1. Screening for Post- Traumatic Stress Disorder in Active Duty Women: Utilizing an Evidence- Based Approach Jennifer L. Varney, RN, BSN, ARNP, DNP Family Nurse Practitioner- BC

2. PTSD Definition “the development of behavior symptoms following exposure to a traumatic event or stressor that involves direct personal experience of threatened death, or the perception of death or serious injury, or threat to one’s physical integrity” (1)

3. Overview of the Problem  Women in the military are underdiagnosed with PTSD (10)  PTSD symptoms can occur any time after the traumatic triggering event (1)  Routine screening for PTSD in the military ends at 180 days post-deployment (9)

4. Significance  As of 2012: 300,000 returning military members with mental health issues (6)  Prevalence of PTSD in women veterans estimated at 12% (7)  2 year cost to treat: $40.96 billion  Many co-morbid illnesses associated with chronic PTSD (2)

5. Review of Literature  Need for ongoing screening programs (2,4,5)  Not enough research completed on women veterans (5,6,7,8,12)  Post-Traumatic Checklist (PCL) (3,4,11,12)

6. Screening Tool (PCL)  Most frequent used screening tool (4,5,12)  17-item self-reported questions using a 5 point Likert scale  Psychometric measures: 0.944 sensitivity/ 0.864 specificity (using cut-off score of 50) (11,12)  Tested for validity in women: better sensitivity and specificity using a cut-off score of 38 (12)

7. Population and Setting Population:  Active duty women (any branch)  Past deployment (time frame not relevant) Setting:  Active Duty Air Force Base out-patient clinic in the South  Recruited from the family practice clinic, women’s health clinic, and flight medicine clinic

8. Collection of Data  Participants given screening tool and consent when checking in for appointments  Completed forms scored (positive = 38 or greater)  Mental health referrals offered for scores 38 or higher  Review of previous PCL scores from Post-Deployment Health Assessments (PDHA)

9. Results  31 positive screenings for PTSD (score of 38 or greater)  18 participants agreed to continued evaluation  100% increase in score from base-line PDHA scores

10. Effectiveness  Showed the need for ongoing screening for PTSD  Education of staff  Education of patients  Seek approval for implementation Department of Defense wide

11. References 1.American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. 2.Beckham, J. C., Crawford, A. L., Feldman, M. E., Kirby, A. C., Hertzberg, M. A., Davidson, J. R., & Moore, S. D. (1997). Chronic posttraumatic stress disorder and chronic pain in Vietnam combat veterans. Journal of Psychosomatic Research, 43(4), 379-389. 3.Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A. (1996). Psychometric properties of the PTSD checklist (PCL). Behaviour Research and Therapy, 34(8), 669-673. 4.Bliese, P. D., Wright, K. M., Adler, A. B., Castro, C. A., Hoge, C. W., & Cabrera, O. (2008). Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat. Journal of Consulting and Clinical Psychology, 76(2), 272-281. 5.Dobie, D. J., Kivlahan, D. R., Maynard, C., Bush, K. R., McFall, M., Epler, A. J., & Bradley, K. A. (2002). Screening for post-traumatic stress disorder in female Veteran's Affairs patients: Validation of the PTSD checklist. General Hospital Psychiatry, 24, 367-374.

12. References 6.Duma, S. J., Reger, M. A., Canning, S. S., McNeil, J. D., & Gahm, G. A. (2010). Longitudinal mental health screening results among postdeployed U.S. soldiers preparing to deploy again. Journal of Traumatic Stress, 23(1), 52-58. 7.Goldzweig, C. L., Balekian, T. M., Rolon, C., Yano, E. M., & Shekelle, P. G. (2006). The state of women veterans' health research. Journal of General Internal Medicine, 1, 82-92. doi:10.1111/j.1225-1497.2006.00380.x 8.Lang, A. J., Laffaye, C., Satz, L. E., Dresselhaus, T. R., & Stein, M. B. (2003). Sensitivity and specificity of the PTSD checklist in detecting PTSD in female veterans in primary care. Journal of Traumatic Stress, 16(3), 257-264. 9.McCarthy, M. D., Thompson, S. J., & Knox, K. L. (2012). Use of the Air Force post-deployment health reassessment for the identification of depression and posttraumatic stress disorder: Public health implications for suicide prevention. American Journal of Public Health, 102(S1), S60-S65. 10.Pereira, A. (2002). Combat trauma and the diagnosis of post-traumatic stress disorder in female and male veterans. Military Medicine, 167, 23-28. 11.Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD checklist: Reliability, validity, and diagnostic utility. Annual Meeting of the International Society for Traumatic Stress Studies, San Antonio, TX, October. 12.Zlotnick, C., Zimmerman, M., Wolfsdorf, B. A., & Mattia, J. L. (2001). Gender differences in patients with posttraumatic stress disorder in a general psychiatric practice. The American Journal of Psychiatry, 155, 1923-1925.