{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T13:58:11Z","timestamp":1785592691080,"version":"3.56.0"},"reference-count":39,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":23,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Post\u2010traumatic stress disorder (PTSD) screening and prediction tools are widely used in veteran and trauma\u2010exposed populations, yet methodological practices show substantial gaps. Rigid threshold application, inconsistent calibration reporting and limited attention to sex\u2010based performance differences, comorbid conditions including traumatic brain injury (TBI) and moral injury and cultural context may introduce inequities and reduce clinical utility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>PTSD screening programmes miss cases in some groups while over\u2010referring in others, yet lack practical guidance for addressing these disparities. We provide an implementation framework that operationalizes existing standards (TRIPOD\u2010AI, PROBAST\u2010AI) with concrete, PTSD\u2010specific procedures for calibration assessment, sex\u2010stratified analysis and comorbidity integration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a systematic scoping review of PTSD screening and prediction studies (2019\u22122024,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200975 studies) and synthesized published meta\u2010analytic evidence on TBI\u2010PTSD associations as a worked exemplar of comorbidity integration. We developed a tiered implementation framework (Tier 1: minimum standards; Tier 2: recommended practices; Tier 3: excellence standards) addressing observed heterogeneity. Technical feasibility was demonstrated using synthetic data explicitly matching published PTSD parameters from landmark veteran studies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The scoping review of 75 studies (2019\u22122024) found that only three studies (4.0%) reported calibration metrics, and only 10.7% provided sex\u2010disaggregated performance metrics. Current reporting practices inadequately address TBI\u2010PTSD comorbidity heterogeneity, moral injury (0% of studies) and cultural adaptation. These findings document substantial methodological gaps and demonstrate framework recommendations target empirically observed heterogeneity. The framework organizes recommendations into three tiers based on feasibility and resource requirements. Tier 1 standards (achievable by all studies) include: precise population definition, pre\u2010specified thresholds, calibration slope reporting, sex\u2010disaggregated performance and missing data documentation. Tier 2 recommendations (feasible for most studies) include: bootstrap internal validation, formal sex\u2010stratified calibration testing with specified interaction thresholds (|\n                      <jats:italic>\u03b2<\/jats:italic>\n                      <jats:sub>3<\/jats:sub>\n                      |\u2009&gt;\u20090.10), decision curve analysis, comorbidity integration and multiple imputation (\n                      <jats:italic>m<\/jats:italic>\n                      \u2009\u2265\u200920). Tier 3 excellence standards (aspirational for well\u2010resourced studies) include: rigorous multi\u2010site external validation, annual calibration monitoring and cultural adaptation for refugee contexts. Synthetic data demonstration (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009850, matching Bovin 2016 and Wortmann 2016 published parameters: PTSD prevalence\u2009=\u200933%, PCL\u20105 distributions, TBI prevalence\u2009=\u200935%) confirmed technical feasibility using standard statistical software. Bootstrap validation (500 iterations) yielded optimism\u2010corrected AUC\u2009=\u20090.969 with negligible optimism. Sex\u2010stratified analysis detected meaningful calibration differences (|\u0394|\u2009=\u20090.14, exceeding threshold). Comorbidity analysis revealed prevalence stratification (40.4% vs. 30.6%) despite minimal discrimination improvement (\u0394AUC\u2009=\u2009+0.003), clarifying comorbidity's dual role in prediction versus case\u2010finding.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Published meta\u2010analyses demonstrate consistent TBI\u2010PTSD associations (2.68\u00d7 risk overall; 4.18\u00d7 in military populations) alongside substantial prevalence heterogeneity (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200996%) that current reporting practices inadequately address. Using TBI as a worked exemplar of comorbidity integration alongside sex\u2010stratified validation, moral injury assessment and cultural adaptation, the tiered framework provides PTSD\u2010specific operational guidance for implementing established methodological standards, designed for incremental adoption based on study resources. All Tier 2 components are implementable with standard methods and moderate sample sizes. Prospective validation studies are needed to assess whether framework implementation improves calibration stability, subgroup equity and clinical outcomes compared to standard practice.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jep.70496","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T10:41:38Z","timestamp":1782297698000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Recalibrating PTSD Screening and Prediction: A Pragmatic Agenda to Reduce Missed Cases, False Alarms and Model Hype"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8331-2778","authenticated-orcid":false,"given":"Malika","family":"Parker","sequence":"first","affiliation":[{"name":"JNP Industries Forest Hills New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"e_1_2_15_2_1","unstructured":"\u201cUsing the PTSD Checklist for DSM\u20105 (PCL\u20105) \u201d National Center for PTSD US Department of Veterans Affairs 2025."},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.36733"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1037\/pas0000254"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1037\/pas0000260"},{"key":"e_1_2_15_6_1","unstructured":"\u201cVA\/DoD Clinical Practice Guideline for the Management of Post\u2010Traumatic Stress Disorder and Acute Stress Disorder. 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