title: Development of a composite trauma exposure risk index.
abstract: The high burden of exposure to chronic life adversities and trauma is quite prevalent, but assessment of this risk burden is uncommon in primary care settings. This calls for a brief, multiple dimensional mental health risk screening tool in primary care settings. We aimed to develop such a screening tool named the University of California, Los Angeles (UCLA) Life Adversities Screener (LADS). Using pooled data across 4 studies from the UCLA Center for Culture, Trauma, and Mental Health Disparities, 5 domains of mental health risk including perceived discrimination, sexual abuse histories, family adversity, intimate partner violence, and trauma histories, were identified. Regression models for depression (Centers for Epidemiology Studies Depression Scale) and posttraumatic stress disorder (Posttraumatic Diagnostic Scale), controlling for demographic factors, were fitted to develop a weighted continuous scale score for the UCLA LADS. Confirmatory factor analysis supported the 5-domain structure, while item response theory endorsed the inclusion of each item. Receiver operating characteristic analysis indicated that the score was predictive for classifying subjects as reaching clinical threshold criteria for either depression (Beck Depression Inventory-II ≥ 14 or Patient Health Questionnaire-9 ≥ 10) or anxiety (Patient Health Questionnaire-13 ≥10). An optimal cut of 0.33 is suggested based on maximizing sensitivity and specificity of the LADS score, identifying patients at high risk for mental health problems. Given its predictive utility and ease of administration, the UCLA LADS could be useful as a screener to identify racial minority individuals in primary care settings who have a high trauma burden, needing more extensive evaluation.
authors.affiliation: School of Dentistry-Public Health, Department of Medicine, David Geffen School of Medicine, University of California.
authors.forename: Honghu
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles.
authors.forename: Nicole
authors.initials: N
authors.lastname: Prause
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles.
authors.forename: Gail E
authors.initials: GE
authors.lastname: Wyatt
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles.
authors.forename: John K
authors.initials: JK
authors.lastname: Williams
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Chin
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles.
authors.forename: Teri
authors.initials: T
authors.lastname: Davis
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles.
authors.forename: Tamra
authors.initials: T
authors.lastname: Loeb
authors.affiliation: Center for Cancer Prevention and Control Research, School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles.
authors.forename: Erica
authors.initials: E
authors.lastname: Marchand
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles.
authors.forename: Muyu
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Center for Medicine, Health, and Society, Vanderbilt University.
authors.forename: Hector F
authors.initials: HF
authors.lastname: Myers
mesh_terms: D000293:Adolescent; D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000523:psychology*; D000368:Aged; D002650:Child Abuse, Sexual / Q000523:psychology; D003863:Depression / Q000523:psychology; D003866:Depressive Disorder / Q000523:psychology; D000069581:Exposure to Violence / Q000523:psychology*; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D000066511:Intimate Partner Violence / Q000523:psychology*; D008297:Male; D008403:Mass Screening; D008603:Mental Health; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D000067073:Psychological Trauma / Q000175:diagnosis* / Q000523:psychology; D063505:Racism / Q000523:psychology*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology; D055815:Young Adult