Community Treatment Centre for Acquired Brain Injury, Glasgow
Faculty of Medicine, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
Correspondence: Professor T. M. McMillan, Psychological Medicine, Faculty of Medicine, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK. E-mail: t.m.mcmillan{at}clinmed.gla.ac.uk
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ABSTRACT |
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Aims To compare PTSDcaseness arising from questionnaire self-report and structured interview.
Method Participants (n=34) with traumatic brain injury were recruited. Screening measures and self-report questionnaires were administered, followed by the structured interview.
Results Using questionnaires, 59% fulfilled criteria for PTSD on the Post-traumatic Diagnostic Scale and 44% on the Impact of Events Scale, whereas using structured interview (Clinician-Administered PTSD Scale) only 3% were cases.This discrepancy may arise from confusions between effects of PTSD and traumatic brain injury.
Conclusions After traumatic brain injury, PTSD self-report measures might be used for screening but not diagnosis.
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INTRODUCTION |
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METHOD |
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Participants
A total of 34 participants were recruited from community out-patient and
rehabilitation services, and voluntary organisations. A power calculation
based on proportions of people with severe traumatic brain injury reaching
PTSD caseness on the Impact of Events Scale (IES) and
Clinician-Administered PTSD Scale (CAPS)
(Turnbull et al,
2001) indicated n=30, needed for 80% power, with
set at 0.05 and ß at 0.2. Participants were >17 years, with a severe
traumatic brain injury (post-traumatic amnesia >1 day) at least 3 months
before interview. Exclusion criteria were scores <27 on the Mini-Mental
State Examination (Folstein et al,
1975), severe dysphasia or dyslexia, or current treatment for
psychosis.
Measures
PTSD
Other
Procedure
Demographic and injury information were obtained at interview. Screening
measures and self-report questionnaires were administered, and then the
clinician-rated GOSE and the structured interview (CAPS).
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RESULTS |
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Diagnostic measures (Table 1)
More cases were found on the PDS (McNemars
2=12.07, P<0.01) and IES (McNemars
2=4.27, P<0.05) than on CAPSwithout
clinical judgement. Only one participant (3%) was diagnosed with PTSD using
CAPSwith clinical judgement. Of 20 cases identified by
questionnaires, 19 were false positives, as were 5 out of 6
cases identified using CAPSwithout clinical judgement. No
false negatives were found. Either questionnaire identified more false
positive cases than CAPSwithout clinical judgement
(McNemars
2=4.32, P<0.05).
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No significant differences were found between PTSD cases and non-cases on questionnaire measures (PDS or IES) or CAPSwithout clinical judgement, for age at interview (PDS or IES, U=105.5, P<0.78; CAPS, U=58.5, P<0.25), age at injury (U=101.5, P<0.67; U=52.0, P<0.15), time since injury (U=112, P<0.63; U=68, P<0.47), years of education (U=105, P<0.63; U=83.5, P<0.98), duration of post-traumatic amnesia (U=100.5, P<0.64; U=55, P<0.19), or premorbid IQ (U=104.5, P<0.76; U=80, P<0.88). No significant differences were found between those pursuing litigation and those not, in terms of PDS symptom severity score (U=123, P<0.76), IES total score (U=99.5, P<0.24), or CAPS total score (U=117.5, P<0.60).
RPQ scores significantly correlated with CAPS total score (r=0.67, P<0.01) and PDS symptom severity score (r=0.32, P<0.07). Scores on the HADS depression sub-scale significantly correlated with IES total score (r=0.34, P<0.05), PDS severity score (r=0.68, P<0.01) and CAPS total score (r=0.73, P<0.01). Scores on the HADS anxiety sub-scale significantly correlated with PDS severity score (r=0.43, P<0.01) and CAPS total score (r=0.49, P<0.01) but not with IES total score (r=0.31, P<0.08). Questionnaire scores did not significantly correlate with total scores on the SCT (PDS r=0.14, P<0.4; IES r=0.15, P<0.39) or the error number on the SCT (PDS r=0.28, P<0.40; IES r=0.07, P<0.83).
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DISCUSSION |
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The current study is limited because the sample was not consecutive, although demographics were in line with a recent prospective traumatic brain injury cohort (Thornhill et al, 2000). Future research should include interview methodology in studies on PTSD after severe traumatic brain injury, and further investigate differential diagnoses and confounding factors in order to standardise assessment with this population. Although self-report measures can be used for screening, they can mislead if used for diagnosis of PTSD after traumatic brain injury.
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Clinical Implications and Limitations |
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LIMITATIONS
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ACKNOWLEDGMENTS |
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Received for publication February 9, 2004. Revision received September 14, 2004. Accepted for publication September 30, 2004.
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