Background: Several instruments have been developed and validated as screens for post-traumatic stress disorder (PTSD) in substance use disorder (SUD) patients. Unfortunately, many of these instruments have one or several disadvantages (e.g. low specificity, low sensitivity or high costs). No research has been conducted on instruments that screen simultaneously for other psychiatric disorders, which would be a potentially time-saving and cost-effective approach. In the current study we tested the psychometric properties of the Depression, Anxiety and Stress Scale (DASS) as a screen for PTSD. Methods: The DASS was assessed in an inpatient facility during intake with 58 patients and again 4 weeks after admission. Another 138 patients were assessed 4 weeks after admission only. The results were compared to the Clinician-Administered PTSD Scale (CAPS) that was also administered after 4 weeks of abstinence. Results: ROC curve analyses showed an area under the curve of 0.84 for the DASS at intake and 0.78 for the DASS after 4 weeks' abstinence. Conclusion: The DASS is therefore a reliable and convenient measure to use as a screen for PTSD in SUD patients.

Keywords:
Screen, Assessment, Post-traumatic stress disorder, Substance use disorder, Depression, Anxiety and Stress Scale
1.
Ouimette P, Read P (eds): Trauma and Substance Abuse: Causes, Consequences, and Treatment of Comorbid Disorders, ed 2. Washington, American Psychological Association, 2013.
2.
Ouimette P, Read J, Brown P: Consistency of retrospective reports of DSM-IV criterion A traumatic stressors among substance use disorder patients. J Trauma Stress 2005;18:43-51.
3.
Reynolds M, Mezey G, Chapman M, Wheeler M, Drummond C, Baldacchino A: Co-morbid post-traumatic stress disorder in a substance misusing clinical population. Drug Alcohol Depend 2005;77:251-258.
4.
Kimerling R, Trafton JA, Nguyen B: Validation of a brief screen for Post-Traumatic Stress Disorder with substance use disorder patients. Addict Behav 2006;31:2074-2079.
5.
Driessen M, Schulte S, Luedecke C, Schaefer I, Sutmann F, Ohlmeier M, et al: Trauma and PTSD in patients with alcohol, drug, or dual dependence: a multi-center study. Alcohol Clin Exp Res 2008;32:481-488.
6.
Najavits LM, Harned MS, Gallop RJ, Butler SF, Barber JP, Thase ME, et al: Six-month treatment outcomes of cocaine-dependent patients with and without PTSD in a multisite national trial. J Stud Alcohol Drugs 2007;68:353-361.
7.
Clark HW, Masson CL, Delucchi KL, Hall SM, Sees KL: Violent traumatic events and drug abuse severity. J Subst Abuse Treat 2001;20:121-127.
8.
Van Dam D, Ehring T, Vedel E, Emmelkamp PMG: Screening for posttraumatic stress disorder in civilian substance use disorder patients: cross-validation of the Jellinek-PTSD screening questionnaire. J Subst Abuse Treat 2013;44:126-131.
9.
Hien DA, Cohen LR, Miele GM, Litt LC, Capstick C: Promising treatments for women with comorbid PTSD and substance use disorders. Am J Psychiatry 2004;161:1426-1432.
10.
Najavits LM: Assessment of trauma, PTSD, and substance use disorder: a practical guide; in Wilson JP, Keane T (eds): Assessing Psychological Trauma and PTSD, ed 2. New York, Guilford Press, 2004, pp 466-491.
11.
Lisak D: The psychological impact of sexual abuse: content analysis of interviews with male survivors. J Trauma Stress 1994;7:525-548.
12.
Hien DA, Nunes E, Levin FR, Fraser D: Posttraumatic stress disorder and short-term outcome in early methadone treatment. J Subst Abuse Treat 2000;19:31-37.
13.
Brown P, Wolfe J: Substance abuse and post-traumatic stress disorder comorbidity. Drug Alcohol Depend 1994;35:51-59.
14.
Van Dam D, Ehring T, Vedel E, Emmelkamp PMG: Validation of the Primary Care Posttraumatic Stress Disorder screening questionnaire (PC-PTSD) in civilian substance use disorder patients. J Subst Abuse Treat 2010;39:105-113.
15.
Blanchard EB, Jones-Alexander J, Buckley TC, Forneris CA: Psychometric properties of the PTSD Checklist (PCL). Behav Res Ther 1996;34:669-673.
16.
Horowitz M, Wilner N, Alvarez W: Impact of Event Scale: a measure of subjective stress. Psychosom Med 1979;41:209-218.
17.
Brewin C, Rose S, Andrews B, Green J, Tata P, McEvedy C, et al: Brief screening instrument for post-traumatic stress disorder. Br J Psychiatry 2002;181:158-162.
18.
Hovens JE, Van der Ploeg HM, Bramsen I, Klaarenbeek MTA, Schreuder JN, Rivero VV: The development of the Self-Rating Inventory for Posttraumatic Stress Disorder. Acta Psychiatr Scand 1994;90:172-183.
19.
Kok T, de Haan HA, van der Velden HJW, van der Meer M, Najavits LM, de Jong CAJ: Validation of two screening instruments for PTSD in Dutch substance use disorder inpatients. Addict Behav 2012;38:1726-1731.
20.
Schippers GM, Broekman TG, Buchholz A, Koeter MWJ, van den Brink W: Measurements in the Addictions for Triage and Evaluation (MATE): an instrument based on the World Health Organization family of international classifications. Addiction 2010;105:862-871.
21.
Lovibond SH, Lovibond PF: The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther 1995;33:335-342.
22.
Borsboom D, Cramer AOJ, Schmittmann VD, Epskamp S, Waldorp LJ: The small world of psychopathology. PLoS One 2011;6:e27407.
23.
De Bellis M: Developmental traumatology: a contributory mechanism for alcohol and substance use disorders. Psychoneuroendocrinology 2002;27:155-170.
24.
Najt P, Fusar-Poli P, Brambilla P: Co-occurring mental and substance abuse disorders: a review on the potential predictors and clinical outcomes. Psychiatry Res 2011;186:159-164.
25.
Herman J: Trauma and Recovery: The Aftermath of Violence from Domestic Abuse to Political Terror. New York, Basic Books, 1992.
26.
Nieuwenhuijsen K, de Boer AGEM, Verbeek JHAM, Blonk RWB, van Dijk FJH: The Depression Anxiety Stress Scales (DASS): detecting anxiety disorder and depression in employees absent from work because of mental health problems. Occup Environ Med 2003;60:77-82.
27.
De Beurs E, van Dyck R, Marquenie LA, Lange A, Blonk RWB: The DASS: a questionniare for assessing depression, anxiety and stress (in Dutch). Gedragstherapie 2001;34:35-53.
28.
Blake DD, Weathers FW, Najavits LM, Kaloupek DG, Gusman FD, Charney DS, et al: The development of a Clinician-Administered PTSD Scale. J Trauma Stress 1995;8:75-90.
29.
Lovibond SH, Lovibond PF: Manual of the Depression, Anxiety and Stress Scales, ed 2. Sydney, Psychology Foundation, 1995.
30.
Brown T, Chorpita BF, Korotitsch W, Barlow DH: Psychometric properties of the Depression Anxiety Stress Scales (DASS) in clinical samples. Behav Res Ther 1997;35:79-89.
31.
Willemsen J, Markey S, Declercq F, Vanheule S: Negative emotionality in a large community sample of adolescents: the factor structure and measurement invariance of the short version of the Depression Anxiety Stress Scales (DASS-21). Stress Health 2011;27:120-128.
32.
Hovens JE, Luinge BA, Van Minnen A: The Clinician-Administered Interview for PTSD (CAPS). [Het klinisch interview voor PTSS (KIP).] Nijmegen, Cure and Care Publishers, 2005.
33.
Weathers FW, Keane TM, Davidson JR: Clinician-administered PTSD Scale: a review of the first ten years of research. Depress Anxiety 2001;13:132-156.
34.
Hovens JE, Bramsen I, van der Ploeg HM: Self-Report Inventory for the Posttraumatic Stress Disorder. (Zelfinventarisatielijst voor de Posttraumatische Stressstoornis.) Tijdschr Klin Psychol 2002, pp 176-180.
35.
Keane TM, Caddell JM, Taylor KL: Mississippi Scale for Combat-Related Posttraumatic Stress Disorder: three studies in reliability and validity. J Consult Clin Psychol 1988;56:85-90.
36.
Jacobsen LK, Southwick SM, Kosten TR: Reviews and overviews substance use disorders in patients with posttraumatic stress disorder: a review of the literature. Am J Psychiatry 2001;158:1184-1190.
37.
Clark LA, Watson D: Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications. J Abnorm Soc Psychol 1991;100:316-336.
38.
Mineka S, Watson D, Clark LA: Comorbidity of anxiety and unipolar mood disorders. Annu Rev Psychol 1998;49:377-412.
39.
Brown TA, Chorpita BF, Barlow DH: Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal. J Abnorm Psychol 1998;107:179-192.
40.
Simms LJ, Watson D, Doebbelling BN: Confirmatory factor analyses of posttraumatic stress symptoms in deployed and nondeployed veterans of the Gulf War. J Abnorm Soc Psychol 2002;111:637-647.
© 2014 S. Karger AG, Basel
2014
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.