AUTHOR=Meffert Susan M. , Mathai Muthoni A. , Ongeri Linnet , Neylan Thomas C. , Mwai Daniel , Onyango Dickens , Akena Dickens , Rota Grace , Otieno Ammon , Obura Raymond R. , Wangia Josline , Opiyo Elizabeth , Muchembre Peter , Oluoch Dennis , Wambura Raphael , Mbwayo Anne , Kahn James G. , Cohen Craig R. , Bukusi David E. , Aarons Gregory A. , Burger Rachel L. , Jin Chengshi , McCulloch Charles E. , Njuguna Kahonge Simon 

TITLE=Defining a screening tool for post-traumatic stress disorder in East Africa: a penalized regression approach

JOURNAL=Frontiers in Public Health

VOLUME=Volume 12 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2024.1383171

DOI=10.3389/fpubh.2024.1383171

ISSN=2296-2565

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.