A systematic review of the diagnostic accuracy of the PTSD Checklist for DSM-5 (PCL-5), and an empirical study on the impact of complex post- traumatic stress disorder on postnatal bonding

Cann, Adam Joshua 2023. A systematic review of the diagnostic accuracy of the PTSD Checklist for DSM-5 (PCL-5), and an empirical study on the impact of complex post- traumatic stress disorder on postnatal bonding. ClinPsy Thesis, Cardiff University. Item availability restricted.

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Abstract

Paper 1 is a systematic review of the PTSD Checklist for DSM-5 (PCL-5), a 20-item self-report questionnaire widely used to screen for probable PTSD diagnosis in clinical and research settings. PTSD is a common mental health problem that can develop following exposure to a traumatic event. Symptoms of PTSD cause people to relive the traumatic event in flashbacks or dreams; to feel fearful, anxious or shameful; think negatively about themselves; and avoid reminders of the trauma. Self-report questionnaires allow clinicians and researchers to screen for probable diagnosis - which is of use in clinical assessment, treatment evaluation and the estimation of prevalence within research samples. The accuracy of self-report measures is dependent on identifying an appropriate threshold or ‘cut-off’ score. Existing PCL-5 scoring guidance published by the National Centre for PTSD suggest thresholds of 31- 33. This review sought to investigate the diagnostic test accuracy of the PCL-5 following the methodology described by the Cochrane Collaboration. Seventeen studies were identified as eligible for meta-analysis. Sensitivity and specificity values across a range of thresholds were entered into a meta-analytic multiple thresholds mixed effects model to estimate an optimal overall threshold (i.e. the highest combined sensitivity and specificity). Sub-group analyses were performed for veteran and outpatient samples. The model produced an optimal threshold of 36, with sub-group analyses producing varied thresholds for veteran (44) and outpatient (42) samples, higher than the most commonly recommended cut-off scores. Studies included in subgroup analyses attracted low risk of bias and applicability concerns on the QUADAS-2 quality appraisal tool, with high risk of bias associated to studies screening high risk populations. The PCL-5 is an accurate and time efficient measure of PTSD with a range of thresholds for specific populations. Paper 2 is an empirical study examining the impact of post- traumatic stress disorder (PTSD), complex post- traumatic stress disorder (CPTSD) and depression on postnatal bonding. Mother- infant bonding in the postnatal period is the early emotional connection felt by the mother towards the infant. Depression and Post-Traumatic Stress Disorder (PTSD) have been associated with impaired bonding, however no studies examining the impact of Complex PTSD on bonding have been published. Complex PTSD consists of both core PTSD symptoms and disturbance of self-organisation (DSO) symptoms. Complex PTSD has all the core symptoms of PTSD, alongside a cluster of symptoms known as disturbance of self-organisation (DSO). The core symptoms of ICD-11 PTSD are strong intrusive memories in which the sufferer re-experiences the trauma, fearfulness, hypervigilance and avoidance. DSO symptoms include problems in maintaining relationships, struggling to manage emotions and holding a negative view of oneself. CPTSD is thought to be associated with long-term interpersonal trauma – such as repeated physical, psychological or sexual abuse by a trusted person. This study asked perinatal women, who have given birth in the last 12-18 months, to complete self-report measures to assess CPTSD, PTSD, depression and postnatal bonding difficulties. It was found that people with clinical CPTSD and DSO-only symptoms reported poorer bonding with their infants than those from the ‘no trauma disorder’ group. Unexpectedly, PTSD and the no trauma disorder group were not significantly different on bonding. Those with CPTSD scored significantly higher on bonding difficulties than those with PTSD. An analysis was then completed to test a model in which PTSD and DSO symptoms impact bonding, mediated by depression (i.e. the extent to which PTSD and DSO symptoms impact bonding is dependent on depression symptoms). Increased DSO symptoms had significant direct effects elevating bonding difficulties and indirect effects via depressive symptoms. Elevated PTSD symptoms predicted decreased postnatal bonding difficulties. It has been suggested that this may be because mothers with PTSD symptoms attempt to compensate for their concerns about bonding by, for example, seeking to be close to their infants. DSO and depression scores were also shown to covary. The findings of this study suggest the importance of detecting and examining the impacts of DSO symptoms in further research, symptoms are likely to cause unique impacts on bonding and require specific interventions in the perinatal period. It is also suggested that other studies of PTSD, and CPTSD, and postnatal bonding should consider assessing the specific impact of DSO symptoms. This is particularly important as previous criteria for PTSD (e.g. DSM-5) includes DSO-like symptoms, but this is not separated in previous studies on postnatal bonding.

Item Type:	Thesis (DClinPsy)
Date Type:	Completion
Status:	Unpublished
Schools:	Psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Date of First Compliant Deposit:	3 November 2023
Last Modified:	03 Nov 2024 02:30
URI:	https://orca.cardiff.ac.uk/id/eprint/163649

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