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O. Joseph Bienvenu, MD, PhD; Dale M. Needham, MD, PhD; Ramona O. Hopkins, PhD
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From the Department of Psychiatry and Behavioral Sciences (Drs Bienvenu), and Division of Pulmonary and Critical Care Medicine (Dr Needham), Johns Hopkins University School of Medicine; and the Psychology and Neuroscience Center (Dr Hopkins), Brigham Young University.

Correspondence to: O. Joseph Bienvenu, MD, PhD, Johns Hopkins University School of Medicine, 600 N Wolfe St, Meyer 115, Baltimore, MD 21287; e-mail: jbienven@jhmi.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(6):1974-1975. doi:10.1378/chest.13-1940
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To the Editor:

We thank Drs Gnanavel and Robert for their comments on our recent article in CHEST,1 and we appreciate the opportunity to respond. Importantly, we cannot take credit for developing the Impact of Event Scale-Revised (IES-R).2 We simply assessed its measurement properties against a “gold standard” clinical interview, the Clinician-Administered Posttraumatic Stress Disorder Scale, in survivors of acute lung injury.

Drs Gnanavel and Robert highlight the shifting nature of psychiatric diagnosis with successive editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). We conducted our study during the era of the fourth edition (DSM-IV), but the fifth edition (DSM-5) was published a few months ago. Notably, the definition of ARDS has changed since we conducted our study, and the previous umbrella term “acute lung injury” has been eliminated.3

Where we may disagree with Drs Gnanavel and Robert is in their statement that DSM-5 changes necessitate substantial revisions to the IES-R to ensure its future clinical utility. To us, a posttraumatic stress disorder (PTSD) measurement tool has clinical utility if it addresses whether a person has substantial PTSD symptoms and whether symptom levels measured using the tool correlate with symptom levels measured using a clinical interview. Although there are changes in the DSM-5 definition, which include separation of the avoidance and numbing criteria and expansion of the potential associated symptoms from 17 to 20, in our view, the phenotype for PTSD is very similar in DSM-IV and DSM-5. Thus, regardless of whether the authors of the IES-R or other researchers further revise the instrument, it already meets our standard for clinical utility, whether PTSD is defined using DSM-IV or DSM-5.

As highlighted by Schelling and Kapfhammer4 in the editorial accompanying our article, tools such as the IES-R have a potentially important role to play in research and clinical practice because critical illness/intensive care-related PTSD symptoms are common5 but often overlooked. We encourage ongoing discussion and research in this area and thank Drs Gnanavel and Robert for raising these issues.

References

Bienvenu OJ, Williams JB, Yang A, Hopkins RO, Needham DM. Posttraumatic stress disorder in survivors of acute lung injury: evaluating the Impact of Event Scale-Revised. Chest. 2013;144(1):24-31. [CrossRef] [PubMed]
 
Weiss DS, Marmar CR. The Impact of Event Scale-Revised.. In:Wilson JP, Keane TM., eds. Assessing Psychological Trauma and PTSD: A Practitioner’s Handbook. New York, NY: Guilford Press; 1997:399-411.
 
Ranieri VM, Rubenfeld GD, Thompson BT, et al; ARDS Definition Task Force. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526-2533. [CrossRef] [PubMed]
 
Schelling G, Kapfhammer H-P. Surviving the ICU does not mean that the war is over. Chest. 2013;144(1):1-3. [CrossRef] [PubMed]
 
Davydow DS, Desai SV, Needham DM, Bienvenu OJ. Psychiatric morbidity in survivors of the acute respiratory distress syndrome: a systematic review. Psychosom Med. 2008;70(4):512-519. [CrossRef] [PubMed]
 

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References

Bienvenu OJ, Williams JB, Yang A, Hopkins RO, Needham DM. Posttraumatic stress disorder in survivors of acute lung injury: evaluating the Impact of Event Scale-Revised. Chest. 2013;144(1):24-31. [CrossRef] [PubMed]
 
Weiss DS, Marmar CR. The Impact of Event Scale-Revised.. In:Wilson JP, Keane TM., eds. Assessing Psychological Trauma and PTSD: A Practitioner’s Handbook. New York, NY: Guilford Press; 1997:399-411.
 
Ranieri VM, Rubenfeld GD, Thompson BT, et al; ARDS Definition Task Force. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526-2533. [CrossRef] [PubMed]
 
Schelling G, Kapfhammer H-P. Surviving the ICU does not mean that the war is over. Chest. 2013;144(1):1-3. [CrossRef] [PubMed]
 
Davydow DS, Desai SV, Needham DM, Bienvenu OJ. Psychiatric morbidity in survivors of the acute respiratory distress syndrome: a systematic review. Psychosom Med. 2008;70(4):512-519. [CrossRef] [PubMed]
 
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