Screening PTSD in clinical populations within East Africa: results from the first follow-up study of NeuroGAP-psychosis

Abstract

Background: Given the high burden of trauma in Sub-Saharan Africa, there is a critical need for scalable tools to screen for trauma and posttraumatic stress disorder (PTSD) symptoms, especially in low-resource settings. Objective: This study aimed to evaluate the utility, reliability, and validity of the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) administered over the telephone to individuals previously enrolled in the Neuropsychiatric Genetics of African Populations-Psychosis study (NeuroGAP-Psychosis) study in Uganda (N = 4,921) and Kenya (N = 3,149). Method: Cases with psychosis and controls without psychosis (patients, caretakers, or employees) were recontacted from the NeuroGAP-Psychosis study and enrolled in a follow-up study. This follow-up included a phone-based assessment of trauma and PTSD using the Life Events Checklist for DSM-5 (LEC-5) and the PC-PTSD-5, followed by an in-person assessment of PTSD using the PTSD Checklist for the DSM-5 (PCL-5). All interviews were conducted in local languages and by trained research assistants. Results: High rates of participant recontact and completion were achieved, with 60% of participants in the Ugandan cohort and 85% in the Kenyan cohort successfully completing the trauma and PTSD assessment over the phone. In both countries, approximately 80% of those screened by phone also completed the in-person interview. The PC-PTSD-5 demonstrated overall good to acceptable reliability (α = 0.85/ω = 0.86 in Ugandan cohort; α = 0.76/ω = 0.77 in Kenyan cohort), across both cases with psychosis and controls without psychosis, and across the different study languages. Furthermore, evaluation of the PC-PTSD-5 against the PCL-5 in Uganda revealed strong performance based on both sensitivity (91%) and specificity (77%). Conclusions: The first follow-up study in NeuroGAP-Psychosis successfully demonstrates the feasibility of a hybrid telephone and in-person PTSD screening protocol in Sub-Saharan Africa. The results are a first step in establishing the research and clinical use of brief, scalable PTSD screening instruments in low-resource settings and in populations affected by psychosis. This study demonstrates large-scale recontact, consent, and PTSD screening via telephone and in-person in the NeuroGAP-Psychosis study in Uganda and Kenya.Studies focused on trauma or PTSD symptom assessments can successfully combine phone and in-person methods to facilitate research in low-resource settings and clinical screenings.The PC-PTSD-5 can be used as an effective first-step screening tool across different local languages and among individuals with and without psychosis in this cohort.