Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Jun 22, 2016; 6(2): 226-232
Published online Jun 22, 2016. doi: 10.5498/wjp.v6.i2.226
Peritraumatic Behavior Questionnaire - Observer Rated: Validation of the objective version of a measure for combat-related peritraumatic stress
Agorastos Agorastos, Abigail C Angkaw, Heather E Johnson, Christian J Hansen, Camille V Cook, Dewleen G Baker
Agorastos Agorastos, Abigail C Angkaw, Dewleen G Baker, Veterans Affairs Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA 92161, United States
Agorastos Agorastos, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, D-20246 Hamburg, Germany
Abigail C Angkaw, Camille V Cook, Dewleen G Baker, Department of Psychiatry, University of California, San Diego (UCSD), San Diego, CA 92161, United States
Heather E Johnson, Dewleen G Baker, Veteran Affairs San Diego Healthcare System, San Diego, CA 92161, United States
Christian J Hansen, Veterans Medical Research Foundation, San Diego, CA 92161, United States
Author contributions: Agorastos A wrote the first draft of the manuscript; Hansen CJ and Cook CV carried out all statistical analyses; Johnson HE made substantial contributions to acquisition of data; Agorastos A, Angkaw AC and Baker DG contributed to the interpretation of data; Baker DG made substantial contributions to the design and implementation; Angkaw AC, Johnson HE and Baker DG were involved in drafting the manuscript and revising it critically for important intellectual content; all authors have approved the final version of the manuscript.
Supported by The Congressionally Directed Medical Research Programs small (pilot) project mechanism, No. Contract W81XWH-10-1-0693 (to Baker DG); It was linked to the MRS study, funded by VA’s Health Services Research and Development Service, No. RDIS 0024; the Marine Corps and Navy BUMED, from which pre- and post-deployment data were drawn.
Institutional review board statement: The “Validation of the Peritraumatic Behavior Questionnaire” study and the MRS study were both IRB and VA research committee reviewed and approved.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare that they have no financial or non-financial competing interests. The opinions and assertions contained herein are the private views of the authors, and do not necessarily reflect the official positions or policies of the Department of Defense or the Department of Veterans Affairs.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dewleen G Baker, MD, Professor, Research Director of Veteran Affairs Center of Excellence for Stress and Mental Health (CESAMH), 3350 La Jolla Village Dr., San Diego, CA 92161, United States. dgbaker@ucsd.edu
Telephone: +1-858-552858-2230 Fax: +1-858-6486448
Received: January 15, 2016
Peer-review started: January 19, 2016
First decision: March 23, 2016
Revised: May 9, 2016
Accepted: May 17, 2016
Article in press: May 27, 2016
Published online: June 22, 2016
Abstract

AIM: To validate the first third-person-rated measure assessing combat-related peritraumatic stress symptoms and evaluate its psychometric properties and war-zone applicability.

METHODS: The valid assessment of peritraumatic symptoms in the theater of military operations represents a significant challenge in combat-related, mental health research, which mainly relies on retrospective, subjective self-report ratings. This longitudinal observational study used data from actively deployed troops to correlate third-person observer ratings of deployment peritraumatic behaviors [Peritraumatic Behavior Questionnaire - Observer Rated (PBQ-OR)] collected on a bi-monthly basis with post-deployment (1-wk follow-up) ratings of the previously validated PBQ self-rate version (PBQ-SR), and (3-mo follow-up) clinician assessed and self-report posttraumatic stress disorder (PTSD) symptoms (Clinician Administered PTSD Scale, PTSD Checklist). Cronbach’s alpha (α) and correlation coefficients were calculated to assess internal reliability and concurrent validity respectively.

RESULTS: Eight hundred and sixty male Marines were included in this study after signing informed consents at pre-deployment (mean age 23.2 ± 2.6 years). Although our findings were limited by an overall sparse return rate of PBQ-OR ratings, the main results indicate satisfactory psychometric properties with good internal consistency for the PBQ-OR (α = 0.88) and high convergent and concurrent validity with 1-wk post-deployment PBQ-SR ratings and 3-mo posttraumatic stress symptoms. Overall, later PBQ-OR report date was associated with higher correlation between PBQ-OR and post-deployment measures. Kappa analysis between PBQ-OR and PBQ-SR single items, showed best agreement in questions relating of mortal peril, desire for revenge, and experience of intense physical reactions. Logistic regression demonstrated satisfactory predictive validity of PBQ-OR total score with respect to PTSD caseness (OR = 1.0513; 95%CI: 1.011-1.093; P = 0.02).

CONCLUSION: Since no comparable tools have been developed, PBQ-OR could be valuable as real-time screening tool for earlier detection of Service Members at risk.

Keywords: Peritraumatic reaction, Posttraumatic stress disorder, Trauma, Military service, Combat, Assessment, Dissociation, Stress

Core tip: The assessment of combat-related peritraumatic symptoms mainly relies on retrospective, subjective self-report ratings. We have therefore developed the Peritraumatic Behavior Questionnaire - Observer Rated (PBQ-OR), a third-person-rated scale for unit-embedded medical personnel to objectively assess symptoms of combat-related peritraumatic stress in deployed troops. In this study, we validated the PBQ-OR during active deployment and longitudinally evaluated its psychometric properties and war-zone applicability. Our findings show that the PBQ-OR could be used as a screening and monitoring tool in real time and may permit earlier detection of Service Members at risk for posttraumatic stress symptoms to target prevention and early intervention efforts.