Clinical utility and incremental validity of brief screening for traumatic event exposure in female university health service patients

Abstract

Evidence suggests that routine screening of primary care patients for exposure to traumatic life events, and particularly assaultive trauma, may yield both clinical and cost benefits for healthcare systems (e.g., Green, Epstein, Krupnick, & Rowland, 1997; Lecrubier, 2004). However, although advocated by authorities, such screening has yet to be widely adopted. A sample of female university healthcare patients (N =339) was assessed for exposure to trauma in order to examine several unaddressed issues that may diminish the clinical utility of screening for trauma in primary care patients. Because the length of the traditional trauma history assessment makes it less acceptable for use in time-pressured primary care settings, the discriminative validity of a brief, self-administered screening question about exposure to trauma, the Structured Clinical Interview for DSM-IV(SCID) posttraumatic stress disorder (PTSD) module's screening question (First, Spitzer, Williams& Gibbon, 1997) was compared to a longer, inventory method of assessment, the Traumatic Life Events Questionnaire (TLEQ; Kubany et al., 2000). Two versions of a brief screening question across two instructional sets were assessed to determine each condition's relative classification accuracy for identifying respondents who reported experiences of sexual or physical assault, and/or symptoms of PTSD. The SCID screen identified more than three-quarters of the survivors of traumatic assault; and more importantly, identified all but 2 of the 47 women who met criteria for PTSD. More than 40% of the participants reported at least one physically or sexually assaultive traumatic event; and while only 4% of those reporting non-assaultive traumatic events met criteria for PTSD on the DEQ, a full one-third of assaultive-trauma survivors met criteria for PTSD. Results suggest that a brief screening question about traumatic life events may be an acceptable option in settings where more time-consuming assessment procedures are not practical. However, given the high rate of symptoms reported by female survivors of assaultive trauma relative to non-assaultive traumatic events in this and other studies (e.g., Kessler, 2000; Lee & Young, 2001) a specific focus on screening for assaultive trauma might afford a more useful approach to trauma screening, at least among female populations. Implications and limitations of the present study are discussed, and suggestions made for the future development of optimal screening approaches for trauma exposure in primary care patients.