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INTRODUCTION: The United States has been actively involved in major armed conflicts over the last 15 years. As a result, a significant proportion of active duty service personnel and returning veterans have endured combat, putting them at risk for developing post-traumatic stress disorder (PTSD), a disabling disorder that may occur after exposure to a traumatic event. Current therapies often require long-term, time-intensive and costly commitment from the patient and have variable degrees of success. There remains an ongoing need for better therapies, including complementary medicine approaches that can effectively reduce PTSD symptoms. While anecdotal evidence suggests that routine practice of Brazilian Jiu Jitsu (BJJ) can reduce symptoms of PTSD, there have been no formal studies to address this. MATERIALS AND METHODS: This study was approved by the University of South Florida Institutional Review Board (#PRO00019430). Male US active duty service members and veterans from the Tampa area participated in a 5-month (40 sessions) BJJ training program. Before beginning and again midway through and upon completion of training the participants completed several validated self-report measures that addressed symptoms of PTSD and other co-morbid conditions. Effect size and 95% confidence intervals were determined using a within-person single-group pretest-posttest design. RESULTS: Study participants demonstrated clinically meaningful improvements in their PTSD symptoms as well as decreased symptoms of major depressive disorder, generalized anxiety and decreased alcohol use; effect sizes varied from 0.80 to 1.85. CONCLUSIONS: The results from this first-of-kind pilot study suggest that including BJJ as a complementary treatment to standard therapy for PTSD may be of value. It will be necessary to validate these promising results with a larger subject cohort and a more rigorous experimental design before routinely recommending this complementary therapy.
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Artes Marciais/psicologia , Militares/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Veteranos/psicologia , Adulto , Feminino , Florida , Humanos , Masculino , Artes Marciais/educação , Artes Marciais/estatística & dados numéricos , Militares/estatística & dados numéricos , Projetos Piloto , Psicometria/instrumentação , Psicometria/métodos , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários , Estados Unidos , Veteranos/estatística & dados numéricosRESUMO
Background: With the release of the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5), the Posttraumatic Stress Disorder Checklist (PCL) has been updated to meet the revisions of the diagnostic criteria for Posttraumatic Stress Disorder (PTSD). However, the diagnostic utility and reliability of a Brazilian version of the new Posttraumatic Stress Disorder Checklist (PCL-5) have not been investigated yet. Objective: To investigate the internal consistency, test-retest reliability, and diagnostic utility of the complete version (21-item) and two abbreviated (8-item and 4-item) versions of the Brazilian PCL-5. Methods: A total of 85 individuals with a history of exposure to at least one traumatic event underwent a diagnostic interview using the Structured Clinical Interview for DSM-5 (SCID-5-CV) and completed the Brazilian version of the PCL-5. Moreover, participants were invited to complete the checklist for a second time 10-30 days after the first assessment. Results: Both the complete and abbreviated versions of the Brazilian PCL-5 showed good internal consistency (complete PCL-5, α = .96; 8-item, α = .93; 4-item, α = .85) and test-retest reliability (complete PCL-5, ICC .87 [95% CI, 0.65-0.95]; 8-item, ICC .84 [95% CI, 0.60-0.94]; 4-item, ICC .84 [95% CI, 0.58-0.94]). Diagnostic utility analyses using the Structured Clinical Interview for DSM-5 (SCID-5-CV) revealed that a cutoff point of 36 presented the higher overall efficiency for predicting a PTSD diagnosis Overall Efficiency (OE, .80) and corresponded to Youden's index J (.65). For the 8-item version, a cutoff point of 13 corresponded to Youden's index J (.61), while scores of 21 or more were associated with the highest OE (.78). For the 4-item PCL-5, scores > 7 presented the highest OE (.77) and corresponded to Youden's index J (.59). Conclusions: Overall, the findings provide relevant evidence regarding the high reliability and diagnostic utility of this Brazilian version of the PCL-5.
Antecedentes: con la publicación de la quinta edición del Manual de Diagnóstico y Estadístico para los Trastornos Mentales (DSM-5), el Cuestionario para el Trastorno de Estrés Postraumático (PCL) se ha actualizado para cumplir con las revisiones de los criterios de diagnósticos del trastorno de estrés postraumático (TEPT). Sin embargo, la utilidad diagnóstica y la confiabilidad de una versión brasileña del nuevo cuestionario de trastorno de estrés postraumático (PCL-5) aún no se ha investigado.Objetivo: investigar la consistencia interna, la confiabilidad test-retest y la utilidad diagnóstica de la versión completa (21 ítems) y dos versiones abreviadas (8 y 4 ítems) del PCL-5 brasileño.Métodos: Un total de 85 individuos con antecedentes de exposición, al menos, a un evento traumático se sometieron a una entrevista diagnóstica utilizando la entrevista clínica estructurada para el DSM-5 (SCID-5-CV) y completaron la versión brasileña del PCL-5. Además, los participantes fueron invitados a completar el cuestionario por segunda vez entre 10 y 30 días después de la primera evaluación.Resultados: Tanto la versión completa como las abreviadas de la PCL-5 brasileña mostraron una buena consistencia interna (PCL-5 completa, α = .96; 8 ítem, α = .93; 4-item, α = .85) y confiabilidad test-retest (PCL-5 completa, ICC .87 [IC 95%, .65 - .95]; 8 ítems, ICC .84 [IC 95%, 0.60 - 0.94]; 4 ítems, ICC .84 [IC 95%, 0.58] - 0,94]). Los análisis de utilidad diagnóstica que utilizaron el SCID-5-CV revelaron que un punto de corte de 36 presentó la mayor eficiencia general para predecir un diagnóstico de TEPT (OE, .80) y correspondió al índice J de Youden (.65). Para la versión de 8 ítems, un punto de corte de 13 correspondió al índice J de Youden (.61), mientras que las puntuaciones de 21 o más se asociaron con el OE más alto (.78). Para el PCL-5 de 4 ítems, los puntajes> 7 presentaron el OE más alto (.77) y correspondieron al índice J de Youden (.59).Conclusiones: En conjunto, los hallazgos proporcionan evidencia relevante con respecto a la alta confiabilidad y utilidad diagnóstica de esta versión brasileña del PCL-5.
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Resumen La Lista Checable de Trastorno por Estrés Postraumático (PCL) ha sido una de las escalas más aplicadas en el ámbito clínico, misma que ha sido adaptada recientemente a los criterios del DSM-5 (PCL-5). Considerando la problemática que representa el TEPT en la población y los cambios recientes propuestos en el DSM-5, resulta importante contar con escalas validadas en México con base a los nuevos criterios diagnósticos descritos. El presente trabajo describe las propiedades psicométricas para la validación en población mexicana de la PCL-5, donde se contó con 204 estudiantes universitarios del sistema abierto de la UNAM, de 18 a 59 años, reclutados a través de una plataforma virtual. Los resultados mostraron una adecuada consistencia interna (.97), así como una validez convergente apropiada (rs = .58 a .88). A su vez, se realizaron distintos análisis factoriales exploratorios y confirmatorios donde se obtuvieron ajustes adecuados a los modelos planteados en el DSM-5 y estudios previos de la escala original. Se concluye que la escala es válida y confiable en población mexicana, lo que la convierte en el único instrumento adaptado al DSM-5 para la evaluación del TEPT en dicho contexto. Sin embargo, se recomiendan estudios adicionales con un mayor control sobre distintos tipos de trauma para mejor descripción del constructo.
Abstract The Posttraumatic Stress Disorder Checklist (PCL) has been one of the most applied scales in the clinical field, which has been recently adapted to the DSM-5 criteria (PCL-5). Considering the problems posed by PTSD in the population and the recent changes proposed in the DSM-5, it is important to have validated scales in Mexican population based on the new diagnostic criteria described. The present work describes the psychometric properties for the validation in Mexican population of the PCL-5, where 204 students from open and distance learning university between 18 and 59 years old participated, recruited through a virtual platform. The results showed an adequate internal consistency (.97), as well as an appropriate convergent validity (rs=.58 to .88). At the same time, different exploratory and confirmatory factor analyses were conducted, where appropriate adjustments to the models proposed in the DSM-5 and previous studies of the original scale were obtained. We conclude that the scale is valid and reliable in the Mexican population, which makes it the only instrument adapted to the DSM-5 for the evaluation of PTSD in this context. However, additional studies with greater control over different types of trauma are recommended for a better description of the construct.
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Abstract Background DSM-5 introduced some modifications on Posttraumatic Stress Disorder (PTSD) criteria. The instruments developed for the assessment of aspects related to PTSD needed a reformulation, as was the case of the Posttraumatic Stress Disorder Checklist (PCL). Objectives To present the process of transcultural adaptation of the three forms of the PCL-5 to Brazilian Portuguese, as well as its face validity. Methods The procedure involved independent translations, a synthesis version, back translation by an independent translator, evaluation by the original author, analysis by an expert committee, and a pretesting study (10 subjects with/without experience of a traumatic situation). The last two steps formed the face validity procedure. Results The synthesis version was approved by the original author and the agreement percentage by the expert committee was excellent, with only two items showing < 90%. The pretesting study showed that the Brazilian version was well understood and linguistically and culturally accepted by the participants, which did not make significant suggestions for changes. Discussion Transcultural adaptation of the PCL-5 for Brazilian Portuguese followed a rigid and standardized procedure. Therefore, after having its face validity assessed by an expert committee and by the target population, it is apt to be used.