Screening for posttraumatic stress disorder in ARDS survivors: validation of the Impact of Event Scale-6 (IES-6)

doi:10.1186/s13054-019-2553-z

Multicenter Study

. 2019 Aug 7;23(1):276.

doi: 10.1186/s13054-019-2553-z.

Screening for posttraumatic stress disorder in ARDS survivors: validation of the Impact of Event Scale-6 (IES-6)

Megan M Hosey^{1

2}, Jeannie-Marie S Leoutsakos³, Ximin Li⁴, Victor D Dinglas^{5

2}, O Joseph Bienvenu^{3

2}, Ann M Parker^{5

2}, Ramona O Hopkins^{6

7

8}, Dale M Needham^{9

10

11}, Karin J Neufeld^{3

2}

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA.
² Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins School of Medicine, Baltimore, MD, USA.
³ Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁴ Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁵ Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁶ Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, UT, USA.
⁷ Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT, USA.
⁸ Neuroscience Center and Psychology Department, Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT, USA.
⁹ Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA. Dale.needham@jhmi.edu.
¹⁰ Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. Dale.needham@jhmi.edu.
¹¹ Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins School of Medicine, Baltimore, MD, USA. Dale.needham@jhmi.edu.

PMID: 31391069
PMCID: PMC6686474
DOI: 10.1186/s13054-019-2553-z

Multicenter Study

Screening for posttraumatic stress disorder in ARDS survivors: validation of the Impact of Event Scale-6 (IES-6)

Megan M Hosey et al. Crit Care. 2019.

. 2019 Aug 7;23(1):276.

doi: 10.1186/s13054-019-2553-z.

Authors

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA.
² Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins School of Medicine, Baltimore, MD, USA.
³ Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁴ Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁵ Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁶ Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, UT, USA.
⁷ Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT, USA.
⁸ Neuroscience Center and Psychology Department, Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT, USA.
⁹ Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA. Dale.needham@jhmi.edu.
¹⁰ Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. Dale.needham@jhmi.edu.
¹¹ Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins School of Medicine, Baltimore, MD, USA. Dale.needham@jhmi.edu.

PMID: 31391069
PMCID: PMC6686474
DOI: 10.1186/s13054-019-2553-z

Erratum in

Correction to: Screening for posttraumatic stress disorder in ARDS survivors: validation of the impact of event Scale-6 (IES-6).
Hosey MM, Leoutsakos JS, Li X, Dinglas VD, Bienvenu OJ, Parker AM, Hopkins RO, Needham DM, Neufeld KJ. Hosey MM, et al. Crit Care. 2020 Feb 4;24(1):37. doi: 10.1186/s13054-020-2759-0. Crit Care. 2020. PMID: 32019601 Free PMC article.

Abstract

Background: Posttraumatic stress disorder (PTSD) symptoms are common in acute respiratory distress syndrome (ARDS) survivors. Brief screening instruments are needed for clinical and research purposes. We evaluated internal consistency, external construct, and criterion validity of the Impact of Event Scale-6 (IES-6; 6 items) compared to the original Impact of Event Scale-Revised (IES-R; 22 items) and to the Clinician Administered PTSD Scale (CAPS) reference standard evaluation in ARDS survivors.

Methods: This study is a secondary analysis from two independent multi-site, prospective studies of ARDS survivors. Measures of internal consistency, and external construct and criterion validity were evaluated.

Results: A total of 1001 ARDS survivors (51% female, 76% white, mean (SD) age 49 (14) years) were evaluated. The IES-6 demonstrated internal consistency over multiple time points up to 5 years after ARDS (Cronbach’s alpha = 0.86 to 0.91) and high correlation with the IES-R (0.96; 95% confidence interval (CI): 0.94 to 0.97). The IES-6 demonstrated stronger correlations with related constructs (e.g., anxiety and depression; |r| = 0.32 to 0.52) and weaker correlations with unrelated constructs (e.g., physical function and healthcare utilization measures (|r| = 0.02 to 0.27). Criterion validity evaluation with the CAPS diagnosis of PTSD in a subsample of 60 participants yielded an area under receiver operating characteristic curve (95% CI) of 0.93 (0.86, 1.00), with an IES-6 cutoff score of 1.75 yielding 0.88 sensitivity and 0.85 specificity.

Conclusions: The IES-6 is reliable and valid for screening for PTSD in ARDS survivors and may be useful in clinical and research settings.

Keywords: Critical care; Mental health; Posttraumatic stress disorder; Psychometric; Survivorship; Validation studies.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Receiver operating curve for IES-6 versus CAPS for DSM-IV Diagnosis of PTSD (posttraumatic stress disorder); area under the curve (95% confidence interval) = 0.93 (0.86, 1.00); Based on n = 60 (13% with PTSD at time of interview, 26% ever experiencing PTSD post-ARDS). Optimal cut-off score for IES-6 is 1.75

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Comment in

What is the best core measure after critical illness when the IES-R is no longer accessible for new researchers?
Umberger R. Umberger R. Crit Care. 2019 Sep 13;23(1):313. doi: 10.1186/s13054-019-2595-2. Crit Care. 2019. PMID: 31519218 Free PMC article. No abstract available.

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References

1. Bienvenu OJ, Friedman LA, Colantuoni E, Dinglas VD, Sepulveda KA, Mendez-Tellez P, et al. Psychiatric symptoms after acute respiratory distress syndrome: a 5-year longitudinal study. Intensive Care Med. 2018;44:38–47. doi: 10.1007/s00134-017-5009-4. - DOI - PMC - PubMed
1. Jackson JC, Jutte JE, Hunter CH, Ciccolella N, Warrington H, Sevin C, et al. Posttraumatic stress disorder (PTSD) after critical illness: a conceptual review of distinct clinical issues and their implications. Rehabil Psychol. 2016;61:132. doi: 10.1037/rep0000085. - DOI - PubMed
1. Bienvenu OJ, Gellar J, Althouse BM, Colantuoni E, Sricharoenchai T, Mendez-Tellez PA, et al. Post-traumatic stress disorder symptoms after acute lung injury: a 2-year prospective longitudinal study. Psychol Med. 2013;43:2657–2671. doi: 10.1017/S0033291713000214. - DOI - PMC - PubMed
1. Parker AM, Sricharoenchai T, Raparla S, Schneck KW, Bienvenu OJ, Needham DM. Posttraumatic stress disorder in critical illness survivors: a metaanalysis. Crit Care Med. 2015;43:1121–1129. doi: 10.1097/CCM.0000000000000882. - DOI - PubMed
1. Jackson JC, Pandharipande PP, Girard TD, Brummel NE, Thompson JL, Hughes CG, et al. Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: a longitudinal cohort study. Lancet RespirMed. 2014;2:369–379. doi: 10.1016/S2213-2600(14)70051-7. - DOI - PMC - PubMed

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[1] Bienvenu OJ, Friedman LA, Colantuoni E, Dinglas VD, Sepulveda KA, Mendez-Tellez P, et al. Psychiatric symptoms after acute respiratory distress syndrome: a 5-year longitudinal study. Intensive Care Med. 2018;44:38–47. doi: 10.1007/s00134-017-5009-4. - DOI - PMC - PubMed

[2] Bienvenu OJ, Friedman LA, Colantuoni E, Dinglas VD, Sepulveda KA, Mendez-Tellez P, et al. Psychiatric symptoms after acute respiratory distress syndrome: a 5-year longitudinal study. Intensive Care Med. 2018;44:38–47. doi: 10.1007/s00134-017-5009-4. - DOI - PMC - PubMed

[3] Jackson JC, Jutte JE, Hunter CH, Ciccolella N, Warrington H, Sevin C, et al. Posttraumatic stress disorder (PTSD) after critical illness: a conceptual review of distinct clinical issues and their implications. Rehabil Psychol. 2016;61:132. doi: 10.1037/rep0000085. - DOI - PubMed

[4] Jackson JC, Jutte JE, Hunter CH, Ciccolella N, Warrington H, Sevin C, et al. Posttraumatic stress disorder (PTSD) after critical illness: a conceptual review of distinct clinical issues and their implications. Rehabil Psychol. 2016;61:132. doi: 10.1037/rep0000085. - DOI - PubMed

[5] Bienvenu OJ, Gellar J, Althouse BM, Colantuoni E, Sricharoenchai T, Mendez-Tellez PA, et al. Post-traumatic stress disorder symptoms after acute lung injury: a 2-year prospective longitudinal study. Psychol Med. 2013;43:2657–2671. doi: 10.1017/S0033291713000214. - DOI - PMC - PubMed

[6] Bienvenu OJ, Gellar J, Althouse BM, Colantuoni E, Sricharoenchai T, Mendez-Tellez PA, et al. Post-traumatic stress disorder symptoms after acute lung injury: a 2-year prospective longitudinal study. Psychol Med. 2013;43:2657–2671. doi: 10.1017/S0033291713000214. - DOI - PMC - PubMed

[7] Parker AM, Sricharoenchai T, Raparla S, Schneck KW, Bienvenu OJ, Needham DM. Posttraumatic stress disorder in critical illness survivors: a metaanalysis. Crit Care Med. 2015;43:1121–1129. doi: 10.1097/CCM.0000000000000882. - DOI - PubMed

[8] Parker AM, Sricharoenchai T, Raparla S, Schneck KW, Bienvenu OJ, Needham DM. Posttraumatic stress disorder in critical illness survivors: a metaanalysis. Crit Care Med. 2015;43:1121–1129. doi: 10.1097/CCM.0000000000000882. - DOI - PubMed

[9] Jackson JC, Pandharipande PP, Girard TD, Brummel NE, Thompson JL, Hughes CG, et al. Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: a longitudinal cohort study. Lancet RespirMed. 2014;2:369–379. doi: 10.1016/S2213-2600(14)70051-7. - DOI - PMC - PubMed

[10] Jackson JC, Pandharipande PP, Girard TD, Brummel NE, Thompson JL, Hughes CG, et al. Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: a longitudinal cohort study. Lancet RespirMed. 2014;2:369–379. doi: 10.1016/S2213-2600(14)70051-7. - DOI - PMC - PubMed

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Screening for posttraumatic stress disorder in ARDS survivors: validation of the Impact of Event Scale-6 (IES-6)

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Screening for posttraumatic stress disorder in ARDS survivors: validation of the Impact of Event Scale-6 (IES-6)

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