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.

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.

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.