Measuring Trauma Workshop Summary (2016) / Chapter Skim
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3 Key Concepts and Measurement Challenges
3 Key Concepts and Measurement Challenges
Pages 25-38
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From page 25... ...
In terms of mental health responses to trauma, disasters, and public health emergencies, the most prevalent distress responses to trauma exposure are a sense of vulnerability, change in sleep, irritability and distraction; belief in exposure; multiple idiopathic physical symptoms and multiple unexplained physical symptoms; and isolation. He pointed out that irritability is important to measure as a separate dimen 25
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From page 26... ...
Ursano also emphasized the importance of studying community-level resilience factors and exposures, whether that means a few blocks or a larger neighborhood. He noted that ZIP-code-level data already exist, and they can provide contextual information to understand potentially traumatic events and the associated morbidity and mortality.
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From page 27... ...
Ursano summarized a potential list of post-disaster community mental health items as follows: • distress • psychiatric illness or symptoms • health risk behaviors • risk perception • safety perception • changes in behavior • preparedness behaviors Ursano also touched on the topic of resilience and listed the follow
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From page 28... ...
Collective efficacy, or the extent to which members of a community take care of each other, is another predictor of PTSD highlighted, Ursano noted. A study that looked at the probability of PTSD among Florida public health workers found that higher levels of collective efficacy at the community level were associated with lower probabilities of PTSD.2 Focusing specifically on the concept of PTSD, Ursano agreed with previous speakers that exposure to potentially traumatic events is very common.
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From page 29... ...
In other words, if the interest is in morbidity and mortality, then the question is what is a person doing that has increased his or her risk of morbidity and mortality? MEASURING EXPOSURE TO TRAUMA, PTSD, AND SUBCLINICAL PTSD Terrence Keane discussed approaches to measuring exposure to trauma, PTSD symptomology, and subclinical PTSD.
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From page 30... ...
For exposure, the options for self-report measures include • Traumatic Life Events Questionnaire • Traumatic Events Questionnaire • Trauma History Questionnaire • Life Events Checklist • Stressful Life Events Screening Questionnaire • Traumatic Stress Schedule • Trauma Assessment for Adults–Self Report • The Life Stressor Checklist–Revised • Trauma History Screen • Brief Trauma Questionnaire In terms of self-report measures for symptoms, one of the main considerations highlighted by Keane is whether the measure has been updated for the DSM-5. Keane noted that some of the most common measures have already been updated or are in the process of being updated.
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From page 31... ...
Keane said that a primary consideration when selecting a measure is the amount of time that can be allocated to administering the items and the topics covered by the other questions on the survey. Some of the relatively short screening instruments are the Traumatic Stress Schedule, the Traumatic Events Questionnaire, the Brief Trauma Questionnaire, the Trauma Assessment for Adults, and the Trauma History Screen.
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From page 32... ...
He said that it is not clear how important it is to SAMHSA to collect data on diagnostic prevalence in contrast with obtaining a more in-depth understanding of the role of posttrauma mental health problems or psychopathology on a continuous scale. The use of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders in the Mental Health Surveillance Study would indicate that diagnosis was the sole topic of interest.
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From page 33... ...
Some very short scales, such as the Primary Care PTSD Screen, do exist, but many of the comments seem to suggest that these would not provide adequate information for SAMHSA's purposes. Schell responded that the Primary Care PTSD Screen does not collect any information about the potentially traumatic event, only about symptoms.
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From page 34... ...
These serial correlations can affect studies that use factor analysis. Schell argued that exposure to traumatic events is not a reflexive construct because the goal is not to measure the common cause, but, rather, the opposite, to measure the common outcome.
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From page 35... ...
Schell said that summing items creates a measure of the common cause, but this approach cannot be used unless the events are uncorrelated and equally predictive of the defined outcome. Because of that, he argued that summing up the items does not work for measuring exposure to traumatic events, even though it is commonly done in the field.
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From page 36... ...
Keane asked whether there are exceptions, such as externality and high risk taking that could be considered latent variables underlying exposure to a variety of different types of traumatic events. Schell agreed that some types of exposure can have common causes, and impulsivity is an example of that.
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From page 37... ...
A rarely utilized option is to minimize covariance before summing by dropping, combining, or down-weighting redundant items. For example, if data were collected on six items about sexual assault and they are all highly correlated, then one could review the covariance matrix and keep only the best item.
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