Review of the Detailed Assessment of Posttraumatic Stress by ROGER A. BOOTHROYD, Associate Professor, Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa, FL: DESCRIPTION. The Detailed Assessment of Posttraumatic Stress (DAPS) is a 104-item selfreport measure assessing exposure to trauma and posttraumatic response. The measure is intended for use with individuals who have undergone a significant psychological stressor. It can be used to assist clinicians in determining the presence or absence of a probable Posttraumatic Stress Disorder (PTSD) or Acute Stress Disorder (ASD) diagnosis. The DAPS can be group or individually administered and scored by individuals with no specialized training. It is appropriate for use with persons 18 years of age and older and requires that respondents have at least a sixthgrade reading level. The measure takes between 20 and 30 minutes to complete and can be scored and profiled in approximately 20 minutes. After reporting their exposure to various potentially traumatic life events, respondents report the severity of the most traumatic experience and the frequency of various symptom clusters using a 5-point scale with varying anchors ranging from a low of 1 to a high of 5. The DAPS contains 13 scales. It has two validity scales designed to identify respondents who deny or underreport their symptoms (i.e., Positive Bias) as well as those who overreport their symptoms and endorse usual symptoms (i.e., Negative Bias). Four scales evaluate respondents' lifetime exposure to trauma. The Relative Trauma Exposure scale assesses the extent to which respondents have been exposed to multiple sources of trauma. A single item on the Onset of Exposure scale determines the recency of the traumatic event. The Peritraumatic Distress scale evaluates the severity of the distress respondents experienced at the time the event occurred. The Peritraumatic Dissociation scale determines whether a respondent dissociated during the traumatic event. Three of the scales relate to common PTSD symptom clusters (i.e., Intrusive Reexperiencing, Avoidance/Numbing, and Autonomic Hyperarousal). Additionally the DAPS contains a summary scale (i.e., Posttraumatic Stress-Total) and a scale to assess impairment of psychosocial functioning (i.e., Posttraumatic Impairment). Finally, the DAPS includes three scales assessing associated features of PTSD (i.e., Trauma-Specific Dissociation, Suicidality, and Substance Abuse). DEVELOPMENT. Originally the author developed 190 items to examine response validity and to assess the diagnostic criteria set forth for Posttraumatic Stress Disorder (309.81) in the DSMIV-TR. The items were subsequently reviewed by clinicians experienced in treating PTSD and 59 items were eliminated because of redundancy or inadequacy. The remaining 131 items were administered to 105 individuals to obtain preliminary psychometric information. Based on these results, an additional 27 items were eliminated, resulting in the current 104-item measure. TECHNICAL. Scoring & Standardization. In the absence of missing responses, raw scores are simply the sum of the item responses within a symptom domain. The manual includes scoring instructions for handling missing responses, including the number of items that can be missing and still produce a valid score, which differs by subscale. Raw scores are converted to standardized T scores by either plotting them on the profile sheets provided or by using the normative conversion tables in the test manual. Normative information was obtained from responses to a stratified (based on geographical location) random sample of adults obtained from a national sampling service. The DAPS and other related materials for assessing its psychometric properties were mailed to an unspecified number of individuals. In addition, 70 college students were administered the same protocol. The author does not provide any information on the response rate for this mailing or the extent to which respondents were representative of the initial sample of individuals to which materials were mailed. The normative sample included 446 participants who completed and returned the DAPS and who reported at least one DSM-IV-TR level traumatic event. Descriptive data on the age, gender, and racial/ethnic composition of respondents from the normative sample are provided. The effects of these respondent characteristics were examined in relation to scale scores. No age or racial/ethnic differences were found. Gender differences were found on a number of scales. Given this, gender specific profiles and normative tables were developed and are provided in the user manual. The manual also provides decision rules to assist users in determining the likelihood that a respondent has a PTSD or ASD diagnosis. The decision rules used to establish a probable diagnosis of PTSD employ symptom scale cutoff scores and those used to identify an ASD diagnosis are based on a criterion-based method. Four examples based on the responses of trauma-exposed individuals are provided to assist DAPS users with score interpretation and determining diagnosis. Reliability. In addition to the normative sample, reliability information is provided based on a combined clinical/community sample and a university sample. Internal consistency reliability in the form of Cronbach's alpha is the only type of reliability information provided. The majority of the 13 multiple-item scales have Cronbach coefficients above .8 across the three samples. The internal consistency estimates on the Positive Bias scale range from .61 to .80 whereas the Negative Bias and Relative Trauma Exposure scales have coefficients in the .49 to .67 range. The author notes that the lower internal consistency reliabilities associated with these two scales is of less concern given that the Negative Bias scale reflects endorsement of unusual symptoms and is not intended to be internally consistent and the Relative Trauma Exposure scale is a count of respondents' exposure to different types of trauma and is not representative of a specific symptom domain. Validity. Three types of evidence are provided in support of the validity of scores from the DAPS: the relationship of DAPS scores with conceptually important variables, its convergence with similar measures, and its discrimination from less-related measures. In terms of theoretically meaningful variables, DAPS scale scores were correlated with the total number of traumas respondents experienced, the type of trauma experienced (i.e., interpersonal [e.g., rape, physical assault] versus noninterpersonal [e.g., disaster, motor vehicle accident]), and the amount of distress experienced at the time of the trauma, to determine if the scales were associated with these variables in the manner suggested by the existing literature. The number of lifetime traumas experienced (i.e., RTE scale) was significantly correlated with most of the symptom scales. As expected, greater exposure to trauma was associated with increased reporting of distress, reexperiencing, avoidance, hyperarousal, posttraumatic impairment, dissociation, and suicidality. Similarly, respondents' ratings of the level of distress experienced at the time of the trauma were found to be significant predictors of subsequent posttraumatic stress levels. As the literature would suggest, higher levels of distress were associated with higher levels of reexperiencing, avoidance, hyperarousal, and posttraumatic impairment. Finally, as anticipated, respondents who experienced interpersonal trauma reported significantly higher levels of distress, reexperiencing, avoidance, and suicidality than did those who had experienced noninterpersonal trauma. Convergent and discriminant validity were assessed by correlating the DAPS scales with various other measures. In general, the Positive Bias and Negative Bias scales of the DAPS were significantly correlated in the anticipated direction (in the ± .4 to .5 range) with the validity scales from the Trauma Symptom Inventory (Briere, 1995), the Minnesota Multiphasic Personality Inventory (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989), and the Personality Assessment Inventory (Morey, 1991) indicating good convergent and discriminant validity. Similarly, the DAPS symptom scale scores were also correlated with symptom scales from these other measures as an assessment of convergent validity. Over 92% of these correlations (46 of 51) were above .60 whereas 33% exceeded .70. When the DAPS subscale scores were correlated with scales from less-related measures (as an assessment of discriminant validity) the magnitude of the correlations was less than .5 in 75% of the cases. The same strategy was used to assess the convergent and discriminant validity of the DAPS associated feature scales and produce similar support for the validity of these scales. The DAPS has also been shown to have a high level of diagnostic agreement (Kappa = .73) with the Clinician-Administered PTSD Scale (CAPS; Blake et al., 1990), a measure that requires nearly three times the amount of time to administer compared to the DAPS. Additionally, the DAPS has been shown to have good sensitivity (.88) and specificity (.86). COMMENTARY. The DAPS was developed to closely conform to the PTSD diagnostic criteria and includes specific scales for each of the three symptom clusters as well as individual scales for three associated features. Its developer is clearly an expert in the field of PTSD assessment. The manual is well written and contains information of the measure's development, administration, scoring, interpretation, and psychometric properties as well as normative information on nearly 450 trauma-exposed individuals. However, additional information on the norming sample such as the response rate to the mailing and representativeness of respondents to the original sample would have been helpful to include. The data provided on the DAPS to date suggest that it is a psychometrically sound measure of PTSD. SUMMARY. The DAPS is a promising measure for assessing PTSD and distinguishing it from ASD. Although information on the stability of the measure is lacking, other psychometric properties are quite acceptable. REVIEWER'S REFERENCES Blake, D. D., Weather, F. W., Nagy, L. M., Kaloupek, D. G., Klauminzer, G., Charney, D. S., & Keane, T. M. (1990). A clinician rating scale for assessing current and lifetime PTSD: The CAPS-1. The Behavior Therapist, 13, 187-188. Briere, J. (1995). Trauma Symptom Inventory. Odessa, FL: Psychological Assessment Resources, Inc. Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A., & Kaemmer, B. (1989). Minnesota Multiphasic Personality Inventory (MMPI-2): Manual for administration and scoring. Minneapolis: University of Minnesota Press. Morey, L. C. (1991). Personality Assessment Inventory: Professional manual. Odessa, FL: PAR Psychological Assessment Resources, Inc. Review of the Detailed Assessment of Posttraumatic Stress by LARISSA SMITH, Presley Center for Crime and Justice Studies, University of California, Riverside, CA: DESCRIPTION. The Detailed Assessment of Posttraumatic Stress (DAPS) is a 104-item, selfreport paper-and-pencil inventory measuring extent of trauma exposure and post-traumatic response. Subscales include three trauma-specific subscales (Relative Trauma Exposure, Peritraumatic Distress, Peritraumatic Dissociation), five posttraumatic scales (Reexperiencing, Avoidance, Hyperarousal, Posttraumatic Stress total, Posttraumatic Impairment), three associated features scales (Trauma-Specific Dissociation, Substance Abuse, and Suicidality), and two validity scales (Positive Bias and Negative Bias). Questions are either dichotomous or on a 5point Likert scale and address experiences and behaviors both during the event and during the month before protocol administration. The DAPS converts to a scoring sheet designed to facilitate hand-scoring, including a worksheet area for evaluating the extent to which the examinee meets DSM-IV criteria for Post-Traumatic Stress Disorder (PTSD). Profile charts are provided for both men and women, allowing visual comparison to the normative sample using standardized T scores. The test can be administered by nonclinical staff, though the interpretation of scores and profiles requires graduate training in clinical/counseling psychology and in test interpretation. Specific instructions for examinees are included in the manual. The manual also provides guidelines for dealing with missing data, calculating raw scores, and T-score conversion, and provides sample profile interpretation case studies. The test takes approximately 20-30 minutes to complete and requires the equivalent of a sixth-grade reading level. DEVELOPMENT. An initial pool of 190 items was reduced to 104 through consultation with expert clinicians and through item analysis based upon the first 105 participants in the normative sample. Scales appear to have been developed based upon DSM-IV criteria and prior research in the field of posttraumatic stress. The manual provides a detailed description of each scale, including item content, characteristics of high scorers, and empirical and/or theoretical basis. TECHNICAL. Standardization. The authors employed a national sampling service to construct a stratified random sample of adults from Department of Motor Vehicles registries and telephone books. Participants were mailed the DAPS as part of a battery of instruments assessing trauma-related experience, including a survey specifically designed to evaluate the presence or absence of childhood and adult trauma. Of the participants contacted, 620 completed the protocol (there is no information about what response rate this represents), and 446 of those participants reported having experienced at least one DSM-IV-TR-level incident in the past. In addition, a sample of 70 university students were administered the protocol in order to extend the age range of the sample. In the trauma-exposed sample, mean age was 45.6 years (range 18-91). Just over half the respondents were men, and the sample was primarily (83.4%) Caucasian. Analyses of this sample showed no age or ethnicity differences in scale scores. Some scales have gender differences; the manual presents norms by gender and separate profile sheets to take those differences into account. Reliability. When the normative process was complete, further data were collected in a clinical/community sample and an undergraduate sample (N = 257) in order to assess reliability and validity. Participants in the undergraduate sample also reported at least one prior traumatic event. The clinical sample (N = 191) was recruited by clinicians in various parts of the United States; the community sample (N = 58) was recruited through flyers and newspaper advertisements and included participants with at least one prior traumatic event. The community sample was primarily female (80%) and Caucasian (77%), mean age of 35 years. The university sample was similarly primarily female (74%) and Caucasian (84%), mean age of 19.6 years. Alpha reliabilities for the scales range from .52 (Negative Bias) to .96 (Posttraumatic StressTotal) overall, though it should be noted that the Negative Bias scale is intended to detect fake- bad responses based upon endorsement of bizarre or unusual symptoms and is not intended to measure a single construct. Reliabilities were marginally lower in the university sample than in the clinical/community sample. No information on test-retest reliability is provided. Most interscale correlations are above .30. Validity. The manual provides an impressive amount of validity information. Depending upon the subsample, the DAPS was co-administered with some subset of at least a dozen scales, including the Minnesota Multiphasic Personality Inventory-II (MMPI-2). The DAPS Positive Bias (PB) and Negative Bias (NB) scales correlate substantially, and in the predicted direction, with validity scales from other trauma- and personality-related assessment instruments. Correlations between the symptom scales and symptom scales of other inventories are presented with their associated Ns and are mostly in the .60-.80 range. Correlations with scales measuring antisocial personality, mania, and somatic complaints, theoretically and empirically unrelated to PTSD, were substantially lower, in the .10-.30 range. Diagnostic utility for PTSD assessment was assessed against the Clinician-Administered PTSD Scale (CAPS). On the basis of the CAPS, a subsample of participants from the clinical sample was categorized as PTSD positive (N = 25) or PTSD negative (N = 44). The DAPS miscategorized only nine of this sample-six false positives and three false negatives-producing a _appa of .73, sensitivity of .88, and specificity of .86. Diagnostic utility for Acute Stress Disorder (ASD) was not assessed due to the recency of the diagnostic category and the paucity of structured clinical interview assessments, and the manual recommends caution in diagnosing ASD solely on the basis of the DAPS decision rules. COMMENTARY. The DAPS manual presents a very thorough survey of currently used PTSD assessment instruments and makes a well-supported case for the DAPS' contribution over and above existing instruments. There is also an impressive level of detail in the scale descriptions, the administration and scoring instructions, and the profile interpretation examples. Information on the normative sample and the validational process is also presented in considerable detail. With regard to the normative sample itself, a substantial amount of care was taken in the acquisition and composition of traumatized and comparison subsamples. The scales have a higher degree of overlap (as indicated by interscale correlations) than might be considered optimal, but the scale structure is well-grounded in prior literature. Items are for the most part clearly worded and readily understandable, though there is the occasional digression into the vernacular (e.g., Item 24, "You 'spaced out.'"). The answer sheet is a bit awkward in its flow, but the ease of scoring and diagnosis that it provides outweighs that awkwardness. Profile sheets are easily understood and completed. That the DAPS allows for both scale scoring and profile interpretation is a benefit, especially given the detailed examples and interpretive instructions. SUMMARY. The DAPS can be administered easily and relatively quickly, and provides a large amount of information. Issues of missing data, response bias, gender effects, and data administration conditions are all adequately addressed in the manual, and evidence for internal consistency reliability and for discriminant, convergent, and predictive validity is fair to good. Scales are well-grounded theoretically and empirically, and the author provides a well-done and detailed placement of the DAPS within the body of already-existing instruments. The bulk of the evidence weighs in favor of the test's utility for its stated purpose.