Exploring Agreement Between Adolescent Self-Reported PTSD Symptoms and Clinical Diagnoses on a Psychiatric Inpatient Unit

ABSTRACT

A significant number of adolescents in the U.S. experience traumatic events, putting them at risk for developing Posttraumatic Stress Disorder (PTSD). Despite this risk, PTSD is not a commonly assigned diagnosis in psychiatric settings. The current study examined rates of psychiatrist-reported PTSD (PR-PTSD) diagnoses compared to probable PTSD diagnoses based on adolescent self-reported PTSD (SR-PTSD) symptoms on a psychiatric inpatient unit (n = 151, age 13–17). Self-report measures included questions on exposure to trauma and The Child PTSD Symptom Scale for DSM-5 (CPSS-5). Approximately 60% of participants met criteria for a “probable PTSD diagnosis” on the CPSS-5; however, only 10 out of 151 (6.6%) and 58 out of 151 (38.4%) were given PR-PTSD at admission and at discharge, respectively. Chi-square analyses indicated adolescents with SR-PTSD were more likely to have previous psychiatric admissions, χ²(1, N = 149) = 3.87, p = .049. There was also a significant association between SR-PTSD and suicide risk, χ²(3, N = 148) = 9.93, p = .019. Both the null and low suicide risk groups contributed the most to predicting SR-PTSD based on the standardized residuals being ±1.96. Additionally, SR-PTSD and insurance status were significantly associated, χ²(1, N = 147) = 4.48, p = .034. All of the cells equally contributed to the significance. When comparing diagnosis given at admission to SR-PTSD, agreement was poor (κ=.070, p = .043), and there was no agreement between diagnosis given at discharge and SR-PTSD (κ=.116, p = .074). Findings from the study highlight a discrepancy in SR-PTSD and PR-PTSD in adolescent psychiatric settings.

Acknowledgement

The authors wish to thank Drs. Taiwo Babatope, MD; Caroline McCool, MD; Allison Yakel, PhD; Cristian Zeni, MD, PhD; and Micah Knobles, MD for providing information about diagnosis at admission and at discharge, and for review of the paper. Additional thanks to the psychology pre-doctoral interns and the psychiatry residents for administering the survey to patients during hospitalization, the clinical staff on Unit 1E for the care provided to patients, and the Management Information Systems team for their help gathering data from medical records.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

Dr. Ugueto is the unit psychologist and provides psychological care on the acute child and adolescent unit at UTHealth - Harris County Psychiatric Center. This study was approved by the Committee for the Protection of Human Subjects at UTHealth - Harris County Psychiatric Center.