Self-reported versus clinician-evaluated symptom assessment and diagnosis of ICD-11 PTSD and CPTSD: a comparison between the International Trauma Interview and the International Trauma Questionnaire.
The ITQ can effectively screen for trauma-related psychopathology, but it should not replace comprehensive clinical interviews for diagnosing PTSD or CPTSD.
Where it sits
this study against the rest of the zenagamtide corpusSummary and findings
This study compared self-reported symptoms using the International Trauma Questionnaire (ITQ) with clinician evaluations using the International Trauma Interview (ITI) in a sample of 108 Danish veterans. The ITQ consistently reported higher symptom scores than the ITI, with varying levels of agreement for specific diagnoses. The findings indicate that while the ITQ may be useful for screening, it should not be solely relied upon for diagnosis.
Abstract
<b>Background:</b> The ICD-11 introduced distinct criteria for Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD), necessitating validated assessment tools. While the International Trauma Questionnaire (ITQ) is a widely used self-report measure, the International Trauma Interview (ITI) is a structured clinician-administered interview considered a gold standard. This study investigated the correspondence between ITQ and ITI symptom and diagnostic classifications in a treatment-seeking veteran population.<b>Methods:</b> A sample of 108 Danish veterans completed both the ITQ and ITI. We calculated descriptive statistics, bivariate correlations, and Cohen's <i>κ</i> values to assess agreement for individual symptom items and diagnostic categories (ICD-11 PTSD, CPTSD, and PTSD or CPTSD combined), using the ITI as the reference standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were also determined.<b>Results:</b> ITQ scores were consistently higher than ITI scores across all symptom domains. Total symptom scores for PTSD, DSO, and CPTSD showed strong associations between instruments (<i>r</i> = .74 to .82, all <i>p</i> < .001). Agreement for individual symptom items varied from fair to substantial (<i>κ</i> = .33 to .70). The combined diagnosis of PTSD or CPTSD showed moderate agreement (<i>κ</i> = .60) with high sensitivity (0.94) and PPV (0.90). However, agreement for ICD-11 PTSD alone was fair (<i>κ</i> = .38), with low PPV (0.39) despite good sensitivity (0.65).<b>Conclusion:</b> The ITQ consistently reported higher symptom endorsement than the ITI. While the ITQ shows strong convergent validity for overall symptom burden and high sensitivity for screening trauma-related psychopathology (PTSD or CPTSD combined), its limited agreement for standalone ICD-11 PTSD diagnosis suggests it should not be used as a sole diagnostic tool. Comprehensive clinical interviews remain crucial for definitive diagnosis, while the ITQ can serve as an effective screening instrument.
Background
This paper addresses the need for validated assessment tools for Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD) following the introduction of ICD-11 criteria. Prior research has established the ITI as a gold standard clinician-administered interview, while the ITQ serves as a self-report measure. Understanding the correspondence between these tools is crucial for accurate diagnosis and treatment planning in veteran populations.
Methods
The study utilized a comparative design involving 108 Danish veterans who completed both the ITQ and ITI. Descriptive statistics, bivariate correlations, and Cohen's κ values were calculated to assess agreement for individual symptom items and diagnostic categories. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were also determined.
Results
The primary finding indicates that total symptom scores for PTSD, DSO, and CPTSD showed strong associations between instruments (r = .74 to .82, all p < .001). The agreement for individual symptom items varied from fair to substantial (κ = .33 to .70). The combined diagnosis of PTSD or CPTSD showed moderate agreement (κ = .60) with high sensitivity (0.94) and PPV (0.90). However, the agreement for ICD-11 PTSD alone was fair (κ = .38), with low PPV (0.39) despite good sensitivity (0.65).
Interpretation
The findings suggest that while the ITQ demonstrates strong convergent validity for overall symptom burden and high sensitivity for screening PTSD or CPTSD, its limited agreement for standalone ICD-11 PTSD diagnosis raises concerns about its use as a sole diagnostic tool. This contrasts with prior literature emphasizing the importance of comprehensive clinical interviews for definitive diagnosis. The small sample size and reliance on self-reported measures may confound the results, indicating a need for further research.
Key findings
- Total symptom scores for PTSD, DSO, and CPTSD showed strong associations between instruments (r = .74 to .82, all p < .001).
- Agreement for individual symptom items varied from fair to substantial (κ = .33 to .70).
- The combined diagnosis of PTSD or CPTSD showed moderate agreement (κ = .60) with high sensitivity (0.94) and PPV (0.90).
- Agreement for ICD-11 PTSD alone was fair (κ = .38), with low PPV (0.39) despite good sensitivity (0.65).
Limitations
- small n=108 veteran sample
- self-reported measures may introduce bias
- limited generalizability due to sample characteristics
- no long-term follow-up data reported