Reliability and validity of the Trauma Symptom Inventory with veterans evaluated for posttraumatic stress disorder.

The Trauma Symptom Inventory (TSI) is one of the most widely used instruments in the assessment of PTSD related symptoms [Elhai, J.D., Gray, M.J., Kashdan, T.B., Franklin, L.C., 2005a. Which instruments are most commonly used to assess traumatic event exposure and posttraumatic effects? A survey of traumatic stress professionals. Journal of Traumatic Stress 18, 541-545]. In spite of the fact that the TSI has demonstrated adequate psychometric qualities in past studies [Briere, J., 1995. Trauma Symptom Inventory professional manual. Psychological Assessment Resources, Psychological Assessment Resources; Briere, J., Elliott, D.M., Harris, K., Cotman, A., 1995. Trauma Symptom Inventory: Psychometrics and association with childhood and adult victimization in clinical samples. Journal of Interpersonal Violence 10, 387-401; McDevitt-Murphy, M.E., Weathers, F.W., Adkins, J.W., 2005. The use of the trauma symptom inventory in the assessment of PTSD symptoms. Journal of Traumatic Stress 18, 63-67] the measure's psychometrics have only as of yet been examined among civilians. We examined the TSI's psychometric properties using archival data from 221 treatment-seeking veterans evaluated for military-related posttraumatic stress disorder (PTSD) symptoms. Results demonstrated adequate internal consistency for the TSI's clinical scales (alphas ranging from 0.73 to 0.91). Convergent validity was established for clinical scales tapping PTSD's re-experiencing, avoidance and hyperarousal symptoms, and depression and irritability, against other similar measures. Structural validity was also supported in confirmatory factor analyses, with a three-factor model, and a similar model merging two of these three factors, best fitting the observed data.

Clinical profile differences between PTSD-diagnosed military veterans and crime victims.

Few studies have conducted symptom comparisons across different trauma-exposed populations. Evidence linking different types of trauma to variations in clinical presentation would have potential implications for the assessment and treatment of trauma-related psychopathology. The current study evaluated whether military veterans (n = 187) and civilian crime victims (n = 47) diagnosed with posttraumatic stress disorder differ in their self-reported posttraumatic symptoms as measured by the Trauma Symptom Inventory. A multivariate profile analysis revealed that military-related trauma is associated with more severe posttraumatic symptoms than criminal victimization and suggested that these 2 types of trauma have statistically distinct symptom profiles. Some potential implications of these findings and considerations for future research are discussed.

Varying cautionary instructions, monetary incentives, and comorbid diagnostic training in malingered psychopathology research.

In this article, we combine two analogue experiments in which we empirically examined three malingering methodological issues in individuals trained and instructed to simulate posttraumatic stress disorder (PTSD) on the Trauma Symptom Inventory (TSI; Briere, 1995). In Experiment 1, we examined TSI scale effects of the following manipulations using a 2 x 2 design with 330 college students: (a) inclusion or exclusion of cautionary instructions regarding believability of participants' simulation and (b) different financial incentive levels. In Experiment 2, we examined comorbid psychiatric diagnostic training with 180 college students who were either trained to simulate PTSD and comorbid major depressive disorder or trained to simulate only PTSD. Caution main effects were significant for all but two TSI Clinical Scales, incentive main effects and interactions were only significant for one Clinical scale each, and the comorbidity manipulation did not yield any scale differences. We discuss malingering research design implications regarding the use of cautionary instructions, financial incentive levels, and comorbid training.

Symptom severity and lifetime and prospective health service use among military veterans evaluated for PTSD.

We used structural equation modeling with 174 treatment-seeking military trauma survivors evaluated for posttraumatic stress disorder (PTSD) at a VA Medical Center PTSD clinic to examine relationships among lifetime mental health service use, PTSD symptom severity and medical problems (from self-report), as well as prospective (1-year) mental health and medical care use visit counts extracted from medical records. We discovered an adequate statistical fit to a hypothesized model of previous and prospective health service use, and current PTSD severity and health-related problems. Previous inpatient mental health treatment was significantly related to PTSD severity and prospective outpatient mental health use. However, PTSD severity was unrelated to prospective use of mental health or medical services. Health problems were related to prospective medical service use. Clinical and administrative implications in predicting health care use among trauma survivors are discussed.

Examining the uniqueness of frequency and intensity symptom ratings in posttraumatic stress disorder assessment.

Data from two studies are presented, investigating the relative effectiveness of posttraumatic stress disorder (PTSD) symptom frequency and intensity rating dimensions, in assessing overall PTSD severity and diagnosis. We assessed frequency and intensity ratings using 1) the Modified PTSD Symptom Scale with 298 trauma-exposed college students, and 2) the Clinician-Administered PTSD Scale with 130 combat-exposed military veterans. Results demonstrated little empirical justification for separating frequency and intensity ratings when measuring PTSD. Large overlaps in variance were evidenced between the dimensions (suggesting construct redundancy), with little meaningful contribution to diagnosing PTSD using one dimension over the other. Implications for future PTSD clinical and research assessment are discussed, including the potential to decrease administration time for these commonly used PTSD measures, given their time-consuming nature.

A primary care perspective of posttraumatic stress disorder for the Department of Veterans Affairs.

Posttraumatic stress disorder (PTSD) is a major mental disorder associated with significant morbidity, psychosocial impairment, and disability. The diagnosis of PTSD can be missed in a primary care setting, as patients frequently present with somatic complaints or depression and are often reluctant to discuss their traumatic experiences. As recent studies of veterans returning from the Gulf War and the Iraqi War suggest high rates of PTSD, the U.S. Department of Veterans Affairs (VA) Hospitals are gearing up to face this challenge. It is important to screen these veterans for symptoms of PTSD and make an appropriate referral if required. In this article, we attempt to review PTSD with a special focus on the VA population. In addition to discussing the epidemiology, diagnosis, and treatment options for PTSD, we also suggest screening questions for both combat-related and military sexual trauma-related PTSD.