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

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.
• ²
  American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Arlington: American Psychiatric Publishing; 2013.
• 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.
• 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.
• ⁵
  Reichenheim ME, Moraes CL. [Operationalizing the cross-cultural adaptation of epidemiological measurement instruments]. Rev Saude Publica. 2007;41:655-73.

Publication Dates

• Publication in this collection
  Jan-Feb 2019

History

• Received
  26 Apr 2018
• Accepted
  21 Sept 2018