|Year : 2022 | Volume
| Issue : 5 | Page : 27-30
Mini international neuropsychiatry interview kid or child posttraumatic stress disorder symptom scale 5I for posttraumatic stress disorder among adolescent girls infected with COVID-19
Anandu Suresh1, Sindhu Shankar1, Pradeep Tarikere Satyanarayana2
1 Postgraduates, Department of Community Medicine, SDUMC, SDUAHER, Kolar, Karnataka, India
2 Assistant Professor, Department of Community Medicine, SDUMC, SDUAHER, Kolar, Karnataka, India
|Date of Submission||09-Aug-2022|
|Date of Decision||11-Aug-2022|
|Date of Acceptance||19-Aug-2022|
|Date of Web Publication||11-Nov-2022|
Pradeep Tarikere Satyanarayana
Assistant Professor, Department of Community Medicine, SDUMC, SDUAHER, Tamaka, Kolar, Karnataka
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Posttraumatic stress disorder (PTSD) is a mental disorder that may develop after exposure to exceptionally life threatening or horrifying events. People suffering from PTSD are vulnerable for both physical and mental health. Objectives: To find out sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and to plot receiver operating characteristic curve taking Mini International Neuropsychiatry Interview-Kid (MINIKID) as the gold standard and Child PTSD Symptom Scale 5I (CPSS-5I) as the newer diagnostic tool for diagnosing PTSD. Materials and Methods: The cross-sectional study was carried out for a period of 6 months from January 2021 to June 2021 at R. L. Jalappa Hospital and Research Center, Kolar, Karnataka through telephonic interviews. All the data entered in Microsoft office Excel sheet, analyzed using the SPSSv22 (IBM Corp). Results: Sensitivity of the CPSS-5I was 56% and specificity was 96% compared with MINIKID. 83% and 85%, respectively, was PPV and NPV of the CPSS-5I compared with MINIKID. Area under the curve is 83.9% with P < 0.001 (72.5–95.2) indicating CPSS-5I is 84% sensitive proving to be a very good diagnostic tool for diagnosing PTSD. Furthermore, scores of 9.5 or 10.5 from CPSS-5I can be used as cutoff in diagnosing PTSD using CPSS 51. Conclusion: CPSS-5I is extremely well designed, helpful and functional tool used in diagnosing PTSD. With the current study showing CPSS-5I can be used in post-COVID PTSD diagnosis, it also provides cutoff which can be helpful in mass screening.
Keywords: Child PTSD Symptom Scale 5I, Mini International Neuropsychiatry Interview-Kid, receiver operating characteristic, sensitivity, specificity
|How to cite this article:|
Suresh A, Shankar S, Satyanarayana PT. Mini international neuropsychiatry interview kid or child posttraumatic stress disorder symptom scale 5I for posttraumatic stress disorder among adolescent girls infected with COVID-19. Indian J Public Health 2022;66, Suppl S1:27-30
|How to cite this URL:|
Suresh A, Shankar S, Satyanarayana PT. Mini international neuropsychiatry interview kid or child posttraumatic stress disorder symptom scale 5I for posttraumatic stress disorder among adolescent girls infected with COVID-19. Indian J Public Health [serial online] 2022 [cited 2023 Jan 27];66, Suppl S1:27-30. Available from: https://www.ijph.in/text.asp?2022/66/5/27/360644
| Introduction|| |
Posttraumatic stress disorder (PTSD) is a mental disorder that may develop after exposure to exceptionally life threatening or horrifying events which can follow just after a single traumatic event or sometimes after perpetuated exposure to trauma. Many people show remarkable resilience and capacity to recover following traumatic exposure. People suffering from PTSD are vulnerable as their physical health is also under threat as they are at increased risk of experiencing somatoform, cardio-respiratory, musculoskeletal, gastrointestinal, and immunological disorders. It is also associated with substantial psychiatric comorbidity, increased risk of suicide and considerable economic burden. PTSD is a widely accepted diagnosis but some believe that the term medicalises understandable responses to catastrophic events and further disempowers those who are already disempowered. The Diagnostic Statistical Manual-5 (DSM-5) requires that a person experience or witness a major traumatic event like exposure to actual or threatened death, serious injury or sexual violence followed by intrusive distressing memories, recurrent distressing dreams, dissociative reactions, intense or prolonged psychological distress at exposure to reminders of the trauma, marked physiological reactions to internal or external cues symbolizing or resembling an aspect of the traumatic event. This is followed by active avoidance of internal and/or external reminders of the trauma accompanied by at least two “alterations in cognitions and mood” symptoms and finally, one has to present at least two of the following arousal symptoms such as irritable behavior and angry outbursts, reckless or self-destructive behavior, problems with concentration, and sleep disturbance.
A various research studies conducted at the different parts of the globe have provided an honest valuation of the worldwide prevalence of PTSD after pandemics or large-scale outbreaks. PTSD has been reported after sudden acute respiratory syndrome, H1N1, Poliomyelitis, Ebola, Zika, Nipah, Middle Eastern respiratory syndrome-CoV, H5N1, and coronavirus disease 2019 (COVID-19) add to the infective origin of PTSD indirectly., The overall pooled prevalence of postpandemic PTSD across all populations was 22.6%. Health-care workers had the highest prevalence of PTSD (26.9%), followed by infected cases (23.8%) and the general public (19.3%). The higher prevalence among general public shows that community which is usually remotely associated with disease per se are also at the equal risk of having PTSD. Men and women differed in lifespan distribution of PTSD. Women had an overall two - fold higher PTSD prevalence than men. The highest female-to-male ratio was found for the 21–25 year-olds. The very physiology of stress-coping in women changes compared with men. When it comes to subjective response like threat perception, women generally score higher than men on acute subjective responses. Women deal with stressful situations distinctively and have evolved diversely probably explained by the psychobiological reactions and effects of oxytocin. Studies show that women appear to have a more sensitized hypothalamus–pituitary–axis than men make them prone for PTSD such as mental health issues. The objective of the present study was to find out sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and to plot receiver operating characteristic curve of Child PTSD Symptom Scale 5I (CPSS-5I) with Mini International Neuropsychiatry Interview-Kid (MINIKID).
| Materials and Methods|| |
This cross-sectional study was carried out for a period of 6 months from January 2021 to June 2021 at COVID care center, Kolar, Karnataka, India after obtaining the Institutional Ethical Committee clearance. 1594 COVID-19-positive patients were diagnosed at R. L. Jalappa Hospital COVID care center through the reverse transcription–polymerase chain reaction (RT-PCR). Among 1594, 19 were boys aged from 11 to 19 years and 116 were adolescent girls found to be positive for COVID-19. 16 adolescent girls who tested positive were for COVID-19, parents did not consent for the study and they belonged to early adolescence aged 11–14 years. Adolescent girls with previously diagnosed PTSD for any previous event were excluded. As no previous published articles were available regarding PTSD and adolescents infected with COVID-19 infection, sample size was calculated assuming adolescents girls who have contracted infection, 50% will have PTSD will be considered as prevalence (p), error as 10% with 95% confidence interval, sample size calculated was 100.
Contact details of all adolescent girls who had tested positive for COVID-19 were obtained from the hospital registers. Parents were sensitized about the research taken with the objectives of the study and purpose of carry this research.
After obtaining consent from parents and assent from adolescent girls, request to participate in the study was made through registered e-mail or phone calls and appointments were made prior to the interviews. Data collection was done for 10 participants/day which lasted for 10 days. Data collection was done by telephonic interviews which lasted not more than 30 min by Assistant Professor in the Department of Community Medicine who had received training from Consultant Psychiatrist and had previous experience using both the tools. The study was started after obtaining institutional ethical committee clearance. To assess the socio-demographic details, a pretested semi-structured questionnaire was used. To assess for PTSD, two tools were used. The first was MINIKID and the other was CPSS-5-I questionnaire. The MINIKID is extremely handy and appropriate psychiatric diagnostic tool used among the child and adolescents. It is a version of the MINI which is a structured diagnostic schedule with axis1diagnostic categories. As MINIKID generates reliable and valid psychiatric diagnoses among children and adolescents, it has gained a lot of attention by various research scholars. MINIKID has been widely used in Indian scenario in diagnosing mental health disorders and in particular PTSD among adolescents.,,,,, The CPSS is a 27-item semi-structured interview tool with advantages such as easy to administer, available for free and quick., It is mainly used to assess PTSD and symptom severity in the past month based on interviewer ratings. CPSS-5-I being a Likert scale initial few questions assesses history of traumatic experiences to identify an index trauma. Next, few items assess DSM-5 PTSD symptoms. The total severity score ranges from 0 to 80 and is calculated by summing the ratings of the first 20 items. The CPSS-5-I also yields subscale scores for intrusion, avoidance, changes in cognition and mood, and increased arousal and reactivity. Participants positive in both MINIKID and CPSS-5-I were diagnosed with PTSD in the present study which was taken as the prevalence of the PTSD. Ethical committee clearance was taken before the start of the study. All data entered in Microsoft office Excel sheet, analyzed using SPSSv22 (IBM Corp., Armonk, NY, USA). The sensitivity of a diagnostic test quantifies its ability to correctly identify subjects with the disease condition. It is the proportion of true positives that are correctly identified by the test. The specificity is the ability of a test to correctly identify subjects without the condition. It is the proportion of true negatives that are correctly identified by the test. The PPV and NPV are the other two basic measures of diagnostic accuracy. They are related to sensitivity and specificity through disease prevalence (Π). The PPV is the probability that the disease is present given a positive test result. The NPV is the probability that the disease is absent given a negative test result.,
| Results|| |
Out of 100 girls infected with COVID-19 through 86% belonged to nuclear families 46% had hospital stay for 7–14 days after diagnosing COVID-19 and 87% had duration of illness more than 7 days. Fever was the most common symptom followed by throat pain and dry cough among adolescent girls who were diagnosed with COVID-19. Body pain and chest pain were the least common symptoms.
Fifteen girls tested positive for PTSD using both MINIKID and CPSS-5I tool who were considered true positives, 70 girls were diagnosed negative for PTSD using both MINIKID and CPSS-5I tool who were considered true negatives. Twelve girls were found to be positive for PTSD using CPSS-5I but negative from MINIKID who were considered false positive, moreover, 3 girls were found to be positive with MINIKID and negative for CPSS-5I who were considered false negatives [Table 1].
|Table 1: Distribution of adolescent girls according to diagnosis made by Mini International Neuropsychiatry Interview-Kid and Child Posttraumatic Stress Disorder Symptom Scale-5I|
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Sensitivity of the CPSS-5I was 56% and specificity of the CPSS-5I was 96% compared with MINIKID. 83% was the PPV of the CPSS-5I and 85% was NPV of the CPSS-5I compared with MINIKID [Table 2].
|Table 2: Sensitivity, specificity, positive predictive value and negative predictive value of Child Posttraumatic Stress Disorder Symptom Scale-5I with Mini International Neuropsychiatry Interview-Kid|
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Area under the curve (AUC) is 83.9% with P < 0.001 (72.5–95.2) which indicates that CPSS-5I is 84% sensitive proving to be a very good diagnostic tool for diagnosing PTSD [Figure 1].
|Figure 1: ROC curve plotting sensitivity and specificity. ROC: Receiver operating characteristic|
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The present study shows that score of 8 of CPSS-5I with 89% sensitivity and 89% specificity, a score of 9.5 from CPSS-5I had sensitivity and specificity of 83% in picking up PTSD using MINIKID as the gold standard. The next value with 83% sensitivity and 86% specificity was 10.5. These cutoffs can be extremely helpful while diagnosis as more emphasis can be given to those participants who cross this cutoff during mass screening post-COVID infection.
| Discussion|| |
The present study being a cross-sectional study carried out for a period of 6 months to identify PTSD using two validated tools MINIKID and CPSS-5I among adolescent girls infected with COVID-19. Sensitivity of the CPSS-5I was 56% and specificity was 96% compared with MINIKID. 83% was the PPV and 85% was NPV of the CPSS-5I compared with MINIKID. AUC is 83.9% proving CPSS-5I to be a very good diagnostic tool for PTSD. The present study shows that scores of 9.5 or 10.5 can be used as cutoff for diagnosing PTSD using CPSS-5I. These two cutoffs can be extremely helpful while diagnosis as more emphasis can be given to those participants who cross this cutoff during interview. Both tools being extremely good in identifying and picking PTSD, the present study considered MINIKID as the gold standard as there are many studies in Indian scenario using this tool for PTSD. CPSS-5I was considered as a newer tool. CPSS-5I has many advantages; however, it does not have extensive psychometric validation and also ethnical imbalanced as its not been extensively used in the Indian scenario. PTSD following pandemics is a significant public health importance which most of the times goes unnoticed and unaddressed. The current COVID-19 pandemic has become more complex phenomenon in terms of health during the 21st century. PTSD is a common psychiatric condition in childhood and adolescence. Rates vary widely depending upon the type of trauma exposure. Clinical presentations are exceedingly complex and children with PTSD are at increased risk of having co-morbid psychiatric diagnoses. Risk factors including individual, family, and societal factors, pandemic-related factors and specific factors in healthcare workers and patients needed special attention. Long-term monitoring and early interventions should be implemented to improve postpandemic mental health abnormalities and long-term recovery. In spite of full layered protection of teachers and working staff being vaccinated for COVID with usage of mask during school timings, adequate distancing, sanitization and proper mask usage among children and adolescents and with unabating trends of COVID-19 pandemic with schools being hotspots, COVID infection and postinfection mental health sequel will be common. PTSD being more likely because of COVID, CPSS-5I tool can be extremely helpful in picking the disease early and managing the condition effectively. The strength of the study being identifying the CPSS-5I tool which is very easy to use and can be utilized for screening children and adolescents in schools post-COVID infection. Limitations of the study are many. Single centric, female gender, and only adolescents being part of the study make it poor generalizability.
| Conclusion|| |
CPSS-5I is extremely well designed, helpful and functional tool used in diagnosing PTSD. With current study showing CPSS-5I can be used in post-COVID PTSD diagnosis, it also provides cutoff which can be helpful in mass screening. CPSS-5I is self-administered and easily understandable; hence, teachers can easily be made aware of this tool and if found symptomatically correlated then early referral can be made possible.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]