Developing A Computer-Adapted Test for PTSD

创伤后应激障碍计算机适配测验的研制 背景：多年来，创伤后应激障碍一直是退伍军人主要关注的问题，而且越来越多 突出的是，数以千计的退伍军人现在从伊拉克和阿富汗的部署返回。其中 越南退伍军人估计，创伤后应激障碍的终生患病率男性为31%，女性为27%。 识别和早期治疗创伤后应激障碍可以防止它成为一种慢性病 伴随着严重的功能障碍。因此，VHA必须能够 识别需要治疗创伤后应激障碍的退伍军人，并评估治疗结果。宽阔的 创伤后应激障碍筛查和评估措施的范围可用，但结果因哪种而异 使用了测量方法。大多数现有的创伤后应激障碍评估工具遵循17项诊断标准 在DSM-IV精神障碍诊断手册中描述的，尽管许多其他项目是 不是针对创伤后应激障碍的，也包括在现有的评估工具中。创建、测试和 实施创伤后应激障碍的计算机适应测试(CAT)将确定最敏感和 在现有措施的数十个项目中区分项目，允许可靠和有效 用很少的项目评估创伤后应激障碍的存在和严重程度。我们建议的创伤后应激障碍猫(P- CAT)将超越现有努力，通过以下方式将以患者为中心的方法引入创伤后应激障碍评估 添加反映自我报告评估文献中确定的其他PTSD子域的项目 并被我们的初步研究证实，退伍军人认为这对评估创伤后应激障碍很重要， 但不在诊断标准之列。我们将在短期内完成的工作的基础上再接再厉 进行本IIR提交所需的初步研究的项目。 目标：目标是：1)创建和测试创伤后应激障碍CAT，这将有助于评估 创伤暴露后特定时间点的创伤后应激障碍症状的存在和严重程度，以及 随着时间的推移纵向监测疗程和/或结果；2)制定静态、简短的形式 创伤后应激障碍评估工具，由最具区分性的信息项目组成，用于情景 在计算机管理不实用的情况下；3)验证CAT和缩写形式 使用其他三种广泛使用的纸和铅笔的仪器也可以自我报告创伤后应激障碍的严重程度 作为临床诊断；以及4)评估该仪器的两个版本对随时间变化的敏感性。 方法：我们将首先对1000名退伍军人进行抽样调查，按年龄/队列进行分层 (越南，OEF/OIF)和性别。我们将使用一家与其他公司合作过的成熟的调查公司 VA研究小组以获得具有代表性的概率为基础的样本。A两参数分级 将使用反应项目反应理论(IRT)模型来校准纳入的创伤后应激障碍项目 变成了猫。将进行单维度测试，以确定创伤后应激障碍CAT是否本质上 一维或多维。将进行不同项目功能的测试，以确定 无论给予相同程度的创伤后应激障碍严重程度，条目反应都不同于队列、性别或 创伤性暴露的类型(战斗或其他)。创伤后应激障碍CAT将与三个已建立的 可靠和有效的自我报告创伤后应激障碍措施，以及针对创伤后应激障碍的临床诊断。 预期影响：开发创伤后应激障碍CAT将促进和加强退伍军人管理局的能力，以：1) 为有效、可靠和有效地监测创伤后应激障碍的过程和结果提供机制 2)评估退伍军人创伤后应激障碍症状的严重程度3)有效和准确 确定患有创伤后应激障碍的退伍军人和4)加快转介和进入 适当的循证治疗方案。

Developing a Computer-Adapted Test for PTSD Background : PTSD has been a major concern among veterans for many years, and is increasingly prominent with thousands of veterans now returning from deployment in Iraq and Afghanistan. Among Vietnam veterans the estimated lifetime prevalence of PTSD is 31% for men and 27% for women. Identification and early treatment of PTSD can prevent it from becoming a chronic condition accompanied by serious impairment in functioning. Consequently, it is important for the VHA to be able to identify veterans who need treatment for PTSD as well as evaluate outcomes of treatment. A wide range of PTSD screening and assessment measures are available, but results vary depending on which measure is used. Most existing PTSD assessment instruments follow the 17 diagnostic criteria described in the DSM-IV diagnostic manual for psychiatric disorders, although many other items that are not specific to PTSD are also included in existing assessment instruments. Creation, testing and implementation of a Computer-Adapted Test (CAT) for PTSD will identify the most sensitive and discriminating items from among dozens of items on existing measures, allowing for reliable and valid assessment of both presence and severity of PTSD with very few items. Our proposed PTSD CAT (P- CAT) will go beyond existing efforts by bringing a patient-centered approach to PTSD assessment by adding items reflective of additional PTSD subdomains identified in the self-report assessment literature and confirmed by our preliminary research that were noted by veterans as important in assessing PTSD, but are not among the diagnostic criteria. We will build on the work accomplished by our short-term project which conducted the preliminary research needed for this IIR submission. Objectives: Objectives are to: 1) create and test a PTSD CAT that will be useful for assessing the presence and severity of PTSD symptoms at a given point in time following traumatic exposure, and longitudinally over time to monitor course and/or outcomes of treatment; 2) develop a static, short-form PTSD assessment instrument composed of the most discriminating informative items for use in situations where computer administration is not practical; 3) validate both the CAT and short forms of the instrument using three other widely used paper and pencil self-report measures of PTSD severity as well as clinical diagnoses; and 4) assess sensitivity to change over time for both versions of the instrument. Methods: We will first administer the items to a sample of 1,000 veterans, stratified by age/cohort (Vietnam, OEF/OIF) and gender. We will use an established survey company that has worked with other VA research groups to obtain a representative probability-based sample. A 2-parameter graded response Item Response Theory (IRT) Model will be used to calibrate the PTSD items for incorporation into the CAT. Tests of unidimensionality will be done to determine whether the PTSD CAT is essentially unidimensional or multi-dimensional. Tests of differential item functioning will be performed to determine whether given the same level of PTSD severity, item responses differ as a function of cohort, gender or type of traumatic exposure (combat or other). The PTSD CAT will be validated against three established reliable and valid self-report PTSD measures, as well as against a clinical diagnosis of PTSD. Anticipated Impacts: Development of a PTSD CAT will facilitate and enhance VA's capacity to: 1) provide a mechanism for efficient, reliable and valid monitoring of the course of PTSD and the outcomes of its treatment; 2) assess the severity of PTSD symptoms in veterans 3) efficiently and accurately identify veterans suffering from PTSD and 4) expedite the processes for referral and entry into appropriate, evidence-based treatment programs.