Developing A Computer-Adapted Test for PTSD

PTSD的计算机适应性测试 背景：创伤后应激障碍多年来一直是退伍军人的主要担忧， 数以千计的退伍军人从伊拉克和阿富汗返回。之间 越南退伍军人PTSD的终生患病率估计为男性31%，女性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疾病 伴随着严重的功能障碍。因此，VHA必须能够 以确定退伍军人谁需要治疗创伤后应激障碍，以及评估治疗结果。广泛 一系列的PTSD筛查和评估措施是可用的，但结果取决于哪一个 措施使用。大多数现有的PTSD评估工具遵循17个诊断标准 在DSM-IV精神疾病诊断手册中描述的，尽管许多其他项目 非创伤后应激障碍特异性指标也包括在现有的评估工具中。创建、测试和 PTSD的计算机适应性测试（CAT）的实施将确定最敏感， 从现有措施的几十个项目中区分项目，允许可靠和有效的 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，通过以下方式为PTSD评估带来以患者为中心的方法： 增加反映自我报告评估文献中确定的其他PTSD子域的项目 我们的初步研究证实了这一点，退伍军人指出，这对评估创伤后应激障碍很重要， 但不属于诊断标准。我们将在短期内完成的工作的基础上， 该项目进行了本次IIR提交所需的初步研究。 目标：目标是：1）创建和测试一个PTSD CAT，这将有助于评估 创伤暴露后给定时间点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评估工具由最具鉴别力的信息项目组成，用于 在计算机管理是不切实际的; 3）验证CAT和简短的形式， 工具使用其他三个广泛使用的纸和铅笔自我报告的措施，创伤后应激障碍的严重程度以及 作为临床诊断;以及4）评估两种版本的仪器随时间变化的灵敏度。 方法：我们将首先对1,000名退伍军人进行项目管理，按年龄/队列分层 （越南，法语国家组织/法语国家组织）和性别问题。我们将使用一个既定的调查公司，已与其他 VA研究小组获得一个具有代表性的基于概率的样本。双参数分次 反应项目反应理论（IRT）模型将用于校准PTSD项目，以便纳入 将进行单维度测试以确定PTSD CAT是否基本上是 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，项目反应作为队列，性别或 创伤暴露类型（战斗或其他）。PTSD CAT将根据三个已建立的 可靠和有效的自我报告PTSD措施，以及对PTSD的临床诊断。 预期影响：PTSD CAT的开发将促进和增强VA的能力：1） 提供一个有效、可靠和有效监测PTSD过程和结果的机制， 2）评估退伍军人PTSD症状的严重程度3）有效和准确 识别患有创伤后应激障碍的退伍军人，4）加快转诊和进入 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.