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CAPS-5 Past Week (16April 2018) National Center for PTSD Page 2 of 21 Scoring 1. As with previous versions of the CAPS, CAPS-5 symptom severity ratings are based on symptom frequency and intensity, except for items 8 (amnesia) and 12 (diminished interest), which are based on amount and intensity. The Clinician-Administered PTSD Scale (CAPS) is an extensively validated and widely used structured diagnostic interview for posttraumatic stress disorder (PTSD). The CAPS was recently revised to correspond with PTSD criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013).

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Print version ISSN 1516-4446On-line version ISSN 1809-452X

http://dx.doi.org/10.1590/1516-4446-2018-0136

Letters to the Editor

The Clinician-Administered PTSD Scale (CAPS-5): adaptation to Brazilian Portuguese

¹Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil

²Departamento de Psiquiatria, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil

Establishing the diagnosis of posttraumatic stress disorder (PTSD) has always been a challenge in clinical practice, as well as in academic research. Since this diagnosis was first published in DSM-III,¹ several of its criteria have been modified and updated, reflecting current understanding of the disorder.

PTSD is currently considered a debilitating condition that develops from exposure to traumatic events such as actual or threatened death, actual or threatened serious injury, or actual or threatened sexual violence. One can develop PTSD symptoms by direct exposure (e.g., witnessing a traumatic event; learning that a relative or close friend was exposed to trauma) or by indirect exposure to aversive details of the event, usually in the course of professional duties. The DSM-5 lists 20 diagnostic criteria² divided into four symptom clusters: re-experience of the traumatic event; avoidance; persistent negative thoughts or feelings; and trauma-related arousal and reactivity.

The Clinician-Administered PTSD Scale (CAPS) is the non-self-administered scale most widely used for PTSD assessment in clinical and research scenarios. It assesses diagnostic status and symptom severity, and was developed in 1989 at the U.S. Department of Veterans Affairs National Center for PTSD.³ To reflect recent changes in the definition and diagnostic criteria of PTSD, the CAPS has been adapted to the DSM-5 criteria,⁴ and has demonstrated good psychometric properties when compared to its previous version. Even though the CAPS-5 is available in English, there is still no DSM-5-based, clinician-administered structured interview in the Brazilian Portuguese language to measure presence and severity of PTSD symptoms. In this letter, we describe the process of cross-cultural adaptation of the CAPS-5 for use in Brazil.

For the cross-cultural adaptation process, we used a formal, structured methodology to ensure conceptual, semantic, and operational equivalence.⁵ The original scale was translated into Brazilian Portuguese by two native Brazilian translators, experts in English, and both first versions merged by one of the authors of this study (RCS, bilingual and qualified in use of the previous version). Back-translation was performed by a native English speaker who is fluent in Portuguese and has extensive experience with psychological instruments. Then, an expert team evaluated the equivalence of the instrument to review cultural differences. A pilot study of this version of the instrument was conducted with five individuals who sought treatment at PROVE, a specialized outpatient PTSD clinic of the Universidade Federal de São Paulo (UNIFESP) Department of Psychiatry. The operational equivalence process was conducted by the expert team to analyze some discrepancies found when the target population completed the instrument, and a final version was proposed.

It is our opinion that incorporation of the CAPS-5 as a diagnostic instrument in the context of Brazilian violence is critical. A reliability study to assess the internal consistency of the final version of this instrument, after the cross-cultural adaptation process, is already ongoing. An important step to follow is validation of the translated version, which will allow it to be widely used in Brazil.

Acknowledgements

This study received financial support from Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP; grant 2014/12559-5) and from Conselho Nacional de Desenvolvimento Cientifico e Tecnológico (CNPq; grant 303389/2016-8).

References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III). Washington: American Psychiatric Publishing; 1980. [ Links ]

2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Arlington: American Psychiatric Publishing; 2013. [ Links ]

3. Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Gusman FD, Charney DS, et al. The development of a clinician-administered PTSD scale. J Trauma Stress. 1995;8:75-90. [ Links ]

4. Weathers FW, Bovin MJ, Lee DJ, Sloan DM, Schnurr PP, Kaloupek DG, et al. The clinician-administered PTSD scale for DSM-5 (CAPS-5): development and initial psychometric evaluation in military veterans. Psychol Assess. 2018;30:383-95. [ Links ]

5. Reichenheim ME, Moraes CL. [Operationalizing the cross-cultural adaptation of epidemiological measurement instruments]. Rev Saude Publica. 2007;41:655-73. [ Links ]

Received: April 26, 2018; Accepted: September 21, 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Weathers FW; Lee DJ; Bovin MJ; Sloan DM; Schnurr PP; Kaloupek DG; Keane TM; Marx BP

Basic description

CAPS-5 is a 30-item questionnaire, corresponding to the DSM-5 diagnosis for PTSD. The language of the CAPS-5 reflects both changes to existing symptoms and the addition of new symptoms in DSM-5. CAPS-5 asks questions relevant to assessing the dissociative subtype of PTSD (depersonalization and derealization), but no longer includes other associated symptoms (e.g., gaps in awareness).

There are three versions of the CAPS-5 corresponding to different time periods: past week (only to evaluate PTSD symptoms over the past week), past month (for current PTSD), and worst month (lifetime PTSD).

A version for children and adolescents ages 7 and above (CAPS-CA-5) is also available. The CAPS-CA-5 assesses the 20 DSM-5 PTSD symptoms.