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Abstract
BACKGROUND
Posttraumatic Stress Disorder (PTSD) is associated with increased health care utilization, medical morbidity, and tobacco and alcohol use. Consequently, screening for PTSD has become increasingly common in primary care clinics, especially in Veteran healthcare settings where trauma exposure among patients is common.
OBJECTIVE
The objective of this study was to revise the Primary Care PTSD screen (PC-PTSD) to reflect the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for PTSD (PC-PTSD-5) and to examine both the diagnostic accuracy and the patient acceptability of the revised measure.
DESIGN
We compared the PC-PTSD-5 results with those from a brief psychiatric interview for PTSD. Participants also rated screening preferences and acceptability of the PC-PTSD-5.
PARTICIPANTS
A convenience sample of 398 Veterans participated in the study (response rate = 41 %). Most of the participants were male, in their 60s, and the majority identified as non-Hispanic White.
MEASURES
The PC-PTSD-5 was used as the screening measure, a modified version of the PTSD module of the MINI-International Neuropsychiatric Interview was used to diagnose DSM-5 PTSD, and five brief survey items were used to assess acceptability and preferences.
KEY RESULTS
The PC-PTSD-5 demonstrated excellent diagnostic accuracy (AUC = 0.941; 95 % C.I.: 0.912– 0.969). Whereas a cut score of 3 maximized sensitivity (κ[1]) = 0.93; SE = .041; 95 % C.I.: 0.849–1.00), a cut score of 4 maximized efficiency (κ[0.5] = 0.63; SE = 0.052; 95 % C.I.: 0.527–0.731), and a cut score of 5 maximized specificity (κ[0] = 0.70; SE = 0.077; 95 % C.I.: 0.550–0.853). Patients found the screen acceptable and indicated a preference for administration by their primary care providers as opposed to by other providers or via self-report.
CONCLUSIONS
The PC-PTSD-5 demonstrated strong preliminary results for diagnostic accuracy, and was broadly acceptable to patients.
Details
1 National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA; Department of Psychology, San Jose State University, San Jose, CA, USA
2 National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
3 National Center for Telehealth and Technology, Joint Base Lewis-McChord, WA, USA
4 National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA; Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
5 Private Practice, Tacoma, WA, USA
6 National Center for PTSD, White River Junction VA Medical Center, White River Junction, VT, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
7 Research Division, San Francisco VA Medical Center, San Francisco, CA, USA
8 National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA; Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; California School of Professional Psychology, Alliant International University, San Francisco, CA, USA