The utility of selected measures for the initiation of treatment for PTSD in the VA healthcare system : a review of contemporary literature
Sheppard, Ronald Matthew
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Through appropriate use of available instruments, recognition and diagnosis of posttraumatic stress disorder (PTSD) can be accomplished, leading to the initiation of treatments vital to achieving optimal health outcomes. Inappropriate use of these same instruments can lead to delayed, inappropriate or ineffective condition treatment, and squandering of limited resources. It was the purpose of this project to identify and analyze factors related to accurate identification through exploration of contemporary literature evaluating psychometric properties of a collection of selected screening tools commonly used within the Veterans Administration (VA) system. A limited journal article search was performed using three electronic health science databases, focusing on the Primary Care PTSD Screen (PC-PTSD), Posttraumatic Stress Disorder Checklist (PCL-M), Mississippi PTSD Scale (M-PTSD) and the Clinician Administrated PTSD Scale (CAPS). Emphasis was placed on each instrument's reported psychometric properties, specifically, the internal consistency, test-retest reliability, discriminant validity, convergent validity and diagnostic utility. Journal results were separated by instrument and organized into table form for ease of comparison. Additional instrument administration details were added in efforts to assemble a comprehensive assessment. Psychometric incongruencies between instruments were found. Specifically between the simple four question PC-PTSD and the comprehensive CAPS instrument. Significant disparity was observed in terms of diagnostic utility when one instrument is used for the purpose of the other. Sensitivity and specificity varied considerably dependent on cut-off scores utilized. Considerable inequality exists in relationship to administration details, resource, and time requirements. The author concluded that with many appropriate instruments available to assist providers with diagnostic efforts, it is unwarranted and inapposite to attempt to attain equivalent results through the use of instruments with inferior psychometric abilities. It is the responsibility of the practitioner to ensure that the strengths and limitations of an instrument are considered before making a diagnosis or treatment decisions based upon results from the administration of any given instrument.