Abstract for:A Model-Based Criticism of Optimal Thresholds for PTSD Diagnosis

Diagnosis of post-traumatic stress disorder (PTSD) is often based on “optimal” thresholds on screening scores. The common presumption is that individuals belong to one of two groups: with and without PTSD. Researchers investigate a diagnosis threshold to minimize false positives and negatives. However, there are three major issues with this approach: Scores close to but on opposite sides of the threshold are characterized as significantly different rather than somewhat similar; optimal thresholds are examined independently from the effectiveness of treatment; and the effects of stigma, which impedes patients from seeking care, are ignored. Stigma creates a vicious cycle: It leads individuals to hide their symptoms during screenings, which in turn increases false negatives and severe cases, leading to an even higher social perception of risks of PTSD and, subsequently, more stigma. We developed a simulation model that includes the effectiveness of treatment and stigma. We contend that current diagnosis policies are only effective in the short term. In order to achieve a reduction in the number of severe PTSD cases, everyone in proximity to a trauma should be identified as positive, scaled on a continuous measure, and receive early care. As a result, the reinforcing loop that previously acted