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How to Use the Trauma Screening Questionnaire (TSQ)
Manual for The Trauma Screening Questionnaire (TSQ)
**NOTE: The Trauma Screening Questionnaire form, found under Online Forms, is used with permission from the authors.
Description and Use
The Trauma Screening Questionnaire (TSQ: Brewin et al. 2002) is a self-report measure of responses to a traumatic event. It consists of 10 questions measuring reexperiencing and arousal symptoms adapted from the Post-traumatic Stress Disorder (PTSD) Symptom Scale (PSS-SR; Foa et al. 1993). It is designed for use a month or more following exposure to a traumatic event to identify individuals who are likely to be currently suffering from PTSD.
The original TSQ paper had been cited 139 times as of September 2014. A review conducted in 2013 determined that 28 governmental and nongovernmental organisations (in various countries) concerned with mental health issues and/or high risk populations had the TSQ on their websites as a mental health education material and self-screening tool. Use of the TSQ is now part of a standard recommended protocol developed for firefighters in the United States as part of Firefighter Life Safety Initiative 13 (http://flsi13.everyonegoeshome.com/). The review also determined that the TSQ had been included in 56 studies, with 32 of them applying it as an assessment tool of PTSD symptoms, and another 18 using it as a screening instrument of the risk of PTSD development. Fifteen studies took place in the UK, 11 in the USA, 9 in Australia, 6 in the Netherlands, and one each in Canada, France, Iceland, India, Republic of Congo, and Republic of Georgia. Studies include the survey of Adult Psychiatric Morbidity in England, 2007, and a programme to screen survivors of the 2005 London bombings and identify those who required treatment (Brewin et al., 2008, 2010a).
Administration
The TSQ is a self-report questionnaire and takes only a few minutes to complete. Instructions are given at the top of the questionnaire.
Scoring
Scoring is straightforward. The 10 questions require a yes or no answer. Six or more positive responses mean that the client is at risk of having PTSD according to the DSM-IV (American Psychiatric Association, 1994) and requires a more detailed assessment. The TSQ has not yet been validated against a DSM-5 PTSD diagnosis but the threshold is likely to be the same.
Interpretation
The time frame for use of the scale is a month or more following exposure to a traumatic event – it is not designed to be used before that time as there is likely to be a temporary elevation of symptoms that will recover naturally. It assesses current symptoms (i.e. those present in the past week). It does not diagnose Post-traumatic Stress Disorder. Its use is recommended in acute settings e.g. liaison services, primary care. It is based on research conducted in the south east of England.
Psychometric Details
Evaluation
The TSQ was originally administered to forty-one train crash survivors, all of who were interviewed one week later with a structured diagnostic interview for PTSD, the Clinician Administered PTSD Scale (CAPS: Blake et al. 1995). The rate of PTSD in this sample was 34%. Using a cutoff of 6 or more positive responses the TSQ performed as follows: sensitivity .86, specificity .93, positive predictive power .86, negative predictive power .93, overall efficiency .90). In a replication sample of 157 victims of violent crime, where the rate of PTSD as determined by a questionnaire was 26.8%, the TSQ performed as follows: sensitivity .76, specificity .97, positive predictive power .91, negative predictive power .92, overall efficiency .92). Further details can found in Brewin et al. (2002).
The utility of the cut-off score of 6 has been replicated by Walters et al. (2007). Dekkers et al. (2009) tested the ability of the TSQ to predict PTSD over a slightly longer period in a Dutch sample. The TSQ was administered about 2 weeks post-trauma and PTSD assessed one month later using a different clinical interview (the Clinician Administered PTSD Scale). The optimum cut-off was 7. This is consistent with the trend for trauma symptoms to diminish steadily over time, and suggests that to predict later PTSD slightly higher cutoff scores may be required.
The performance of the TSQ has also been tested after a major terrorist attack, the 2005 London bombings (Brewin et al., 2010b). This event differed from traumas featuring in previous research in that a whole community was affected, there was extensive and prolonged media coverage, and there was ongoing threat of further attacks. Under these circumstances the sensitivity of the TSQ remained high but specificity was initially greatly reduced, increasing steadily over the following two years. Specificity was also lower in respondents from ethnic minorities. There are no data to indicate if these effects are common to other screening instruments or are likely to be specific to the TSQ.
Comparison
While there are now many questionnaires designed to assess PTSD symptoms that could be employed for screening purposes (see Brewin, 2005, and Brewin, Rose & Andrews, 2003, for reviews), the TSQ is one of the simplest and shortest self-report measures currently available. The performance of the TSQ is as good if not better than other available instruments and has been found to be equivalent to that obtained from the comparison of diagnoses yielded by the two most highly regarded interview assessments currently available for PTSD: the Structured Clinical Interview for DSM-IV (SCID, First et al. 1996) PTSD module and the CAPS.
There appear to be two main limitations. Firstly, the TSQ was not designed to assess multiple or very extended trauma and may underestimate the effects of this. This is a limitation when assessing populations such as military veterans or victims of domestic violence. Secondly, interpretation of the findings should be cautious while its use is explored further with populations differing in ethnic and cultural background, in type of trauma, and in base rates of PTSD.
Other TSQ Versions
The TSQ has been adapted for children (Kenardy et al., 2006). Translated versions of the adult TSQ available from the author include Arabic, French, Dutch, German, Finnish, Swedish, Romanian, Lithuanian, Georgian, Chinese, and Japanese.
References
Andrews B, Brewin CR, Rose S & Kirk M (2000) Predicting PTSD in victims of violent crime: The role of shame, anger and childhood abuse. Journal of Abnormal Psychology 109,69-73.
Blake DD, Weathers FW, Nagy LM et al. (1995) The development of a clinician-administered PTSD Scale. Journal of Traumatic Stress 8, 75-90.
Brewin CR (2005) Systematic review of screening instruments for the detection of posttraumatic stress disorder in adults. Journal of Traumatic Stress, 18, 53-62.
Brewin CR, Andrews B, Rose S & Kirk M (1999) Acute stress disorder and posttraumatic stress disorder in victims of violent crime. American Journal of Psychiatry 156, 360-366.
Brewin CR, Fuchkan N, Huntley Z, Robertson M, Thompson M, Scragg P, d’Ardenne P & Ehlers A (2010a). Outreach and screening following the 2005 London bombings: Usage and outcomes. Psychological Medicine, 40, 2049-2057.
Brewin CR, Fuchkan N, Huntley Z & Scragg P (2010b). Diagnostic accuracy of the Trauma Screening Questionnaire after the 2005
Brewin CR, Rose S & Andrews B (2003) Screening to identify individuals at risk after exposure to trauma. In R Ørner & U Schnyder (Eds.), Reconstructing Early Intervention After Trauma.
Brewin CR, Rose S, Andrews B, Green J, Tata P, McEvedy C, Turner S & Foa EB (2002) Brief screening instrument for post-traumatic stress disorder. British Journal of Psychiatry 181, 158-162.
Brewin CR, Scragg P, Robertson M, Thompson M, d’Ardenne P & Ehlers A (2008) Promoting mental health following the
Dekkers AMM, Olff M, & Näring GWB (2009) Identifying persons at risk for PTSD after trauma with TSQ in the
First MB, Spitzer RL, Gibbon M et al. (1996) Structured Clinical Interview for DSM-Axis 1 Disorders.
Foa EB, Riggs D, Dancu C & Rothbaum, B (1993) Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. Journal of Traumatic Stress 6, 459-474.
Kenardy, JA, Spence SH & Macleod AC (2006) Screening for posttraumatic stress disorder in children after accidental injury. Pediatrics, 118, 1002-1009.
Rose S, Brewin CR, Andrews B & Kirk M (1999) A randomized controlled trial of psychological debriefing in victims of violent crime. Psychological Medicine 29, 793-799.
Walters JTR, Bisson JI & Shepherd JP (2007) Predicting post-traumatic stress disorder: Validation of the Trauma Screening Questionnaire in victims of assault. Psychological Medicine, 37, 143-150.