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The British Journal of Psychiatry (2002) 181: 535
© 2002 The Royal College of Psychiatrists

Correspondence

Screening for PTSD

M.-L. Lu and W. W. Shen

Department of Psychiatry, Taipei Medical University — Wan Fang Hospital, No. III, Hsin-Long Road, Sec. 3, Taipei, Taiwan

We read with great interest the article by Brewin et al (2002). The authors examined the efficiency of the 10-item version of the Trauma Screening Questionnaire (TSQ) in detecting post-traumatic stress disorder (PTSD). In our opinion, the scale design has some limitations which may have a negative influence on its practical application.

First, the TSQ contains five re-experiencing items and five arousal items, but not the avoidance and numbing symptoms. According to DSM-IV diagnostic criteria for PTSD (American Psychiatric Association, 1994), the patient requires the presence of at least one re-experiencing symptom (criterion B), three avoidance symptoms (criterion C), and two arousal symptoms (criterion D). The criterion C is the least frequently met criterion but critically significant to the diagnosis of PTSD (Maes et al, 1998). Some trauma survivors, who express most PTSD symptoms, do not fulfil the avoidance criterion and are diagnosed as having ‘partial’ PTSD. Other briefer screening instruments, such as the four-item SPAN (Meltzer-Brody et al, 1999) or the seven-item scale by Breslau et al (1999), place much weight on the avoidance and numbing symptoms. Therefore, this specific item composition may influence the efficiency of the TSQ.

Second, the TSQ uses the frequency threshold allied to a ‘yes/no’ response format. Although comparison of scores derived by frequency and by severity indicated a degree of similarity, the severity dimension might provide better discrimination than the frequency dimension (Meltzer-Brody et al, 1999). In our clinical experience, subjects can score the severity variable more accurately than the frequency ones (Chen et al, 2001). The item selection and scoring method have greater influence on the efficacy of the rating scale.

EDITED BY KHALIDA ISMAIL

REFERENCES

1. American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM—IV). Washington, DC: APA.
2. Breslau, N., Peterson, E. L., Kessler, R. C., et al (1999) Short screening scale for DSM—IV posttraumatic stress disorder. American Journal of Psychiatry, 156, 908-911.[Abstract/Free Full Text]
3. Brewin, C. R., Rose, S., Andrews, B., et al (2002) Brief screening instrument for post-traumatic stress disorder. British Journal of Psychiatry, 181, 158-162.[Abstract/Free Full Text]
4. Chen, C. H., Lin, S. K., Tang, H. S., et al (2001) The Chinese version of the Davidson Trauma Scale: a practice test for validation. Psychiatry and Clinical Neuroscience, 55, 493-499.[Medline]
5. Maes, M., Delmeire, L., Schotte, C., et al (1998) Epidemiologic and phenomenological aspects of post-traumatic stress disorder: DSM—III—R diagnosis and diagnostic criteria not validated. Psychiatry Research, 81, 179-193.[CrossRef][Medline]
6. Meltzer-Brody, S., Churchill, E. & Davidson, J. R. T. (1999) Derivation of the SPAN, a brief diagnostic screening test for post-traumatic stress disorder. Psychiatry Research, 88, 63-70.[CrossRef][Medline]

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Author's reply

C. R. Brewin

Sub-Department of Clinical Health Psychology, University College London, Gower Street, London WCIE 6BT, UK

EDITED BY KHALIDA ISMAIL

Drs Lu and Shen claim that our Trauma Screening Questionnaire (TSQ; Brewin et al, 2002) is flawed because it omits avoidance and numbing symptoms and asks about symptom frequency using a simple ‘yes/no’ response format. It is puzzling then that the performance of the TSQ is superior to that of all comparable screening measures, including ones that follow Lu and Shen's recommendations. Their views are clearly contradicted by the data from the two studies we reported. Our reasons for designing the TSQ in the way we did were based on empirical and practical rather than theoretical considerations. In our original article we discussed some general principles for designing successful screening instruments, whereas Lu and Shen's comments seem more relevant to a diagnostic instrument. The two types of measure tend to be administered by different professionals, under different circumstances, and with different aims in mind. It seems to us that, as a screening instrument, what the TSQ gains in simplicity and clarity more than compensates for the absence of symptoms that may be difficult to understand and judgements that may be difficult to make.

REFERENCES

1. Brewin, C. R., Rose, S., Andrews, S., et al (2002) Brief screening instrument for post-traumatic stress disorder. British Journal of Psychiatry, 181, 158-162.[Abstract/Free Full Text]

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This Article Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Lu, M.-L. Articles by Brewin, C. R. Search for Related Content PubMed PubMed Citation Articles by Lu, M.-L. Articles by Brewin, C. R.