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. 2015 Sep;27(3):965-74.
doi: 10.1037/pas0000069. Epub 2015 May 18.

Development of a composite trauma exposure risk index

Honghu Liu  1 , Nicole Prause  2 , Gail E Wyatt  2 , John K Williams  2 , Dorothy Chin  2 , Teri Davis  2 , Tamra Loeb  2 , Erica Marchand  3 , Muyu Zhang  2 , Hector F Myers  4
Affiliations

Development of a composite trauma exposure risk index

Honghu Liu et al. Psychol Assess. 2015 Sep.

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.

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Figures

Figure 1
Figure 1
Item characteristics curve and item information curves
Figure 2
Figure 2
Receiver operating characteristic curves showing (smoothed) prediction (A) and Youden’s optimal cut-off +/− 95% CI (B) predicting presence of either depression or somatization
See this image and copyright information in PMC

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