PTSD: National Center for PTSD
Late-Onset Stress Symptomatology (LOSS) Scale
Late-Onset Stress Symptomatology (LOSS) Scale
Description
The LOSS Scale is a 44-item self-report measure that assesses late-onset stress symptomatology in aging (age 55 and older) male combat Veterans. This scale may serve as a supplement to more traditional PTSD assessment for aging combat Veterans, providing more descriptive detail on the nature of presenting symptoms. An 11-item short form (LOSS-SF) that can be used to screen Veterans who may be actively re-examining their past wartime experiences is also available.
The LOSS Scale and LOSS-SF may have practical use in primary care settings to detect underlying concerns and difficulties for persons presenting with physical health complaints. As a research instrument, the LOSS Scale is intended to help examine the process of aging in Veterans exposed to early-life wartime stressors.
The LOSS Scale reflects revisions to the concept of late-onset stress symptomatology framework which has been renamed Later-Adulthood Trauma Reengagement (LATR) in the literature. The developing understanding of the construct represents a process that may be successfully resolved and lead toward positive outcomes such as growth, acceptance and satisfaction, or, conversely, may lead to increased distress and more negative outcomes such as depression, substance use or PTSD.
Administration and Scoring
The LOSS Scale and LOSS-SF are paper-and-pencil self-report measures which can be used in clinical and research settings. In both measures, respondents rate each item on a 5-point Likert scale ranging from "Strongly disagree" to "Strongly agree." The estimated time to complete the LOSS scale is 5-10 minutes, and the LOSS-SF takes up to 3 minutes to complete.
Within the LOSS Scale, 11 of the 44 items reflect positive appraisals of military service, and these are not included in the scoring of the measure. The remaining 33 items of the LOSS Scale are summed to create a total score. The LOSS-SF is scored by summing all responses. For scoring manuals or questions about the measures, email Anica.PlessKaiser@va.gov.
If a Veteran endorses agreement on any of the items (e.g., 3="Agree" or 4="Strongly Agree"), this reflects an indication that they may be reengaging with past trauma. It may be useful for a provider to follow-up with a Veteran who endorses several items with agreement to determine if additional services are clinically indicated.
Sample Item
- Item: As I get older, I get more upset when talking about the war than I used to.
- Response: 5-point Likert scale from 0="Strongly disagree" to 4="Strongly agree"
References
Brady, C. B., Pless Kaiser, A., Spiro, A., III, Davison, E. H., King, D. W., & King, L. A. (2019). Late-Onset Stress Symptomatology (LOSS)-Short Form: Development and validation. Aging & Mental Health, 23, 952-960. doi:10/1080/13607863.2018.1450831
Davison, E., Pless Kaiser, A., Spiro, A. III, Moye, J., King, L., & King, D. (2016). From Late-Onset Stress Symptomatology to Later-Adulthood Trauma Reengagement in aging combat Veterans: Taking a broader view. The Gerontologist, 56, 14-21. doi:10.1093/geront/gnv097
King, L. A., King, D. W., Vickers, K., Davison, E., & Spiro, A., III. (2007). Assessing late-onset stress symptomatology among aging male combat Veterans. Aging & Mental Health, 11,175-191. doi:10.1080/13607860600844424
Potter, C., Pless Kaiser, A., King, L. A., King, D. W., Davison, E. H., Seligowski, A. V., ...& Spiro, A. III. (2013). Distinguishing late-onset stress symptomatology from posttraumatic stress disorder in older combat Veterans. Aging and Mental Health, 17, 173-179. 10.1080/13607863.2012.717259
To Obtain Scale
This measure was developed by staff at VA's National Center for PTSD and the Stress, Health, and Aging Research Program at VA Boston Healthcare System.
Download the Late-Onset Stress Symptomatology Scale and Short Form:
Are you using this measure with U.S. Veterans or Service members?
Our PTSD Consultation Program can answer administration or scoring questions: PTSDconsult@va.gov or 866-948-7880.
Measure availability: We provide information on a variety of measures assessing trauma and PTSD. These measures are intended for use by qualified mental health professionals and researchers. Measures authored by National Center staff are available as direct downloads or by request. Measures developed outside of the National Center can be requested via contact information available on the information page for the specific measure.
