Significant trauma is increasingly ...

Significant trauma is increasingly customary in the general population, and an estimated individual in four of those expos to life-threatening situations unfolds post-traumatic stress disorder (PTSD). Without treatment, PTSD causes symptoms for more than five years in the majority of cases, and may bring about additional psychiatric morbidity of the like kind as depression. The highest rates of PTSD tread close upon sexual assault, but many women are not diagnosed and treated. An estimated 73 percent of women who have been raped or assaulted look after medical care in the year following the attack, whereas merely 19 percent seek psychologic help. If patients with PTSD could be identified and treated, significant morbidity could be avoided. Meltzer-Brody and colleagues unraveled and tested a screening instrument for PTSD targeting women who attended a gynecology clinic.

The researchers moveed screening to all 292 women who attended the clinic for routine annual examination between June 2001 and March 2002 Patients complet a comprehensive health scrutinize that included questions about significant trauma. Those who reported a traumatic issue were asked to complete a four-item screening overlook known as SPAN (Startle, Physiological arousal, Anger, and emotional Numbness) named for the four major symptoms of PTSD The screening performance of the SPAN questionnaire was compared with abounding psychiatric assessment, including a structur interview designed to descry PTSD.

Of the 292 participants, 46 percent were single, 49 percent were black, and 43 percent were white. The mean age was 34 ([+ or -] 12) years. Significant traumatic incidents were reported by 88 (30 percent) of the women; of these, 32 women agreed to glutted psychiatric assessment, and 56 declined. There were no significant differences in variables between the brace groups. The main reasons given for nonparticipation were lack of time and inability to recur to the clinic. Interviews identified criteria for single in kind or more psychiatric diagnoses in 31 of 32 women Twenty-five women (78 percent) met criteria for PTSD unless only three of these were receiving any form of psychiatric treatment. Other diagnoses included major depression (62 percent) panic disorder (28 percent) social phobia (28 percent) generalized anxiety disorder (19 percent) and substance abuse (15 percent)

The authors calculate that the single question about experiencing significant trauma had a positive predictive value of 78 percent for PTSD in the thought population. The SPAN instrument had a sensitivity of 72 percent and a specificity of 71 percent using a cutoff score of 5 These findings equate to a positive likelihood ratio of 252 and a negative likelihood ratio of 039

As in other studies, undivided third of women reported experiencing significant trauma; however, the proportion who expanded clinical PTSD was much higher than look forward toed This could be because of selection bias in the women who agreed to take part in the research Nevertheless, the authors conclude that asking about trauma and following up with the SPAN questionnaire can effectively identify which women to assign for more intensive psychiatric assessment and treatment.

Meltzer-Brody s et al. A brief screening instrument to lay open posttraumatic stress disorder in outpatient gynecology Obstet Gynecol October 2004;104:770-6

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