patient health questionnaire

The Primary Care PTSD Screen (PC-PTSD)

Jeffrey Wilson — Thu, 18 Oct 2018 16:54:45 +0000

Date Added:

October 18, 2018

Journal/Publication:

Journal of General Internal Medicine

Issue:

Volume:

Pages:

1206-1211

URL:

The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5)

Type:

Clinical Decision Aids, Practice Management Research Results

Format:

Article

DOI (1):

10.1007/s11606-016-3703-5

Keywords

PTSD

post-traumatic stress disorder

DSM

PMID (1):

27170304

MeSH

stress disorder, post-traumatic

self report

diagnostic and statistical manual of mental disorders

patient health questionnaire

The PC-PTSD is a 4-item screen that was designed for use in primary care and other

medical settings and is currently used to screen for PTSD in veterans at the VA.

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BACKGROUND

Posttraumatic Stress Disorder (PTSD) is associated with increased health care utilization, medical morbidity, and tobacco and alcohol use. Consequently, screening for PTSD has become increasingly common in primary care clinics, especially in Veteran healthcare settings where trauma exposure among patients is common.

OBJECTIVE

The objective of this study was to revise the Primary Care PTSD screen (PC-PTSD) to reflect the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for PTSD (PC-PTSD-5) and to examine both the diagnostic accuracy and the patient acceptability of the revised measure.

DESIGN

We compared the PC-PTSD-5 results with those from a brief psychiatric interview for PTSD. Participants also rated screening preferences and acceptability of the PC-PTSD-5.

PARTICIPANTS

A convenience sample of 398 Veterans participated in the study (response rate = 41 %). Most of the participants were male, in their 60s, and the majority identified as non-Hispanic White.

MEASURES

The PC-PTSD-5 was used as the screening measure, a modified version of the PTSD module of the MINI-International Neuropsychiatric Interview was used to diagnose DSM-5 PTSD, and five brief survey items were used to assess acceptability and preferences.

KEY RESULTS

The PC-PTSD-5 demonstrated excellent diagnostic accuracy (AUC = 0.941; 95 % C.I.: 0.912– 0.969). Whereas a cut score of 3 maximized sensitivity (κ[1]) = 0.93; SE = .041; 95 % C.I.: 0.849–1.00), a cut score of 4 maximized efficiency (κ[0.5] = 0.63; SE = 0.052; 95 % C.I.: 0.527–0.731), and a cut score of 5 maximized specificity (κ[0] = 0.70; SE = 0.077; 95 % C.I.: 0.550–0.853). Patients found the screen acceptable and indicated a preference for administration by their primary care providers as opposed to by other providers or via self-report.

CONCLUSIONS

The PC-PTSD-5 demonstrated strong preliminary results for diagnostic accuracy, and was broadly acceptable to patients.

Author/s:

Prins, Annabel, Bovin, Michelle J., Smolenski, Derek J., Marx, Brian P., Kimmerling, Rachel, Jenkins-Guarnieri, Michael A., Kaloupek, Danny G.

Adverse Childhood Experience (ACE) Questionnaire and Resource Packet

Jeffrey Wilson — Thu, 18 Oct 2018 16:45:33 +0000

Date Added:

October 18, 2018

Publisher:

The Child & Adolescent Health Measurement Initiative

Publication Date:

October 18, 2018

Type:

Clinical Decision Aids, Practice Management Research Results

Format:

Article

Keywords

ACE

children

child

adverse childhood experience

patient health questionnaire

MeSH

patient health questionnaire

ACE

children

child

adverse childhood experience

Adverse childhood experiences (ACEs) are strong predictors of subsequent adverse health outcomes. Helping patients deal with the effects of ACEs can be very helpful. This is a summary of information about ACEs and a screening test that can be used to reveal and quantify ACEs.

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What is the role of healthcare providers?
The healthcare system is a natural place to respond to ACEs and promote resilience in children,
youth and families. Guidelines for well childcare are extensive in the early years – 13 visits in
the first three years of lifei --, which is a crucial period of child development. Health systems,
and in particular pediatric providers, are in a unique position to identify issues for both children
and their families that contribute to either promoting or inhibiting healthy development. The
American Association of Pediatrics (AAP) issued a policy statement in 2012 that encourages,
among other things, pediatricians to take a more proactive role in educating patients and
families about the impact of toxic stress and in advocating for the development of interventions
that mitigate its impact. ii

What is trauma-informed care?
Trauma-informed care encompasses three levels of focus from a systems level: addressing
policy and procedures, creating approaches for organizing and delivering services and providing
specific programs or interventions for families.

The federal agency Substance Abuse and Mental Health Services Administration (SAMHSA) has
outlined six principles for trauma informed care: (1) creating a culture of physical and
psychological safety for staff and the people they serve; (2) building and maintaining
trustworthiness and transparency among staff, clients and others involved with the
organization; (3) utilizing peer support to promote healing and recovery; (4) leveling the power
differences between staff and clients and among staff to foster collaboration and mutuality; (5)
cultivating a culture of empowerment, voice and choice that recognizes individual strengths,
resilience and an ability to heal from past trauma; and (6) recognizing and responding to the
cultural, historical and gender roots of trauma.

Generalized Anxiety Disorder 7-Item Scale

Jeffrey Wilson — Thu, 18 Oct 2018 16:40:04 +0000

Date Added:

October 18, 2018

Journal/Publication:

Archives of Internal Medicine

Publisher:

American Medical Association

Publication Date:

May 22, 2006

Issue:

Volume:

166

Pages:

1092-1097

URL:

A brief measure for assessing generalized anxiety disorder: the GAD-7.

Type:

Clinical Decision Aids, Practice Management Research Results

Format:

Article

DOI (1):

10.1001/archinte.166.10.1092

Keywords

Self report

depression

mental health

patient health questionnaire

PMID (1):

16717171

MeSH

self report

depression

mental health

patient health questionnaire

This is the most widely used screening tool for identifying patients with anxiety disorders. Many practices now include it in their periodic assessment processes.

BACKGROUND:

Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity.

METHODS:

A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use.

RESULTS:

A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale.

CONCLUSION:

The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.

Author/s:

Spitzer, Robert L., Kroenke, Kurt, Williams, Janet B. W.