ARTICLE INFO

Article Type

Descriptive & Survey Study

Authors

Karimi   M. (1)
Rahnejat   A.M. (*1)
Dabaghi   P. (1)
Taghva   A. (2)
Majdian   M. (3)
Donyavi   V. (2)
Shahed-HaghGhadam   H. (4)






(1) Department of Clinical Psychology, Medicine Faculty, Aja University of Medical Sciences, Tehran, Iran
(2) Psychiatry Department, Medicine Faculty, Aja University of Medical Sciences, Tehran, Iran
(3) Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
(4) Clinical Psychology Department, Varamin Branch, Islamic Azad University, Varamin , Iran

Correspondence

Address: Department of Clinical Psychology, Psychiatric Hospital of the Islamic Republic of Iran Army Ground Forces, Oshan Blvd., Artesh Hwy., Tehran, Iran.
Phone: +98 (21) 22195164
Fax: +98 (21) 22197198
arahnedjat@yahoo.com

Article History

Received:  January  21, 2020
Accepted:  May 19, 2020
ePublished:  June 17, 2020

BRIEF TEXT


...[1-7]. One of the psychological disorders that have a significant relationship in the face of traumatic events is a post-traumatic stress disorder. PTSD eventually will affect approximately 25% of people who experience a traumatic event [8].

…[9]. The results indicate that the Lifelong prevalence of PTSD in the general population is approximately between 1 and 9% [17-10]. On the other hand, war and military missions are some of the most common traumatic events in military organizations, which sometimes leads to PTSD in the staff of this type of organization, especially veterans [2, 18-22]. …[23-30]. In recent decades, a wide range of trauma screening tools and related symptoms have been developed and validated for PTSD testing. One of the tools is the post-traumatic stress disorder symptom scale based on the 5th edition of the diagnostic and statistical manual of mental disorders (PSS-I-5). The PSS-I-5 checklist is based on the DSM-5 and is an executive scale that assesses the severity and diagnosis of PTSD symptoms according to the DSM-5 criteria. The PSS-I-5 checklist is designed based on the DSM-5 and an executive scale that assesses the severity of PTSD symptoms according to the DSM-5 criteria. …[31]. The PSS-I-5 is similar to the PSS-I, a flexible semi-structured interview. The PSS-I-5 is a flexible semi-structured interview similar to the PSS-I, Which allows clinicians to diagnose PTSD and its severity.

This study aimed to evaluate veteran populations' psychometric properties using the latest PTSD diagnostic scale, PSS-I-5.

This is descriptive research.

This research was conducted from September 2019 to May 2020. The sample consisted of 287 male veterans of the army of the Islamic Republic of Iran who had been referred to the 505th psychiatric hospital of the army ground forces to participate in the commission of article 87.

Sampling was based on the available sampling method (due to the impossibility of random sampling) and inclusion criteria consisting 1- employed or retired military or those who have served in one of the four forces of the army (the defense force, air force, ground force and joint staff of the Islamic Republic of Iran army); 2- having a record of participating in the war during the eight years of holy defense; 3- having the high motivation to participate in research; and 4- literacy. Exclusion criteria also included: 1- not attending the war and 2- the unwillingness to participate in the research. The research sampling method is simple random sampling (available sampling). According to the target population and based on Cohen's formula (n=z2 (1-p)/d2), the minimum sample size was 267, after considering d2 equal to 0.06 by consulting with methodologists [32].

Data collection was conducted using a researcher-made demographic characteristics questionnaire (age, education, military rank, duration of presence on the war, age of presence on the war, service units during the war, number of traumatic events experienced during the war, the signs and symptoms after a stressful war experience, percentage of injuries in veterans and so on] the post-traumatic stress disorder scale, the fifth edition of the list of post-traumatic stress disorder, the second edition of the Beck depression inventory, the mode-trait anxiety scale, the structured clinical executive scale of post-traumatic stress disorder. …[38]. Psychometric properties of PSS-I-5 were evaluated by calculating validity (structural and concurrent), sensitivity and reliability (Cronbach's alpha), and determination of shear point. Data were analyzed using SPSS 24 software.

The Cronbach's alpha coefficient range of all questions and the total score of the scale were in the desired range (α=0.91); therefore, PSS-I-5 had optimal reliability (internal consistency) (Table 1).Pearson correlation coefficient was used to evaluate the convergence validity of PSS-I-5. For this purpose, the correlation of PSS-I-5 scales with PCL-M-5 and CAPS-5 was measured (Table 2). The results showed a significant relationship between the correlation coefficients of PSS-I-5 subscales with PCL-M-5 and CAPS-5 (p<0.01). Also, the correlation coefficients of PSS-I-5 subscales with CAPS-5 were included: the signs of reexperiencing (r=0.72), avoidance symptoms (r=0.56), changes in cognition and mood (r=0.72), arousal and reactivity (r=0.65), and total PSS-I-5 score (r=0.80). Therefore, it can be said that PSS-I-5 had convergent validity. Pearson correlation coefficient was used to evaluate the divergent validity of the PSS-I-5 scale. For this purpose, the correlation of PSS-I-5 scales with BDI-II and STAI scale was measured (Table 3). The correlation coefficients of PSS-I-5 subscales with BDI-II and STAI with STAI were significant in other subscales and the total score (p<0.01). Also, the correlation coefficients of PSS-I-5 subscales with STAI were included: the signs of reexperiencing (r=0.22), avoidance (r=0.10), changes in cognition and mood (r=0.26), arousal and reactivity (r=0.22), and total PSS-I-5 score (r=0.26). Also, the correlation of PSS-I-5 subscales with BDI-II was included: the signs of reexperiencing (r=0.38), avoidance (r=0.23), changes in cognition and mood (r=0.49), arousal and reactivity (r=0.49), and total PSS-I-5 score (r=0.50). Due to the low correlation coefficients of PSS-I-5 subscales with BDI-II and STAI, it can be said that PSS-I-5 had divergent validity.Receiver factor curve analysis and rock diagram were used to find the closest point of convergence that obtained the best sensitivity and specificity and be able to distinguish symptomatically (post-traumatic stress disorder) from asymptomatic (no post-traumatic stress disorder) (Figure 1). There was a significant difference in the area under the curve by 0.88% (p<0.01). The scale's sensitivity was equal to 0.97%, and its specificity was equal to 0.62%. Therefore, according to the most suitable sensitivity and specificity, the cutting point of PSS-I-5 was evaluated as 25. In other words, sensitivity equal to 0.97% indicated a score higher than 25 (symptomatic person; post-traumatic stress disorder), and specificity equal to 0.62% indicated a score lower than 25 (symptomatic person; post-traumatic stress disorder) (Figure 1).The independent t-test was used to compare the means of sick and healthy individuals on the PSS-I-5 scale (Table 4). There was a significant difference between the means of people without PTSD and people with PTSD in the subscales and the total score of the PSS-I-5 scale (p<0.01).

The results of internal consistency measurement showed that this coefficient was high between PSSI-5 questions (0.91). This result is consistent with the results of studies on the psychometric properties of PSS-I-5 [33, 44, 45]. The study of Foa et al. Indicates that this coefficient is high in PSSI-5 questions (0.89). Therefore, due to the alignment of this study's results with other studies in this field, this scale can be used for the diagnostic evaluation of PTSD. By evaluating the correlation between PSS-I-5 and CAPS-5, and PCL-M, the PSS-I-5 convergent validity study results indicated that PSS-I-5 had good convergent validity. This finding is also consistent with the results obtained in the field of PSS-I-5 psychometric properties [33, 44, 45]. Foa et al. [33] found a correlation between PSSI-5 and PDS-5, PCL-S, and overall CAPS-5 scores. Also, the PSS-I-5 divergent validity study results, by evaluating the correlation of PSS-I-5 with BDI-II and STAI, showed that PSS-I-5 had good divergent validity. This result is consistent with the results of studies on the psychometric properties of PSS-I-5 [33, 44, 45]. Also, according to the rock curve analysis results, the best sensitivity and specificity were 0.97 and 0.62 for PSS-I-5, respectively, and the number of 25 was chosen as the cut-off point. The cut-off point obtained in this study is slightly higher than the cut-off point obtained in the study of Foa et al . because the cut-off point was 23 [33]. Foa et al. reported 77% sensitivity and specificity for PSS-I-5. ...[46-51].

It is suggested that in future studies, PSS-I-5 be used in large numbers of civilian populations of both sexes who have experienced exposure to traumatic events.

The most important limitations of the present study are the limitation of the sample size, the limitation of the sample population to war veterans, and the sample population's homogeneity, which does not allow comparisons between men and women. For this reason, we should be careful in generalizing the results to other samples and the female gender.

It can be said that PSS-I-5 has the appropriate homogeneity, convergent, divergent, differential validities, cut-off point, sensitivity, and specificity; therefore, PSS-I-5 can be used to screen military forces participating in war and military enforcement missions with a history of dealing with harmful war and military events.

We thank and appreciate all the veterans who participated in this study and the psychiatrists, psychologists, and staff of the 505th Psychiatric Hospital of the Army of the Islamic Republic of Iran.

No case has been reported.

The vice-chancellor has approved this study for Research and Technology of the Army University of Medical Sciences of the Islamic Republic of Iran with IR's ethics number.AJAUMS.REC.1398.138.

This study was conducted with the financial support of the vice-chancellor for Research and Technology of the Army University of Medical Sciences of Iran's Islamic Republic.

TABLES and CHARTS

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