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:

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:

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.

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 http://www.ahrq.gov/clinic/3rduspstf/suicide/suiciderr.pdf 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.

This page has four different screening tools that can be helpful in the assessment of PTSD. Besides the Primary Care Screen, the other screens, or checklists, are targeted either toward civilians, military personnel, or specific stressors.