Assessing posttraumatic stress related impairment and well-being: The Posttraumatic Stress Related Functioning Inventory (PRFI)

Highlights

• This study examines a novel measure of PTSD related functional impairment.

• Findings indicate that the measure has acceptable validity and reliability.

• The measure can be used in a time-efficient fashion to assess impairment.

• This measure can be useful for guiding further assessment and treatment.

Abstract

Posttraumatic stress symptoms are associated with poorer social and occupational functioning and quality of life. However, general assessments of functioning do not determine the extent to which these difficulties are directly related to PTSD symptoms. This study examines the psychometric properties of a self-report measure, the 27-item Posttraumatic Stress Related Functioning Inventory (PRFI), which was developed to provide a self-report tool for clinicians and researchers to better understand the perceived impact of PTSD symptoms on functioning. The psychometric properties of the PRFI were examined utilizing data collected within a larger study examining quality of life and functioning in 251 veterans who had served in OEF/OIF/OND and endorsed the presence of subsyndromal or greater levels of PTSD symptoms at screening. One-year test-retest reliability of the measure was examined in a subset of the baseline sample who received a second administration of the PRFI (n = 109). Higher levels of PTSD symptoms were associated with poorer functioning in all domains. The PRFI demonstrated convergent validity with a measure of PTSD symptoms and was less correlated with measures of alcohol and drug use, good internal consistency and test-retest reliability from baseline to one-year follow-up. The PRFI provides self-report information regarding several domains of functioning. This initial examination of psychometric properties of the scale indicated that it may be useful for efficiently eliciting information about the ways in which PTSD symptoms in veterans impact everyday functioning.

Introduction

Posttraumatic stress disorder (PTSD) has been highlighted as a signature wound of the conflicts in Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom; OIF; Operation New Dawn; OND), with rates of PTSD found to vary between 11% and 22% among veterans who served in these operations (Milliken et al., 2007, Seal et al., 2007). While a great deal of attention has been placed on the suffering associated with PTSD symptoms, less emphasis has been given to the equally important impact these symptoms have on the daily lives of veterans, in particular on their capacity to thrive at work or school and to develop, maintain and enjoy personal relationships. Indeed, it is well-established that PTSD symptoms are linked to difficulties in functioning across a number of life domains, including social and occupational functioning (Larson and Norman, 2014, Jakupcak et al., 2008, Beckham et al., 1997, Thorp and Stein, 2005, Prigerson et al., 2001, Rodriguez et al., 2012, Schnurr et al., 2009). Results from the National Vietnam Veterans Readjustment Study (NVVRS) found that veterans with PTSD, compared with combat exposed veterans without PTSD, had more interpersonal difficulties, greater occupational instability, poorer physical health, and greater medical service utilization (Kulka et al., 1990). Further analyses with this sample found that PTSD predicted poorer outcome in physical health, employment, and diminished well-being, over and above comorbid psychiatric and other medical disorders (Zatzick et al., 1997). Other studies examining interpersonal relationships among veterans with PTSD reported worse family relationships (Koenen et al., 2008), difficulties in intimacy and communication, and higher rates of separation and divorce (Riggs et al., 1998, Cook et al., 2004).

Assessment of PTSD-related functioning has been recommended for improved PTSD diagnostic accuracy, treatment, and assessment of treatment outcome (Rodriguez et al., 2012). The direct relationship of PTSD symptoms to social and occupational functioning and general quality of life is clouded by other conditions that commonly co-occur in individuals with PTSD, such as depression and substance use disorders. Moreover, variation in functioning among those with PTSD symptoms has been observed, such that some individuals with relatively mild severity of PTSD symptoms report substantial functional difficulties (e.g., McLaughlin et al., 2015, Pietrzak et al., 2009) while others with high symptom levels have reported positive changes in psychological and functional outcomes (e.g., relationship closeness; see Linley and Joseph, 2004 for review). This lack of a perfect correspondence between level of PTSD symptoms and functional impairment suggests a need for more precise assessment and a deeper understanding of this relationship. Further, general assessments of functioning do not determine the extent to which functioning difficulties are directly related to PTSD symptoms. Unfortunately, this can lead to mistaken assumptions regarding the impact of PTSD, versus other factors or co-morbid conditions, on social and occupational functioning and leave unanswered the question about the degree to which difficulties in functioning or poor quality of life are attributable to PTSD symptoms.

We have developed a self-report measure, the Posttraumatic Stress Related Functioning Inventory (PRFI), to begin to address this gap in knowledge. This brief measure is intended to provide a means for those providing psychiatric and psychological care to patients with PTSD to better understand the perceived impact of symptoms on social and occupational functioning and quality of life (i.e., lifestyle) and to indicate points of intervention. For this study we examined the psychometric properties of the PRFI utilizing data collected within a larger study examining quality of life and functioning in 251 OEF/OIF/OND veterans with PTSD symptoms. We also examined one-year test-retest reliability of the measure in a subset of the baseline sample (N = 109) who received a second administration of the PRFI.