A Turkish version of the UCLA PTSD Reaction Index for DSM-5 distinguished adolescents with clinician-diagnosed post-traumatic stress disorder (PTSD) from trauma-exposed teens without the diagnosis in a clinic study from Izmir.
The study included 157 adolescents ages 11 to 17 who had experienced at least one traumatic event. Clinicians used the PTSD section of the K-SADS to diagnose PTSD; 88 participants had PTSD and 69 did not.
A higher cutoff performed best in this clinic sample
The teens with PTSD had an average questionnaire score of 59.1 out of 80, compared with 33.9 among those without PTSD. The difference was 25.2 points, with a 95% confidence interval of 20.8 to 29.6.
Across possible thresholds, the questionnaire’s total score had an area under the receiver operating characteristic curve of 0.909. The researchers identified 49.5 out of 80 as the best cutoff in this group. At that threshold, sensitivity was 86.4% and specificity was 84.1%.
The original guide uses a cutoff of 35. The researchers suggest that applying that lower threshold to Turkish adolescents could classify too many as likely to have PTSD. However, the 49.5 cutoff was selected and tested in the same 157 participants, so its performance needs to be examined in a new group.
What the questionnaire measures
The UCLA PTSD Reaction Index includes a trauma-history section, a 27-item symptom scale scored from 0 to 4 over the previous month, and questions about distress and difficulties at home, school, with peers and in developmental progress.
Its symptom sections cover intrusion, avoidance, negative thoughts and mood, and arousal and reactivity. Four additional items assess dissociation. Using DSM-5 symptom rules rather than a total-score cutoff identified 80.6% of PTSD cases and correctly cleared 78.2% of teens without PTSD.
The questionnaire is intended as a screening and severity measure. The fact sheet states that diagnosis still depends on a clinician’s full evaluation, ideally including a structured interview.
Scores were linked with daily functioning
Higher total scores were associated with more reported difficulties in daily life. For every 10-point increase, the odds were approximately 2.5 times higher for developmental problems, 2.2 times higher for problems at home, twice as high for peer problems and 1.8 times higher for school problems.
These findings describe associations measured at the same visit, not evidence that PTSD symptoms caused the difficulties. Negative thoughts and mood were linked to peer and developmental problems, while arousal and reactivity were linked to home and school problems. Avoidance was linked to problems at home. Intrusion was not independently linked to any of the four impairment areas after all symptom groups were considered together.
Who took part in the study
The sample was 84% female, with 132 girls participating. Sexual abuse by someone outside the family was the most common reported index event, affecting 107 teens, or 68% of the sample. Eighty-eight percent were direct victims rather than witnesses.
Self-harm was reported by 14 of the 88 teens with PTSD and by none of the 69 teens without PTSD. Major depression was reported in 42.0% of the PTSD group and 4.3% of the group without PTSD.
These characteristics matter when considering how the results might apply elsewhere. The study took place in a child and adolescent psychiatry clinic, more than half of participants had PTSD, and the sample was mostly female and largely affected by one type of trauma. Accuracy may differ in schools or community screening.
Reliability findings were mixed across symptom groups
Internal consistency for the symptom groups ranged from a Cronbach’s alpha of 0.774 to 0.931, although avoidance was lower at 0.651. Among 30 adolescents who completed the questionnaire again after two weeks, total scores were fairly stable, with an intraclass correlation coefficient of 0.707.
Stability was more limited for individual areas: the intrusion and dissociation sections had intraclass correlation coefficients of 0.483 and 0.436. The fact sheet notes that intrusion symptoms may change with recent reminders and that clinicians should consider total and group scores rather than changes in single items.
Total scores correlated strongly with a separate PTSD severity scale, with a Spearman correlation of 0.750. Dissociation items had a moderate correlation of 0.547 with a separate dissociation scale. A five-factor model comprising the four DSM-5 symptom groups and dissociation fit the data well on most standard measures.
Why the cutoff requires further testing
An earlier Turkish clinic study involving 208 children and adolescents reported an area under the curve of 0.94 among the 64 participants who received a diagnostic interview. In that study, a cutoff of 35 had 96% sensitivity and 75% specificity.
The differing thresholds illustrate why questionnaire performance depends on the population and setting. The newer study offers evidence for evaluating a higher cutoff in this particular clinic sample, but it does not establish that 49.5 will perform the same way in schools, community programs or groups with different trauma histories.
AI tools were used to assist with the preparation of this article under our editorial standards.
Leave a Reply