Evaluation of the Self-reported Questionnaires used to Assess Mental Health After the January 2015 Terrorist Attacks in the Paris Region: IMPACTS Survey

Abstract

Background: Gold standard measures in mental health are composed of structured clinical interviews. The design of a study could impede using gold standard measures. Several self-report questionnaires are then used to screen for a number of psychiatric symptoms. Therefore, the need to understand which among those would be most appropriate to be applied after terrorism. The present study examined the performance of self-report questionnaires used to assess post-traumatic stress disorder (PCL-S) and symptoms of depression and anxiety (HADS) compared to the MINI among civilians and first responders involved in terror attacks. Methods: This study was based on the data from the IMPACTS Survey conducted from 6 to10 months among civilians (N=190) and first responders (N=232) after the January 2015 terrorist attacks in the Paris Region, France. Sensitivity and specificity of the PCL-S and HADS were estimated by the ROC curve. The optimal threshold for each of the questionnaires was defined using the Youden index. The area under the curve was determined to assess the ability of the instruments to diagnose or score the proposed disorders. Results: Data of 190 civilians and 232 first responders were used to assess the performance of PCL-S and HADS. Concerning the PCL-S: for civilians, the overall AUC was 0.947, and the optimal threshold was 38.5; for first responders, the overall AUC was 0.899, and the optimal threshold was 39.5. Regarding the HADS-D: for civilians, the overall AUC was 0.908 and optimal threshold was 7.5; for first responders, the overall AUC was 0.617 and the “optimal” threshold was 1.5. About the HADS-A for civilians, the overall AUC was 0.823 and the optimal threshold was 9.5; for first responders, the overall AUC was 0.717 and the optimal threshold was 6.5. Conclusions: Our findings demonstrated a satisfactory performance of the PCL-S and the HAD-D to screen for PTSD or depression (respectively) compared to the MINI, and an unsatisfactory performance of the HAD-A to assess anxiety disorders compared to the MINI. It would be interesting if the study were replicated in other countries and in different types of disaster.