Developing A Computer-Adapted Test for PTSD

开发适用于计算机的 PTSD 测试

• 批准号: 8182126
• 负责人: SUSAN V. EISEN
• 金额: --
• 依托单位: EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-10-01 至 2013-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8182126
• 关键词: Accounting; Affect; Afghanistan; Age; Arts; Characteristics; Chronic; Clinical; Computerized Medical Record; Computers; DSM-IV; Development; Diagnosis; Diagnostic; Early treatment; Evaluation; Evidence based treatment; Gender; Gold; Health; Healthcare Systems; Impairment; Individual; Information Technology; Interview; Iraq; Literature; MMPI; Manuals; Measurement; Measures; Mental disorders; Methods; Mississippi; Modeling; Monitor; Outcome; Outcome Assessment; Paper; Patient Monitoring; Patient Self-Report; Patients; Post-Traumatic Stress Disorders; Prevalence; Probability; Process; Receiver Operating Characteristics; Research; Sampling; Sensitivity and Specificity; Severities; Specificity; Structure; Surveys; Symptoms; Tail; Testing; Time; Treatment outcome; Validation; Veterans; Vietnam; Woman; Work; base; burden of illness; clinical Diagnosis; clinical care; cohort; combat; expectation; instrument; men; patient oriented; prevent; response; screening; theories; time interval; trait; treatment program

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.

开发针对 PTSD 的计算机适应测试 背景：创伤后应激障碍 (PTSD) 多年来一直是退伍军人的主要担忧，并且越来越多 数千名从伊拉克和阿富汗部署返回的退伍军人中表现突出。之中 越战退伍军人中，估计终生 PTSD 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其成为一种慢性疾病 并伴有严重的功能障碍。因此，VHA 能够 识别需要治疗 PTSD 的退伍军人并评估治疗结果。宽 有一系列 PTSD 筛查和评估措施可供使用，但结果因具体情况而异 使用措施。大多数现有的 PTSD 评估工具遵循 17 条诊断标准 DSM-IV 精神疾病诊断手册中描述了这一点，尽管许多其他项目 现有的评估工具中也包含非特定于 PTSD 的内容。创建、测试和 实施针对 PTSD 的计算机适应测试 (CAT) 将识别出最敏感和最敏感的 从现有措施的数十个项目中区分项目，从而实现可靠和有效 用很少的项目评估 PTSD 的存在和严重程度。我们提出的 PTSD CAT (P- CAT）将超越现有的努力，采用以患者为中心的方法进行 PTSD 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 并得到我们的初步研究的证实，退伍军人指出这对于评估 PTSD 很重要， 但不属于诊断标准。我们将在短期内完成的工作的基础上再接再厉 该项目进行了本 IIR 提交所需的初步研究。 目标：目标是：1) 创建并测试 PTSD CAT，该工具将有助于评估 创伤暴露后特定时间点的 PTSD 症状的存在和严重程度，以及 随着时间的推移纵向监测治疗过程和/或结果； 2）开发静态的、简短的形式 PTSD 评估工具由最具辨别力的信息项目组成，供情境使用 计算机管理不可行的地方； 3) 验证 CAT 和简短形式 仪器还使用其他三种广泛使用的纸笔自我报告测量 PTSD 严重程度 作为临床诊断； 4) 评估两个版本仪器随时间变化的敏感性。 方法：我们首先将项目管理给 1,000 名退伍军人样本，按年龄/队列分层 （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调查公司 VA 研究小组获得具有代表性的基于概率的样本。 2 参数分级 反应项目反应理论 (IRT) 模型将用于校准 PTSD 项目以供合并 进入猫。将进行一维性测试以确定 PTSD CAT 本质上是否是 一维或多维。将进行差异项目功能测试以确定 无论是否给予相同水平的 PTSD 严重程度，项目反应都会因队列、性别或群体的功能而有所不同 创伤暴露的类型（战斗或其他）。 PTSD CAT 将针对三个已建立的项目进行验证 可靠且有效的自我报告 PTSD 测量，以及针对 PTSD 的临床诊断。 预期影响：开发 PTSD CAT 将促进和增强 VA 的能力：1) 提供一种有效、可靠和有效地监测 PTSD 过程和结果的机制 其治疗； 2) 评估退伍军人 PTSD 症状的严重程度 3) 高效、准确 识别患有创伤后应激障碍 (PTSD) 的退伍军人，并 4) 加快转介和进入的流程 适当的、基于证据的治疗方案。