were delivered in group format as well as individual counseling sessions . Data were analyzed for each retreat , as well as for the six retreats as a whole . Mean post-test PCL scores decreased to 41.8 ( SE ± 1.2 ; p < .001 ) for veterans , with 28 % still clinical . Spouses demonstrated substantial symptom reductions ( M = 28.7 , SE ± 1.0 ; p < .001 ) , with 4 % still clinical . A follow-up assessment ( n = 63 ) found PTSD symptom levels dropping even further for spouses ( p < .003 ) , whereas gains were maintained for veterans . The significant reduction in PTSD symptoms is consistent with other published reports of EP treatment , though counter to the usual long-term course of the condition . The results indicate that a multimodal CAM intervention incorporating EP may offer benefits to family members as well as veterans suffering from PTSD symptoms . Recommendations are made for further research to answer the questions posed by this study
Findings indicated that although studies generally met st and ards in several quality areas , there is still room for improvement .
Areas for improvement include establishing representativeness , adequately describing clinical and demographic characteristics of the sample , and presenting better descriptions of important aspects of test and reference st and ard execution .
In addition , study quality has not appreciably improved since the publication of the STARD Statement in 2003 .
Despite the popularity of the PTSD Checklist ( PCL ) as a clinical screening test , there has been no comprehensive quality review of studies evaluating its diagnostic accuracy .