Example Of Literature Review On Use Of The Impact Of Event Scale-Revised (Ies-R) To Assess Post-Traumatic Stress Disorder (PTSD)

Abstract

Post-Traumatic Stress Disorder (PSTD) is an anxiety disorder that is related to serious traumatic experiences and events. Different tools have been devised to assess PTSD. One of the most important tool in its assessment is The Impact of Event Scale-Revised (IES-R). It is an effective tool as it correlates with the DSM-IV criteria for PTSD. The IES-R instrument functions in such a way that the observation of the cut-off score or the kappa coefficients helps one assess and evaluate PTSD. The IES-R can be used to do repetitive measurements with the objective of monitoring the progress among PTSD individuals. This tool has successfully been used in various circumstances such as child soldiers, ICU survivors, older adults, and bereaved people. However, it can become difficult to assess PTSD in certain situations as, for example, PTSD individuals, who fail to identify their past stressful experiences, make it hard for the medical professionals to use the IES-R instrument to assess their conditions.

Use of The Impact of Event Scale-Revised (IES-R) to assess Post-Traumatic Stress Disorder

Introduction
Post-Traumatic Stress Disorder (PSTD) is an anxiety disorder that is related to serious traumatic experiences and events of the past life. It is characterized by recurrent thoughts, survivor guilt, lack of involvement with reality, and reliving of trauma in dreams (Buckley, 2013). It is considered as the fifth most common psychiatric disorder, and is two times more common in women as compared to men (Almli, Fani, Smith, & Ressler, 2014). According to Morina, Ehring, & Priebe, (2013), PTSD is a common experience among old people, especially when they go through periods or moments of depression. Researchers have also noted that it is rapidly becoming a global issue; therefore, several tools have been designed and developed to help in its assessment (Krippner, Pitchford, & Davies, 2012). PTSD is among the most common psychiatric problems, so it is important to use advanced tools to assess PTSD.
Presently, The Impact of Event Scale-Revised (IES-R) is widely used in the assessment of patients with PTSD (Farčić & Barać, 2012). Symptoms of PTSD that result in the use of IES-R include re-experiencing symptoms, avoidant symptoms, negative altercations and mood symptoms, and arousal symptoms (Chen et al., 2014). According to Hyer & Brown (2008), IES-R plays an integral role in the assessment of subjective distress that result from traumatic events. IES-R is a revised version of the older version (IES) having 15 items. The revised version of IES-R contains additional seven items related to hyperarousal symptoms of PTSD (Hyer & Brown, 2008). Now, IES-R has 22 items that are used to illustrate different symptoms associated with a traumatic experience or event. These items have three response subscales; Intrusion, Avoidance, and Hyperarousal. Intrusion is assessed with seven items, Avoidance is assessed with eight items and Hyperarousal is assessed with seven items (Paton, 2012). Additionally, its use is effective as it correlates with the DSM-IV criteria for PTSD. These items are helpful in working on 14 out of the 17 DSM-IV symptoms found in PTSD. IES-R is different from all other tools as it is self-administered questionnaire issued to PTSD patients. Moreover, it can be used in different languages, and researchers have found no bias of IES-R in favor of any language out of English, German, Czech, Polish, Italian, Swedish, Spanish, and Turkish (Feuerherd, Knuth, Muehlan, & Schmidt, 2014). IES-R can also help in early detection of chronic PTSD (Mouthaan, Sijbrandij, Reitsma, Gersons, & Olff, 2014).

Use of IES-R in assessment of PTSD

IES-R is used as a screening tool (Horowitz, 1979) for the treatment of individuals suffering from PTSD, especially those individuals, who suffer from depression as a result of their experiences in wars or other traumatic events. In this assessment, respondents are asked to rate the frequency of symptoms of PTSD in the past month on a scale of “5” from 0 as “Not at all” to 4 as “Extremely”. The total severity score as a result of assessment is obtained after summation of all scores, and this total score ranges from 0 to 88. Moreover, subscale scores can also be computed for the three symptom cluster subscales. This assessment takes about 10 to 15 minutes to complete (Friedman, Keane, & Resick, 2014; Nutt, & Ballenger, (2008). It can also be used through telephonic conversation (Stevens, Hart, & Herridge, 2014).The IES-R instrument functions in such a way that the observation of the cut-off score or the kappa coefficients helps one assess and evaluate PTSD.
The use of the IES-R is effective and good in screening of PTSD among patients because the tool can identify the absolute majority of individuals suffering from PTSD (Morina et al., 2013). However, the use of IES-R requires a trained interviewer, so that there would be no complications in the process (Ford, 2009). Essentially, there should be good understanding and relations between PTSD individuals and medical professionals. Medical professional can start with the treatment of depression. This will enhance the working of IES-R tool in evaluation of conditions of the PTSD individuals (Roberts, 2003).

Use of IES-R in children with symptoms of PTSD

IES-R has been effectively used as an instrument for screening PTSD in several health institutions and various cultural settings across the world as it has more depth and is not much time consuming (Luber, 2013). Moreover, it shows good reliability as well as validity (Moscardino, Scrimin, Cadei, & Altoe, 2012). For instance, researchers successfully used IES-R to assess PTSD symptoms of Ugandan child soldiers. In that study, children filled the items of IES-R, and showed that the death of a parent could increase the score for avoidance symptoms (Derluyn, Broekaert, Schuyten, & Temmerman, 2004). In another study on child soldiers, in Northern Uganda, researchers have found that IES-R can help in distinguishing the problems of child soldiers from never-abducted children. Former child soldiers face more war-related traumatic events as compared to nonabducted children. Total scores on PTSD symptoms were significantly high for child soldiers (Moscardino et al., 2012).

Use of IES-R in older adults with symptoms of PTSD

The physical and psychological functioning of the old is very different from that of young people. They are prone to memory lapses, and they often find it hard to identify their past stressful events. Apparently, the effect or impact of disasters on old people is recognized by the fact that they are always under serious medication, chronic illnesses, as well as sensory limitations (Wu et al., 2011). In some circumstances, old people are unable to talk or hear because of a past traumatic experience (Schelling & Kapfhammer, 2013).
People across the globe are concerned about the conditions of the old people because of their past traumatic experiences and impacts of those experiences on them. Evaluation of responses of adults to disasters has been done, and this has been facilitated by the use of IES-R. It can also help in the determination of posttraumatic stress after many years of the traumatic event. Moreover, the target population of the use of IES-R is both healthy and frail older adults who have experienced any traumatic events (Khitab et al., 2013). The IES-R can be used to do repetitive measurements with the objective of monitoring the progress among PTSD individuals (Beck & Sloan, 2012).
In a study, researchers examined posttraumatic stress in people, who survived after an MS Estonia ferry disaster. In the study, researchers surveyed 51 Swedish survivors with the help of IES-R at 3 months, 1, 3, and 14 years after the disaster. They found that symptoms reduced in the first year, but no change was found after that. Moreover, 27% of survivors reported significant symptoms after 14 years. Researchers found that posttraumatic event can change with time, but traumatic bereavement can hinder the recovery (Arnberg, Eriksson, Hultman, & Lundin, 2011).

Use of IES-R for bereaved people

IES-R can be used to detect posttraumatic reactions in the bereaved relatives of a terror attack on youngsters as shown by a research of Dyregrov, Dyregrov, & Kristensen, (2014) on the parents and siblings, whose relatives were killed in a terror attack on political youth camp in Norway. In another study, researchers worked with Japanese undergraduate students, who were bereaved of their loved ones in the past 5 years. Researchers found that posttraumatic growth of those students increased initially but then decrease with time (Taku, Tedeschi, & Cann, 2014).

Use of IES-R in patients, especially ICU survivors

IES-R can help in identifying the psychological problems in Intensive Care Unit (ICU) survivors. It can help in assessing whether the patient require further treatment or not. In a study, researchers assessed 61 patients after 3, 6 and 12 months of intensive care. They were assessed with IES-R along with the Hospital Anxiety and Depression Scale (HADS). Researchers found that 34 of 61 patients showed moderate to severe symptoms of posttraumatic stress and/or depression or anxiety. Researchers concluded that screening and treatment of patients in the first six months can help in reducing further follow-up after spending time in intensive care (Schandl et al., 2011).
The IES-R can also be used to evaluate the conditions of patients of acute lung injury (ALI). Researchers have reported that patients, who have gone through the critical illnesses such as ALI may experience symptoms of PTSD. They compared IES-R with the Clinician-Administered PTSD Scale (CAPS), which is considered as the reference standard for PTSD diagnosis. They concluded that IES-R is “an excellent brief PTSD symptom measure and screening tool” in the survivors of ALI (Bienvenue et al., 2013a). In a prospective, longitudinal cohort study, researchers assessed patients from 13 ICUs from four different hospitals. Researchers followed-up the patients 3, 6, 12 and 24 months after the onset of ALI. These patients were assessed with IES-R, and researchers found that 66 out of 186 patients showed symptoms of PTSD with the greatest prevalence found in 3rd month. Researchers have concluded that PTSD symptoms are commonly found in patients after ALI (Bienvenu et al., 2013b).

Difficulties faced by experts in the use of IES-R

It is argued that, in assessing PTSD among individuals, they are often asked to identify specific stressful life experiences or events, and they have to indicate how much distressed they were during those experiences (Tramm, Hodgson, Ilic, Sheldrake, & Pellegrino, 2014). PTSD individuals, who fail to identify their past stressful experiences, make it hard for the medical professionals to use the IES-R instrument to assess their conditions. Apparently, stressful experiences are memorable except for a few individuals, who are always mentally disturbed and have memory lapses.

Concluding Remarks

Individuals suffering from PTSD are on a safe side today due to the use of a variety of instruments to evaluate and assess their conditions. In this case, one of the most important tools is IES-R. It is a self-administered, 22-item questionnaire that is used in the assessment and evaluation of symptoms exhibited by individuals suffering from PTSD (Lanius et al., 2010). The evaluated symptoms include intrusion, avoidance, as well as hyperarousal. The use of the IES-R as a tool for screening of PTSD is on the rise worldwide because it is short, easily administered and scored method for the assessment of PTSD. However, only trained persons should be allowed to use the IES-R to assess or evaluate the conditions of PTSD individuals. These trained experts can overcome the problems, which are usually faced by people in the use of IES-R.

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