Evaluation of Candidate Items for Severe PTSD Screening for Patients With Chronic Pain: Pilot Data Analysis With the IRT Approach

Dokyoung S. You*, Maisa S. Ziadni, Gadi Gilam, Beth D. Darnall, Sean C. Mackey

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objectives: Post-traumatic stress disorder (PTSD) commonly co-occurs with chronic pain. Although PTSD symptoms are associated with negative health outcomes in patients with chronic pain, PTSD is typically under-detected and under-treated in outpatient pain settings. There is a need for rapid, brief screening tools to identify those at greatest risk for severe PTSD symptoms. To achieve that goal, our aim was to use item response theory (IRT) to identify the most informative PTSD symptoms characterizing severe PTSD in patients with chronic pain. Methods: Fifty-six patients (71% female, 61% White) with mixed etiology chronic pain completed the PTSD Checklist-Civilian Version (PCL-C) as part of their appointment with a pain psychologist at a tertiary outpatient pain clinic. We used an IRT approach to evaluate each item's discriminant (a) and severity (b) parameters. Results: Findings revealed that “feeling upset at reminders” (a = 3.67, b = 2.44) and “avoid thinking or talking about it” (a = 3.61, b = 2.17) as being highly discriminant for severe PTSD. Conclusions: We identified 2 candidate items for a brief PTSD screener as they were associated with severe PTSD symptoms. These 2 items may provide clinical utility in outpatient pain treatment settings to identify those suffering from severe PTSD, enabling physicians to refer them to trauma-specific evaluation or therapy. Future research is needed to further validate and confirm these candidate PTSD items in a larger clinic sample. Lay Summary: The current study used the IRT approach to identify candidate items for a brief screener for severe PTSD. We examined 17 items of the PCL-C, and identified 2 items that were highly discriminant for severe PTSD. The 2 items were “feeling upset at reminders” and “avoid thinking or talking about it.” These 2 items may provide clinical utility, since they may enable physicians to screen and make a referral for further assessment or treatment for PTSD.

Original languageAmerican English
Pages (from-to)262-268
Number of pages7
JournalPain Practice
Volume20
Issue number3
DOIs
StatePublished - 1 Mar 2020
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2019 World Institute of Pain

Keywords

  • PTSD symptoms
  • a brief screener
  • chronic pain
  • item response theory

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