Narrowing the focus on the assessment of psychosis-related PTSD: a methodologically orientated systematic review

Abstract

BackgroundPosttraumatic stress disorder (PTSD) in response to psychosis and associated experiences (psychosis-related PTSD, or PR-PTSD) is the subject of a growing field of research. However, a wide range of PR-PTSD prevalence rates has been reported. This may be due to definitional and methodological inconsistencies in the assessment of PR-PTSD.ObjectiveThe focus of the review is two-fold. (1) To identify factors that enhance, or detract from, the robustness of PR-PTSD assessment and (2) to critically evaluate the evidence in relation to these identified criteria, including the impact on PR-PTSD prevalence rates.MethodFour quality criteria, whose development was informed by mainstream PTSD research, were selected to evaluate findings on PR-PTSD prevalence. Two criteria related to assessment of psychosis-related stressors (participant identification of worst moments of discrete threat events; psychometrically robust trauma measure) and two focussed on PR-PTSD symptom measurement (adequate time elapsed since trauma; use of validated PTSD interview) in the context of psychosis.ResultsTwenty-one studies of PR-PTSD, with prevalence rates ranging from 11 to 51%, were evaluated. Fourteen studies (67%) used robust PTSD measures but PR-trauma was not specifically defined or assessed with validated measures. Eleven studies (52%) assessed PTSD before sufficient time had elapsed since the trauma. Due to significant methodological limitations, it was not possible to review PR-PTSD rates and provide a revised estimate of prevalence.ConclusionsMethodological limitations are common in existing studies of PR-PTSD prevalence. Specific recommendations for improving assessment of psychosis-related trauma are made to guide the development of this new and emerging field. The review concludes with a proposed conceptualisation of PR-PTSD in the context of current diagnostic systems. The utility of the PR-PTSD term and its theoretical underpinnings are discussed.Highlights of the articleOverall, robust measures of PTSD were employed but psychosis-related trauma was not specifically defined and time since trauma was not consistently recordedGiven the above methodological limitations in the assessment of PR-PTSD, a revised prevalence rate is not providedA new conceptualisation of PR-PTSD in relation to the type of stressor is proposed in the context of current diagnostic systems

Neglected causes of post-traumatic stress disorder

“…People with the delusion that others are trying to kill them, for example, might experience PTSD symptoms such as intrusive memories, flashbacks, and nightmares related to episodes when they thought that they were about to be attacked. That the experience of psychosis itself can be traumatic has been known for at least 30 years,2 and in recognition of this an informal category of “psychosis related PTSD” has been proposed by researchers 34…”

A systematic review of PTSD to the experience of Psychosis: Prevalence and associated factors

“…Our review and both previous reviews found wide variations in reported prevalence rates. In our narrative synthesis we examined differences in the conceptualisation, de nition and assessment of psychosis-related PTSD between the included studies and it is likely that these factors can provide some explanation for variations in prevalence rates across all three reviews (20). Other factors such as differences in participant populations, in the amount of cumulative exposure to traumatic psychosis and in service provision experienced, may also account for the wide variations in prevalence rates between studies across all three reviews.…”

“…We adapted a quality assessment tool because we could not nd a more appropriate, validated tool for this review. This could have been further adapted to include some factors speci cally relevant to the assessment of PTSD, such as whether su cient amount of time had lapsed since traumatic event for a diagnosis of PTSD (20). However, the tool we used was utilised in a similar adapted form in previous studies (15).…”

“…Anxiety and depression were identi ed as potential risk factors but again the evidence for this was generally weak. The reported prevalence rates from both previous reviews vary widely (11-67%); arguments for such variation have focussed on methodological inconsistencies in assessing psychosis-related PTSD such as measurement tools used and de nitions of psychosis-related PTSD (20).…”

The Trauma and Life Events (TALE) checklist: development of a tool for improving routine screening in people with psychosis

“…A second problem is that psychosis-related traumas, such as hearing voices or involuntary hospitalization, are rarely incorporated in assessments, despite evidence that internally generated, physical threats or external, psychological threats can result in posttraumatic stress (Berry, Ford, Jellico-Jones, & Haddock, 2013; Fornells-Ambrojo, Gracie, Brewin, & Hardy, 2016). Any robust assessment of trauma in psychosis needs to include these events.…”