Scoring consistency checks for the Clinician Administered PTSD Scale (CAPS-IV & CAPS-V)

BackgroundThe CAPS is regarded as the "gold standard" in PTSD assessment. It is a structured interview that yields a categorical diagnosis of PTSD and also a measure of the severity of PTSD symptoms. Since a PTSD diagnosis in some settings could be connected to getting benefits, scoring inconsistencies may be more abundant with this rating scale as they not only reflect raters carelessness but intentional inaccurate reporting by the subject. ObjectiveThe objective of the current effort was to derive rating consistency flags for the CAPS-IV. MethodsWe deconstructed CAPS scoring instructions and anchors to identify potential scoring inconsistency flags. These inconsistency flags were reviewed and confirmed by expert raters. To test the ability of the flags to identify careless responses the flags were applied to Monte Carlo simulated data of 100,000 CAPS administrations. ResultsTwelve flags were derived (presented in Table 1). Two flags applied to most of the 17 symptom items (Flag 1: Frequency=0 & Intensity>0 and Flag 2: Frequency>0 & Intensity=0). The remaining 10 flags pertained to individual items. Five flags were rated as "High" flags, representing very probably or definitely incorrect rating, one as medium, reflecting probably incorrect rating. Flags were raised for 95% of the Monte Carlo simulated CAPS administrations, 78% of the administrations had 4 or more flags and 60% 5 or more. O_TBL View this table: org.highwire.dtl.DTLVardef@13ca638org.highwire.dtl.DTLVardef@c4c5f0org.highwire.dtl.DTLVardef@9f3d17org.highwire.dtl.DTLVardef@63e189org.highwire.dtl.DTLVardef@16bfe16_HPS_FORMAT_FIGEXP M_TBL O_FLOATNOTable 1.C_FLOATNO O_TABLECAPTIONList of CAPS IV items and inconsistency FLAGS C_TABLECAPTION C_TBL ConclusionsScoring consistency flags for the CAPS may be useful in the quest to improve reliability and validity of clinical trials. Modified flags are currently being developed to cover the CAPS-V. Further testing of flags using clinical trial data is planned to examine their potential impact on signal detection.