Mental Health

Mental health screening for PTSD following disasters

As a mental health professional, you are likely to see an increase in traumatized individuals after a disaster. Many of these clients or consumers will present with physical rather than mental or emotional symptoms, and will be referred to you by their physicians after physical work-ups for stress. In addition to being familiar with disaster-related stress and practicing psychological first-aid, you will want to educate yourself about PTSD and start to screen those you work with for its effects following major disasters.

First, some general PTSD screening considerations:

• In addition to disasters and other traumatic life events, life-threatening medical conditions such as heart attack, severe burns, severe injuries, and cancer can cause or exacerbate PTSD.

• You will want to make certain that your clients or consumers have had a thorough physical examination to rule out other causes of stress.

• Patients with PTSD experience a significant degree of functional impairment similar to that observed in patients suffering from Major Depressive Disorder.

• Anxiety disorders, of which PTSD is a subtype, often present as physical symptoms that can impair functioning severely. Persistent anxiety also brings about hormonal, neurochemical, immune functioning, and autonomic nervous system changes that can affect physical health.

• PTSD is associated with significant problems in living, including alcohol abuse, marital problems, unemployment, and suicidal ideation. PTSD is also associated with high levels of use of medical services.

• PTSD often presents to physicians, but goes unrecognized. Few medical clinics systematically identify trauma survivors who have related mental-health problems.

• Failure to identify and treat PTSD has adverse effects on the peoples’ physical and mental health, and mental health professionals are often the first to suggest this as a possible struggle.

Thus, thorough and early screening for PTSD is essential to its diagnosis and treatment.

Screen administration

Of course, as with clinical practice in general, we have numerous options for how we begin to understand others’ struggles. Here are several:

• Familiarize yourself with the diagnostic features of PTSD and include questions about these features in your initial intake for people with history of trauma and suspected PTSD symptoms.

• Administer the Primary Care PTSD Screen (PC-PTSD), a brief verbal measure designed for use by physicians and mental health professionals. The PC-PTSD is brief and problem-focused, and consists of the following four questions:

In your life, have you ever had any experience that was so frightening, horrible, or upsetting that, in the past month, you:

1. Have had nightmares about it or thought about it when you did not want to?
YES NO

2. Tried hard not to think about it or went out of your way to avoid situations that reminded you of it?
YES NO

3. Were constantly on guard, watchful, or easily startled?
YES NO

4. Felt numb or detached from others, activities, or your surroundings?
YES NO

A positive response to the screen (answering “YES” to any three items) does not necessarily indicate that a patient has Posttraumatic Stress Disorder. It does suggest, however, trauma-related problems that should be investigated further. Those of you practicing in areas in which a disaster has occurred may even add these screening items to the standard history forms that your clients or consumers complete at first visits.

• Perform specific PTSD assessment of people you suspect of struggling in this way. Here is a PTSD-specific self-test, that is a more thorough measure of PTSD symptoms and related response. This measure is in the public domain and you may print it out and give it to your clients or consumers to complete.

STRESS-RELATED SELF-TEST

Please complete the following self-test by clicking the "yes or "no" boxes next to each question.

Yes or No?

A.

Yes No

Have you experienced or witnessed a life-threatening event that caused intense fear, helplessness or horror?

B.

Yes No	Repeated, distressing memories and/or dreams?
Yes No	Acting or feeling as if the event were happening again (flashbacks or a sense of reliving it)?
Yes No	Intense physical and/or emotional distress when you are exposed to things that remind you of the event?

C.

Yes No	Avoiding thoughts, feelings, or conversations about it?
Yes No	Avoiding activities, places, or people who remind you of it?
Yes No	Blanking on important parts of it?
Yes No	Losing interest in significant activities of you life?
Yes No	Feeling detached from other people?
Yes No	Feeling your range of emotions is restricted?
Yes No	Sensing that your future has shrunk (for example, you don't expect to have a career, marriage, children, or a normal life span)?

D.

Yes No	Problems sleeping?
Yes No	Irritability or outbursts of anger?
Yes No	Problems concentrating?
Yes No	Feeling "on guard"?
Yes No	Being easily and unusually startled?

Sometimes people have more than one struggle at a time. Please take a minute to answer the following questions:

Yes No

Have you experienced changes in sleeping or eating habits?

More days than not, do you feel:

Yes No	Sad or depressed?
Yes No	Disinterested in life?
Yes No	Worthless or guilty?

During the last year, has the use of alcohol or drugs:

Yes No	Resulted in your failure to fulfill responsibilities with work, school, or family?
Yes No	Placed you in a dangerous situation, such as driving a car under the influence?
Yes No	Gotten you arrested?
Yes No	Continued despite causing problems for you and/or your loved ones?

Scoring of this measure is straightforward. A positive response to “A” indicates experience of trauma. Within the “B” re-experiencing cluster, at least one positive response is required. The Avoidance items in “C” require three or more positive responses, and the Numbing questions in “D” are diagnostic as well with three or more.

The remaining items are intended to elaborate depression and substance-related struggles.

Discussion and referral

After a review of the screening results and a discussion with your client or consumer, you may decide whether he or she is in need of further specialized mental-health evaluation or treatment. People may be referred, depending on availability, to specialized PTSD treatment, behavioral medicine, or more general mental-health services for further evaluation and possible treatment. Of course, some patients who screen "positive" will not actually be diagnosed with PTSD after more detailed clinical evaluation by you or another mental health professional.

Keep in mind, you should also be concerned with and assess for suicidal ideation for anyone you suspect is experiencing PTSD.

Web Links

This is the homepage for the National Center for Trauma-Informed Care, funded by SAMHSA. The Center’s goal is to provide training in the support and empowerment of trauma survivors. On the right-hand side of the page, you can access resources on trauma and trauma-informed care.

This page provides an overview of trauma, its causes, and coping strategies. There is also a section that specifically addresses PTSD.

This is the American Psychological Association’s website on Posttraumatic Stress Disorder. Within the site are general resources on PTSD, as well as the latest findings, research, and press releases concerning PTSD.