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Prevalence of post-traumatic stress disorder and validity of the Impact of Events Scale - Revised in primary care in Zimbabwe, a non-war-affected African country

Melanie A. A. Abas, Monika Muller, Lorna J. J. Gibson, Sarah Derveeuw (UGent) , Nirosha Dissanayake, Patrick Smith, Ruth Verhey, Andrea Danese and Dixon Chibanda
(2023) BJPSYCH OPEN. 9(2).
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Abstract
BackgroundA critical step in research on the epidemiology of post-traumatic stress disorder (PTSD) in low-resource settings is the validation of brief self-reported psychometric tools available in the public domain, such as the Impact Event Scale - Revised (IES-R). AimsWe aimed to investigate the validity of the IES-R in a primary healthcare setting in Harare, Zimbabwe. MethodWe analysed data from a survey of 264 consecutively sampled adults (mean age 38 years; 78% female). We estimated the area under the receiver operating characteristic curve and sensitivity, specificity and likelihood ratios for different cut-off points of the IES-R, against a diagnosis of PTSD made using the Structured Clinical Interview for DSM-IV. We performed factor analysis to evaluate construct validity of the IES-R. ResultsThe prevalence of PTSD was 23.9% (95% CI 18.9-29.5). The area under the curve for the IES-R was 0.90. At a cut-off of >= 47, the sensitivity of the IES-R to detect PTSD was 84.1 (95% CI 72.7-92.1) and specificity was 81.1 (95% CI 75.0-86.3). Positive and negative likelihood ratios were 4.45 and 0.20, respectively. Factor analysis revealed a two-factor solution, with both factors showing good internal consistency (Cronbach's factor-1 alpha = 0.95, factor-2 alpha = 0.76). In a post hoc analysis, we found the brief six-item IES-6 also performed well, with an area under the curve of 0.87 and optimal cut-off of 15. ConclusionsThe IES-R and IES-6 had good psychometric properties and performed well for indicating possible PTSD, but at higher cut-off points than those recommended in the Global North.
Keywords
Global mental health, psychological testing, low- and middle-income, countries, post-traumatic stress disorder, rating scales, IES-R, PSYCHOMETRIC PROPERTIES, PSYCHOLOGICAL DISTRESS, LIFE EVENTS, DEPRESSION, POPULATION, EXPOSURE, ANXIETY, TRAUMA, DSM-5

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MLA
Abas, Melanie A. A., et al. “Prevalence of Post-Traumatic Stress Disorder and Validity of the Impact of Events Scale - Revised in Primary Care in Zimbabwe, a Non-War-Affected African Country.” BJPSYCH OPEN, vol. 9, no. 2, Cambridge Univ. Press, 2023, doi:10.1192/bjo.2022.621.
APA
Abas, M. A. A., Muller, M., Gibson, L. J. J., Derveeuw, S., Dissanayake, N., Smith, P., … Chibanda, D. (2023). Prevalence of post-traumatic stress disorder and validity of the Impact of Events Scale - Revised in primary care in Zimbabwe, a non-war-affected African country. BJPSYCH OPEN, 9(2). https://doi.org/10.1192/bjo.2022.621
Chicago author-date
Abas, Melanie A. A., Monika Muller, Lorna J. J. Gibson, Sarah Derveeuw, Nirosha Dissanayake, Patrick Smith, Ruth Verhey, Andrea Danese, and Dixon Chibanda. 2023. “Prevalence of Post-Traumatic Stress Disorder and Validity of the Impact of Events Scale - Revised in Primary Care in Zimbabwe, a Non-War-Affected African Country.” BJPSYCH OPEN 9 (2). https://doi.org/10.1192/bjo.2022.621.
Chicago author-date (all authors)
Abas, Melanie A. A., Monika Muller, Lorna J. J. Gibson, Sarah Derveeuw, Nirosha Dissanayake, Patrick Smith, Ruth Verhey, Andrea Danese, and Dixon Chibanda. 2023. “Prevalence of Post-Traumatic Stress Disorder and Validity of the Impact of Events Scale - Revised in Primary Care in Zimbabwe, a Non-War-Affected African Country.” BJPSYCH OPEN 9 (2). doi:10.1192/bjo.2022.621.
Vancouver
1.
Abas MAA, Muller M, Gibson LJJ, Derveeuw S, Dissanayake N, Smith P, et al. Prevalence of post-traumatic stress disorder and validity of the Impact of Events Scale - Revised in primary care in Zimbabwe, a non-war-affected African country. BJPSYCH OPEN. 2023;9(2).
IEEE
[1]
M. A. A. Abas et al., “Prevalence of post-traumatic stress disorder and validity of the Impact of Events Scale - Revised in primary care in Zimbabwe, a non-war-affected African country,” BJPSYCH OPEN, vol. 9, no. 2, 2023.
@article{01GX3R4GQZE14F7TRBRS6S170G,
  abstract     = {{BackgroundA critical step in research on the epidemiology of post-traumatic stress disorder (PTSD) in low-resource settings is the validation of brief self-reported psychometric tools available in the public domain, such as the Impact Event Scale - Revised (IES-R). AimsWe aimed to investigate the validity of the IES-R in a primary healthcare setting in Harare, Zimbabwe. MethodWe analysed data from a survey of 264 consecutively sampled adults (mean age 38 years; 78% female). We estimated the area under the receiver operating characteristic curve and sensitivity, specificity and likelihood ratios for different cut-off points of the IES-R, against a diagnosis of PTSD made using the Structured Clinical Interview for DSM-IV. We performed factor analysis to evaluate construct validity of the IES-R. ResultsThe prevalence of PTSD was 23.9% (95% CI 18.9-29.5). The area under the curve for the IES-R was 0.90. At a cut-off of >= 47, the sensitivity of the IES-R to detect PTSD was 84.1 (95% CI 72.7-92.1) and specificity was 81.1 (95% CI 75.0-86.3). Positive and negative likelihood ratios were 4.45 and 0.20, respectively. Factor analysis revealed a two-factor solution, with both factors showing good internal consistency (Cronbach's factor-1 alpha = 0.95, factor-2 alpha = 0.76). In a post hoc analysis, we found the brief six-item IES-6 also performed well, with an area under the curve of 0.87 and optimal cut-off of 15. ConclusionsThe IES-R and IES-6 had good psychometric properties and performed well for indicating possible PTSD, but at higher cut-off points than those recommended in the Global North.}},
  articleno    = {{e37}},
  author       = {{Abas, Melanie A. A. and  Muller, Monika and  Gibson, Lorna J. J. and Derveeuw, Sarah and  Dissanayake, Nirosha and  Smith, Patrick and  Verhey, Ruth and  Danese, Andrea and  Chibanda, Dixon}},
  issn         = {{2056-4724}},
  journal      = {{BJPSYCH OPEN}},
  keywords     = {{Global mental health,psychological testing,low- and middle-income,countries,post-traumatic stress disorder,rating scales,IES-R,PSYCHOMETRIC PROPERTIES,PSYCHOLOGICAL DISTRESS,LIFE EVENTS,DEPRESSION,POPULATION,EXPOSURE,ANXIETY,TRAUMA,DSM-5}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{7}},
  publisher    = {{Cambridge Univ. Press}},
  title        = {{Prevalence of post-traumatic stress disorder and validity of the Impact of Events Scale - Revised in primary care in Zimbabwe, a non-war-affected African country}},
  url          = {{http://doi.org/10.1192/bjo.2022.621}},
  volume       = {{9}},
  year         = {{2023}},
}
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