Defining a screening tool for post-traumatic stress disorder in East Africa: a penalized regression approach - PubMed (original) (raw)
. 2024 Jun 13:12:1383171.
doi: 10.3389/fpubh.2024.1383171. eCollection 2024.
Muthoni A Mathai 2, Linnet Ongeri 3, Thomas C Neylan 1, Daniel Mwai 4, Dickens Onyango 5, Dickens Akena 6, Grace Rota 6, Ammon Otieno 6, Raymond R Obura 7, Josline Wangia 8, Elizabeth Opiyo 8, Peter Muchembre 7, Dennis Oluoch 7, Raphael Wambura 5, Anne Mbwayo 2, James G Kahn 9 10, Craig R Cohen 11, David E Bukusi 2, Gregory A Aarons 12, Rachel L Burger 1, Chengshi Jin 10, Charles E McCulloch 10, Simon Njuguna Kahonge 13
Affiliations
- PMID: 38947359
- PMCID: PMC11211862
- DOI: 10.3389/fpubh.2024.1383171
Defining a screening tool for post-traumatic stress disorder in East Africa: a penalized regression approach
Susan M Meffert et al. Front Public Health. 2024.
Abstract
Background: Scalable PTSD screening strategies must be brief, accurate and capable of administration by a non-specialized workforce.
Methods: We used PTSD as determined by the structured clinical interview as our gold standard and considered predictors sets of (a) Posttraumatic Stress Checklist-5 (PCL-5), (b) Primary Care PTSD Screen for the DSM-5 (PC-PTSD) and, (c) PCL-5 and PC-PTSD questions to identify the optimal items for PTSD screening for public sector settings in Kenya. A logistic regression model using LASSO was fit by minimizing the average squared error in the validation data. Area under the receiver operating characteristic curve (AUROC) measured discrimination performance.
Results: Penalized regression analysis suggested a screening tool that sums the Likert scale values of two PCL-5 questions-intrusive thoughts of the stressful experience (#1) and insomnia (#21). This had an AUROC of 0.85 (using hold-out test data) for predicting PTSD as evaluated by the MINI, which outperformed the PC-PTSD. The AUROC was similar in subgroups defined by age, sex, and number of categories of trauma experienced (all AUROCs>0.83) except those with no trauma history- AUROC was 0.78.
Conclusion: In some East African settings, a 2-item PTSD screening tool may outperform longer screeners and is easily scaled by a non-specialist workforce.
Keywords: East Africa (Kenya); low and middle income countries (LMIC); posttraumatic stress disorder (PTSD); primary care; screening tools; sub Saharan Africa; traumatic stress.
Copyright © 2024 Meffert, Mathai, Ongeri, Neylan, Mwai, Onyango, Akena, Rota, Otieno, Obura, Wangia, Opiyo, Muchembre, Oluoch, Wambura, Mbwayo, Kahn, Cohen, Bukusi, Aarons, Burger, Jin, McCulloch and Njuguna Kahonge.
Conflict of interest statement
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Figures
Figure 1
Averaged squared error vs. number of questions included in the LASSSo fit. (A) for the PC-PTSD questions only (B) for the PCL questions only. (C) for the combined PCL and PC-PTSD questions.
References
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