The Peritraumatic Behavior Questionnaire: development and initial validation of a new measure for combat-related peritraumatic reactions

BMC Psychiatry

Dewleen G Baker²  James B Lohr³  Heather Johnson³  Brett T Litz⁴  Abigail Goldsmith³  Kate A Yurgil³  Sarah Nunnink³  William P Nash¹  Agorastos Agorastos⁵ 

[1]Department of Psychiatry, University of California, San Diego, CA, USA

[2]Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0603V), 92093-0603V, La Jolla, CA, USA

[3]VA San Diego Healthcare System, San Diego, CA, USA

[4]National Center for Post Traumatic Stress Disorder, VA Boston Healthcare System, Boston, MA, USA

[5]Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

关键词: Assessment;    Screening;    Reliability;    Validity;    Psychometric properties;    Stress;    Posttraumatic stress disorder (PTSD);    Peritraumatic reaction;    Peritraumatic dissociation;    Peritraumatic behavior questionnaire;   

Others  :  1124184
DOI  :  10.1186/1471-244X-13-9

 received in 2012-10-08, accepted in 2013-01-02,  发布年份 2013

【 摘 要 】

Background

Posttraumatic stress disorder (PTSD) is one of the most commonly observed stress-related conditions following combat exposure and its effective prevention is a high health-care priority. Reports of peritraumatic reactions have been shown to be highly associated with PTSD among combat exposed service members. However, existing instruments measuring peritraumatic symptoms were not specifically developed to assess combat-related peritraumatic stress and each demonstrates a different peritraumatic focus. We therefore developed the Peritraumatic Behavior Questionnaire (PBQ), a new military-specific rating scale focused upon the wide range of symptoms suggestive of combat-related peritraumatic distress in actively deployed Service Members. This study describes the development of the PBQ and reports on the psychometric properties of its self-rated version (PBQ-SR).

Methods

688 Marine infantry service members were retrospectively assessed by the PBQ-SR within the scope of the Marine Resiliency Study after their deployment to war zone. Participants have been additionally assessed by a variety of questionnaires, as well as clinical interviews both pre and post-deployment.

Results

The PBQ-SR demonstrated satisfactory internal consistency, convergent and discriminant validity, as well as high correlation with trait dissociation prior to deployment. Component analysis suggested a latent bi-dimensional structure separating a peritraumatic emotional distress and physical awareness factor. The PBQ-SR total score showed high correlation to general anxiety, depression, poorer general health and posttraumatic symptoms after deployment and remained a significant predictor of PTSD severity, after controlling for those measures. The suggested screening cut-off score of 12 points demonstrated satisfactory predictive power.

Conclusions

This study confirms the ability of the PBQ-SR to unify the underlying peritraumatic symptom dimensions and reliably assess combat-related peritraumatic reaction as a general construct. The PBQ-SR demonstrated promise as a potential standard screening measure in military clinical practice, while It’s predictive power should be established in prospective studies.

【 授权许可】

   
2013 Agorastos et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Smith TC, Ryan MA, Wingard DL, Slymen DJ, Sallis JF, Kritz-Silverstein D: New onset and persistent symptoms of post-traumatic stress disorder self reported after deployment and combat exposures: prospective population based US military cohort study. BMJ Clinical research ed 2008, 336(7640):366-371.
• [2]Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL: Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med 2004, 351(1):13-22.
• [3]Lapierre CB, Schwegler AF, Labauve BJ: Posttraumatic stress and depression symptoms in soldiers returning from combat operations in Iraq and Afghanistan. J Trauma Stress 2007, 20(6):933-943.
• [4]Hellmann J, Heuser I, Kronenberg G: Targeted prevention of posttraumatic stress disorder. Nervenarzt 2010. Epub ahead of print
• [5]Grasso D, Boonsiri J, Lipschitz D, Guyer A, Houshyar S, Douglas-Palumberi H, Massey J, Kaufman J: Posttraumatic stress disorder: the missed diagnosis. Child Welfare 2009, 88(4):157-176.
• [6]Druss BG, Hwang I, Petukhova M, Sampson NA, Wang PS, Kessler RC: Impairment in role functioning in mental and chronic medical disorders in the United States: results from the National Comorbidity Survey Replication. Mol Psychiatry 2009, 14(7):728-737.
• [7]Bovin MJ, Marx BP: The importance of the peritraumatic experience in defining traumatic stress. Psychol Bull 2011, 137(1):47-67.
• [8]Ozer EJ, Best SR, Lipsey TL, Weiss DS: Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Bull 2003, 129(1):52-73.
• [9]Lima AA, Fiszman A, Marques-Portella C, Mendlowicz MV, Coutinho ES, Maia DC, Berger W, Rocha-Rego V, Volchan E, Mari JJ: The impact of tonic immobility reaction on the prognosis of posttraumatic stress disorder. J Psychiatr Res 2010, 44(4):224-228.
• [10]Lensvelt-Mulders G, van der Hart O, van Ochten JM, van Son MJ, Steele K, Breeman L: Relations among peritraumatic dissociation and posttraumatic stress: a meta-analysis. Clin Psychol Rev 2008, 28(7):1138-1151.
• [11]Gershuny BS, Cloitre M, Otto MW: Peritraumatic dissociation and PTSD severity: do event-related fears about death and control mediate their relation? Behav Res Ther 2003, 41(2):157-166.
• [12]Gould NF, McKibben JB, Hall R, Corry NH, Amoyal NA, Mason ST, McCann UD, Fauerbach JA: Peritraumatic heart rate and posttraumatic stress disorder in patients with severe burns. J Clin Psychiatry 2011, 72(4):539-547.
• [13]Marmar CR, McCaslin SE, Metzler TJ, Best S, Weiss DS, Fagan J, Liberman A, Pole N, Otte C, Yehuda R: Predictors of posttraumatic stress in police and other first responders. Ann N Y Acad Sci 2006, 1071:1-18.
• [14]McGhee LL, Slater TM, Garza TH, Fowler M, DeSocio PA, Maani CV: The relationship of early pain scores and posttraumatic stress disorder in burned soldiers. J Burn Care Res 2011, 32(1):46-51.
• [15]Breh DC, Seidler GH: Is peritraumatic dissociation a risk factor for PTSD? J Trauma Dissociation 2007, 8(1):53-69.
• [16]McNally RJ: Psychological mechanisms in acute response to trauma. Biol Psychiatry 2003, 53(9):779-788.
• [17]Briere J, Scott C, Weathers F: Peritraumatic and persistent dissociation in the presumed etiology of PTSD. Am J Psychiatry 2005, 162(12):2295-2301.
• [18]Fikretoglu D, Brunet A, Best S, Metzler T, Delucchi K, Weiss DS, Fagan J, Marmar C: The relationship between peritraumatic distress and peritraumatic dissociation: an examination of two competing models. J Nerv Ment Dis 2006, 194(11):853-858.
• [19]Griffin MG, Resick PA, Mechanic MB: Objective assessment of peritraumatic dissociation: psychophysiological indicators. Am J Psychiatry 1997, 154(8):1081-1088.
• [20]Gabert-Quillen CA, Fallon W, Delahanty DL: PTSD after traumatic injury: an investigation of the impact of injury severity and peritraumatic moderators. J Health Psychol 2011, 16(4):678-687.
• [21]Pacella ML, Irish L, Ostrowski SA, Sledjeski E, Ciesla JA, Fallon W, Spoonster E, Delahanty DL: Avoidant coping as a mediator between peritraumatic dissociation and posttraumatic stress disorder symptoms. J Trauma Stress 2011, 24(3):317-325.
• [22]Eid J, Morgan CA 3rd: Dissociation, hardiness, and performance in military cadets participating in survival training. Mil Med 2006, 171(5):436-442.
• [23]Morgan CA, Southwick SM, Hazliett G, Dial-Ward M: Baseline dissociation and prospective success in special forces assessment and selection. Psychiatry (Edgmont) 2008, 5(7):53-58.
• [24]Galatzer-Levy IR, Madan A, Neylan TC, Henn-Haase C, Marmar CR: Peritraumatic and trait dissociation differentiate police officers with resilient versus symptomatic trajectories of posttraumatic stress symptoms. J Trauma Stress 2011, 24(5):557-565.
• [25]Orr SP, Metzger LJ, Lasko NB, Macklin ML, Peri T, Pitman RK: De novo conditioning in trauma-exposed individuals with and without posttraumatic stress disorder. J Abnorm Psychol 2000, 109(2):290-298.
• [26]Tiet QQ, Rosen C, Cavella S, Moos RH, Finney JW, Yesavage J: Coping, symptoms, and functioning outcomes of patients with posttraumatic stress disorder. J Trauma Stress 2006, 19(6):799-811.
• [27]Henckens MJ, Hermans EJ, Pu Z, Joels M, Fernandez G: Stressed memories: how acute stress affects memory formation in humans. J Neurosci 2009, 29(32):10111-10119.
• [28]McCleery JM, Harvey AG: Integration of psychological and biological approaches to trauma memory: implications for pharmacological prevention of PTSD. J Trauma Stress 2004, 17(6):485-496.
• [29]Zohar J, Juven-Wetzler A, Myers V, Fostick L: Post-traumatic stress disorder: facts and fiction. Curr Opin Psychiatry 2008, 21(1):74-77.
• [30]Otte C, Neylan TC, Pole N, Metzler T, Best S, Henn-Haase C, Yehuda R, Marmar CR: Association between childhood trauma and catecholamine response to psychological stress in police academy recruits. Biol Psychiatry 2005, 57(1):27-32.
• [31]Southwick SM, Bremner JD, Rasmusson A, Morgan CA 3rd, Arnsten A, Charney DS: Role of norepinephrine in the pathophysiology and treatment of posttraumatic stress disorder. Biol Psychiatry 1999, 46(9):1192-1204.
• [32]Pitman RK, Shalev AY, Orr SP: Posttraumatic stress disorder: emotion, conditioning and memory. In The New Cognitive Neurosciences. Edited by Corbetta MD, Gazzaniga MS. New York: Plenum Press; 2000:687-700.
• [33]Krystal JH, Neumeister A: Noradrenergic and serotonergic mechanisms in the neurobiology of posttraumatic stress disorder and resilience. Brain Res 2009, 1293:13-23.
• [34]Friedman MJ, Pitman RK: New findings on the neurobiology of posttraumatic stress disorder. J Trauma Stress 2007, 20(5):653-655.
• [35]Heim C, Nemeroff CB: Neurobiology of posttraumatic stress disorder. CNS Spectr 2009, 14(1 Suppl 1):13-24.
• [36]Milad MR, Pitman RK, Ellis CB, Gold AL, Shin LM, Lasko NB, Zeidan MA, Handwerger K, Orr SP, Rauch SL: Neurobiological basis of failure to recall extinction memory in posttraumatic stress disorder. Biol Psychiatry 2009, 66(12):1075-1082.
• [37]Bryant RA: Acute stress reactions: can biological responses predict posttraumatic stress disorder? CNS Spectr 2003, 8(9):668-674.
• [38]Cahill L, Prins B, Weber M, McGaugh JL: Beta-adrenergic activation and memory for emotional events. Nature 1994, 371(6499):702-704.
• [39]Ehring T, Ehlers A, Cleare AJ, Glucksman E: Do acute psychological and psychobiological responses to trauma predict subsequent symptom severities of PTSD and depression? Psychiatry Res 2008, 161(1):67-75.
• [40]Birmes P, Brunet A, Carreras D, Ducasse JL, Charlet JP, Lauque D, Sztulman H, Schmitt L: The predictive power of peritraumatic dissociation and acute stress symptoms for posttraumatic stress symptoms: a three-month prospective study. Am J Psychiatry 2003, 160(7):1337-1339.
• [41]Agorastos A, Marmar CR, Otte C: Immediate and early behavioral interventions for the prevention of acute and posttraumatic stress disorder. Curr Opin Psychiatry 2011, 24(6):526-532.
• [42]Nash WP, Krantz L, Stein N, Westphal R, Litz BT: Comprehensive soldier fitness, battlemind, and the stress continuum model: military organizational approaches to prevention. In Caring for veterans with deployment-related stress disorders. Edited by Ruzek JI, Schnurr PP, Vasterling JJ, Friedman MJ. Iraq, Afghanistan, and beyond: American Psychological Association; 2011:193-214.
• [43]Birmes P, Brunet A, Benoit M, Defer S, Hatton L, Sztulman H, Schmitt L: Validation of the Peritraumatic Dissociative Experiences Questionnaire self-report version in two samples of French-speaking individuals exposed to trauma. Eur Psychiatry 2005, 20(2):145-151.
• [44]Brunet A, Weiss DS, Metzler TJ, Best SR, Neylan TC, Rogers C, Fagan J, Marmar CR: The Peritraumatic Distress Inventory: a proposed measure of PTSD criterion A2. Am J Psychiatry 2001, 158(9):1480-1485.
• [45]Bui E, Brunet A, Allenou C, Camassel C, Raynaud JP, Claudet I, Fries F, Cahuzac JP, Grandjean H, Schmitt L: Peritraumatic reactions and posttraumatic stress symptoms in school-aged children victims of road traffic accident. Gen Hosp Psychiatry 2010, 32(3):330-333.
• [46]Marmar CR, Metzler TJ, Otte C: The Peritraumatic Dissociative Experiences Questionnaire. In Assessing Psychological Trauma and PTSD: A Handbook for Practitioners. Edited by Wilson JP, Keane TM. New York, NY: Guilford Press; 2004:144-167.
• [47]Nishi D, Matsuoka Y, Yonemoto N, Noguchi H, Kim Y, Kanba S: Peritraumatic Distress Inventory as a predictor of post-traumatic stress disorder after a severe motor vehicle accident. Psychiatry Clin Neurosci 2010, 64(2):149-156.
• [48]Baker DG, Nash WP, Litz BT, Geyer MA, Risbrough VB, Nievergelt CM, O'Connor DT, Larson GE, Schork NJ, Vasterling JJ: Predictors of risk and resilience for posttraumatic stress disorder among ground combat marines: methods of the marine resiliency study. Prev Chronic Dis 2012, 9:E97.
• [49]Vogt DS, King DW, King LA: Focus groups in psychological assessment: enhancing content validity by consulting members of the target population. Psychol Assess 2004, 16(3):231-243.
• [50]Haynes SN, Richard DC, Kubany ES: Content validity in psychological assessment: a functional approach to concepts and methods. Psychol Assess 1995, 7(3):238-247.
• [51]Helmer O: Looking forward: A guide to future research. Beverly Hills, CA: Sage; 1983.
• [52]Nijenhuis ER, Spinhoven P, Van Dyck R, Van der Hart O, Vanderlinden J: The development and psychometric characteristics of the Somatoform Dissociation Questionnaire (SDQ-20). J Nerv Ment Dis 1996, 184(11):688-694.
• [53]Nijenhuis ER, Spinhoven P, van Dyck R, van der Hart O, Vanderlinden J: Degree of somatoform and psychological dissociation in dissociative disorder is correlated with reported trauma. J Trauma Stress 1998, 11(4):711-730.
• [54]Marmar CR, Weiss DS, Metzler TJ: The Peritraumatic Dissociative Experiences Questionnaire. In Assessing Psychological Trauma and PTSD. Edited by Wilson JP, Keane TM. New York, NY: Guilford Press; 1997:412-428.
• [55]Bremner JD, Krystal JH, Putnam FW, Southwick SM, Marmar C, Charney DS, Mazure CM: Measurement of dissociative states with the Clinician-Administered Dissociative States Scale (CADSS). J Trauma Stress 1998, 11(1):125-136.
• [56]Bruner VE, Woll P: The battle within: understanding the physiology of war-zone stress experience. Soc Work Health Care 2011, 50(1):19-33.
• [57]Nash WP, Steenkamp M, Conoscenti L, Litz BT: The stress continuum model: a military organizational approach to resilience and recovery. In Resilience and Mental Health: Challenges Across the Lifespan. Edited by Southwick SM, Litz BT, Charney D, Friedman MJ. New York: Cambridge University Press; 2011.
• [58]Dubester KA, Braun BG: Psychometric properties of the Dissociative Experiences Scale. J Nerv Ment Dis 1995, 183(4):231-235.
• [59]Wright DB, Loftus EF: Measuring dissociation: comparison of alternative forms of the dissociative experiences scale. Am J Psychol 1999, 112(4):497-519.
• [60]Blanchard EB, Jones-Alexander J, Buckley TC, Forneris CA: Psychometric properties of the PTSD Checklist (PCL). Behav Res Ther 1996, 34(8):669-673.
• [61]Wilkins KC, Lang AJ, Norman SB: Synthesis of the psychometric properties of the PTSD checklist (PCL) military, civilian, and specific versions. Depress Anxiety 2011, 28(7):596-606.
• [62]Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Gusman FD, Charney DS, Keane TM: The development of a Clinician-Administered PTSD Scale. J Trauma Stress 1995, 8(1):75-90.
• [63]Weathers FW, Litz BT: Psychometric properties of the Clinician-Administered PTSD Scale, CAPS-1. PTSD Research Quarterly 1994, 5:2-6.
• [64]Weathers FW, Ruscio AM, Keane TM: Psychometric properties of nine scoring rules for the Clinician-Administered Posttraumatic Stress Disorder Scale. Psychol Assess 1999, 11(2):124-133.
• [65]Watson D, Clark LA, Tellegen A: Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol 1988, 54(6):1063-1070.
• [66]Crawford JR, Henry JD: The positive and negative affect schedule (PANAS): construct validity, measurement properties and normative data in a large non-clinical sample. Br J Clin Psychol 2004, 43(Pt 3):245-265.
• [67]Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J: An inventory for measuring depression. Arch Gen Psychiatry 1961, 4:561-571.
• [68]Beck AT, Steer RA, Garbin MG: Psychometric properties of the Beck depression inventory: twenty-five years of evaluation. Clin Psychol Rev 1998, 8:77-100.
• [69]Beck AT, Epstein N, Brown G, Steer RA: An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988, 56(6):893-897.
• [70]Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE, Bullinger M, Kaasa S, Leplege A, Prieto L: Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 1998, 51(11):1171-1178.
• [71]World Health Organization: Measuring Health and Disability: Manual for WHO Disability Assessment Schedule – WHODAS 2.0. Geneva: WHO; 2010.
• [72]Inslicht SS, McCaslin SE, Metzler TJ, Henn-Haase C, Hart SL, Maguen S, Neylan TC, Marmar CR: Family psychiatric history, peritraumatic reactivity, and posttraumatic stress symptoms: a prospective study of police. J Psychiatr Res 2010, 44(1):22-31.
• [73]McCaslin SE, Inslicht SS, Metzler TJ, Henn-Haase C, Maguen S, Neylan TC, Choucroun G, Marmar CR: Trait dissociation predicts posttraumatic stress disorder symptoms in a prospective study of urban police officers. J Nerv Ment Dis 2008, 196(12):912-918.
• [74]Southwick SM, Morgan A, Nicolaou AL, Charney DS: Consistency of memory for combat-related traumatic events in veterans of operation desert storm. Am J Psychiat 1997, 154(2):173-177.
• [75]Nash WP: Combat/operational stress adaptations and injuries. In Combat Stress Injury Theory, Research, and Management. Edited by Figley CR, Nash WP. New York, NY: Routledge Press; 2007.