Narrowing the focus on the assessment of psychosis-related PTSD: a methodologically orientated systematic review.
BACKGROUND
Posttraumatic stress disorder (PTSD) in response to psychosis and associated experiences (psychosis-related PTSD, or PR-PTSD) is the subject of a growing field of research. However, a wide range of PR-PTSD prevalence rates has been reported. This may be due to definitional and methodological inconsistencies in the assessment of PR-PTSD.


OBJECTIVE
The focus of the review is two-fold. (1) To identify factors that enhance, or detract from, the robustness of PR-PTSD assessment and (2) to critically evaluate the evidence in relation to these identified criteria, including the impact on PR-PTSD prevalence rates.


METHODS
Four quality criteria, whose development was informed by mainstream PTSD research, were selected to evaluate findings on PR-PTSD prevalence. Two criteria related to assessment of psychosis-related stressors (participant identification of worst moments of discrete threat events; psychometrically robust trauma measure) and two focussed on PR-PTSD symptom measurement (adequate time elapsed since trauma; use of validated PTSD interview) in the context of psychosis.


RESULTS
Twenty-one studies of PR-PTSD, with prevalence rates ranging from 11 to 51%, were evaluated. Fourteen studies (67%) used robust PTSD measures but PR-trauma was not specifically defined or assessed with validated measures. Eleven studies (52%) assessed PTSD before sufficient time had elapsed since the trauma. Due to significant methodological limitations, it was not possible to review PR-PTSD rates and provide a revised estimate of prevalence.


CONCLUSIONS
Methodological limitations are common in existing studies of PR-PTSD prevalence. Specific recommendations for improving assessment of psychosis-related trauma are made to guide the development of this new and emerging field. The review concludes with a proposed conceptualisation of PR-PTSD in the context of current diagnostic systems. The utility of the PR-PTSD term and its theoretical underpinnings are discussed.
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK; miriam.fornells-ambrojo@ucl.ac.uk.
Miriam
M
Fornells-Ambrojo
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
Alison
A
Gracie
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
Chris R
CR
Brewin
Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Amy
A
Hardy
PTSD; Psychosis; assessment; psychosis-related PTSD; trauma
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