Development and Validation of Computerized Adaptive Assessment Tools for the Measurement of Posttraumatic Stress Disorder Among US Military Veterans

Key Points

Question

Can rapid psychometrically sound adaptive diagnostic screening and dimensional severity measures be developed for posttraumatic stress disorder?

Findings

In this diagnostic study including 713 US military veterans, the Computerized Adaptive Diagnostic–Posttraumatic Stress Disorder measure was shown to have excellent diagnostic accuracy. The Computerized Adaptive Test–Posttraumatic Stress Disorder also provided valid severity ratings and demonstrated convergent validity with the Post-Traumatic Stress Disorder checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

Meaning

In this study, the Computerized Adaptive Diagnostic–Posttraumatic Stress Disorder and Computerized Adaptive Test–Posttraumatic Stress Disorder measures appeared to provide valid screening diagnoses and severity scores, with substantial reductions in patient and clinician burden.

Abstract

Importance

Veterans from recent and past conflicts have high rates of posttraumatic stress disorder (PTSD). Adaptive testing strategies can increase accuracy of diagnostic screening and symptom severity measurement while decreasing patient and clinician burden.

Objective

To develop and validate a computerized adaptive diagnostic (CAD) screener and computerized adaptive test (CAT) for PTSD symptom severity.

Design, Setting, and Participants

A diagnostic study of measure development and validation was conducted at a Veterans Health Administration facility. A total of 713 US military veterans were included. The study was conducted from April 25, 2017, to November 10, 2019.

Main Outcomes and Measures

The participants completed a PTSD-symptom questionnaire from the item bank and provided responses on the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ( DSM-5) (PCL-5). A subsample of 304 participants were interviewed using the Clinician-Administered Scale for PTSD for DSM-5.

Results

Of the 713 participants, 585 were men; mean (SD) age was 52.8 (15.0) years. The CAD-PTSD reproduced the Clinician-Administered Scale for PTSD for DSM-5 PTSD diagnosis with high sensitivity and specificity as evidenced by an area under the curve of 0.91 (95% CI, 0.87-0.95). The CAT-PTSD demonstrated convergent validity with the PCL-5 ( r = 0.88) and also tracked PTSD diagnosis (area under the curve = 0.85; 95% CI, 0.79-0.89). The CAT-PTSD reproduced the final 203-item bank score with a correlation of r = 0.95 with a mean of only 10 adaptively administered items, a 95% reduction in patient burden.

Conclusions and Relevance

Using a maximum of only 6 items, the CAD-PTSD developed in this study was shown to have excellent diagnostic screening accuracy. Similarly, using a mean of 10 items, the CAT-PTSD provided valid severity ratings with excellent convergent validity with an extant scale containing twice the number of items. The 10-item CAT-PTSD also outperformed the 20-item PCL-5 in terms of diagnostic accuracy. The results suggest that scalable, valid, and rapid PTSD diagnostic screening and severity measurement are possible.

Abstract

This diagnostic study develops and validates a tool for use in diagnostic screening of US military veterans for posttraumatic stress disorder.