The Impact of Event Scale-Revised: Examining Its Cutoff Scores among Arab Psychiatric Patients and Healthy Adults within the Context of COVID-19 as a Collective Traumatic Event

Abstract

The Impact of Event Scale-Revised (IES-R) is the most popular measure of post-traumatic stress disorder (PTSD). It has been recently validated in Arabic. This instrumental study aimed to determine optimal cutoff scores of the IES-R and its determined six subscales in Arab samples of psychiatric patients (N = 168, 70.8% females) and healthy adults (N = 992, 62.7% females) from Saudi Arabia during the COVID-19 pandemic as a probable ongoing collective traumatic event. Based on a cutoff score of 14 of the Depression Anxiety Stress Scale 8-items (DASS-8), receiver operator curve (ROC) analysis revealed two optimal points of 39.5 and 30.5 for the IES-R in the samples (area under the curve (AUC) = 0.86 & 0.91, p values = 0.001, 95% CI: 0.80–0.92 & 0.87 to 0.94, sensitivity = 0.85 & 0.87, specificity = 0.73 & 0.83, Youden index = 0.58 & 0.70, respectively). Different cutoffs were detected for the six subscales of the IES-R, with numbing and avoidance expressing the lowest predictivity for distress. Meanwhile, hyperarousal followed by pandemic-related irritability expressed a stronger predictive capacity for distress than all subscales in both samples. In path analysis, pandemic-related irritability/dysphoric mood evolved as a direct and indirect effect of key PTSD symptoms (intrusion, hyperarousal, and numbing). The irritability dimension of the IES-R directly predicted the traumatic symptoms of sleep disturbance in both samples while sleep disturbance did not predict irritability. The findings suggest the usefulness of the IES-R at a score of 30.5 for detecting adults prone to trauma related distress, with higher scores needed for screening in psychiatric patients. Various PTSD symptoms may induce dysphoric mood, which represents a considerable burden that may induce circadian misalignment and more noxious psychiatric problems/co-morbidities (e.g., sleep disturbance) in both healthy and diseased groups.

Cardiometabolic Morbidity (Hypertension and Obesity) in PTSD: Treatment Implications for the Predictive Validity of Two Structures of the Impact of Event Scale-Revised

“…Reporting/recall bias is inherent in self-reported data like in the present study. PTSD as a diagnosis was based on self-reported measures only, with lack of confirmation of Criterion A in the DSM (COVID-19 was not confirmed by the respondents as a direct threat) [38], which casts doubt on the credibility of the results. The absence of some key measures (e.g., mood symptoms) deprived us of the chance of having an in-depth investigation of factors, which may influence the association of PTSD components with cardiometabolic problems in this sample.…”

“…It significantly predicted psychological distress in psychiatric patients and healthy adults. The predictivity of the factors of this structure differed considerably, with the highest predictivity reported for hyperarousal and irritability [38]. Until this moment, this structure has not been tested in other groups or cultures.…”

“…It consists of three subscales, herein referred to as IES-R3, which measure intrusion (e.g., intrusive thoughts/feelings/imagery and nightmares: items 1, 2, 3, 6, 9, 14, 16, and 20), avoidance (e.g., avoidance of feelings/situations/ideas: items 5, 7, 8, 11, 12, 13, 17, and 22), and hyperarousal (e.g., anger/irritability and hypervigilance/heightened startle: items 4, 10, 15, 18, 19, and 21) [40]. The six dimension structure of the IES-R, herein referred to as IES-R6, are avoidance (items 5,8,11,17,22), intrusion (items 1, 3, 6, 9, 20), numbing (e.g., numbing of responsiveness: items 7, 12, 13, 14), hyperarousal (e.g., physical reactions and being on guard: items 16, 18, 19, 21), sleep problems/disturbance (e.g., trouble falling staying asleep, items 2, 15), and irritability/dysphoria (e.g., anger and irritability: items 4, 10) [38]. The respondents rate the items of the IES-R on 5-point equal response intervals ranging from 0 (not at all) to 4 (extremely) [40].…”

“…The six-dimension structure of the IES-R has been reported recently in two Arab samples of healthy adults and psychiatric patients, and it expressed superior construct validity relevant to previously reported structures. Its subscales demonstrated good internal consistency, discriminant validity, convergent validity, and criterion validity, which denotes their usefulness for revealing people with higher levels of distress [37,38]. The concurrent validity of this structure has not been tested yet, with a possibility that its psychometric qualities may considerably vary in a different cultural context.…”

Male Victims of Sexual Abuse: Impact and Resilience Processes, a Qualitative Study

“…Thus, traumatic memory might worsen the overall feeling of hurt and losing control, hence the defensive use of avoidance strategies [ 19 ]. Traumatic memory figures among numerous symptoms of PTSD, along with persistent stress responses, hyperarousal, dysphoric mood, and circadian rhythm dysregulation [ 20 ], and increases the risk of psychoactive substance use and suicidality.…”