PTSD screen updated for DSM-5 criteria effective, efficient for veterans

The Primary Care PTSD screen for the DSM-5 effectively and efficiently screened for PTSD in Veterans Affairs primary care clinics, according to results of a cross-sectional, diagnostic accuracy study published in JAMA Network Open.

“In 2013, the American Psychiatric Association presented revised PTSD diagnostic criteria in the [DSM-5],” Michelle J. Bovin, PhD, of the National Center for PTSD at VA Boston Healthcare System, and colleagues wrote. “The [Primary Care PTSD screen (PC-PTSD)] was revised as the PC-PTSD-5 to reflect DSM-5 criteria. Furthermore, language to assess traumatic exposure was clarified to ensure that respondents understood that symptom questions referred to traumatic events and not to other stressors. Pilot testing suggested that the PC-PTSD-5 had sound diagnostic accuracy.”

The investigators conducted the current study to evaluate whether the PC-PTSD-5 could accurately diagnose and acceptably measure PTSD in VA primary care clinics. They analyzed data of 396 veterans aged 18 years or older who were scheduled for a primary care visit from clinics across two VA medical centers. The researchers noted demographic similarity between participants and the VA primary care population and that participants were predominantly white men. In the first session, conducted in person, participants completed questionnaires. In the second session, conducted within 30 days via telephone, participants completed the PC-PTSD-5 administered by a research assistant, and then a clinician assessor blind to the results of the screen conducted a structured diagnostic interview for PTSD. Bovin and colleagues assessed the range of PC-PTSD-5 cut points overall and across gender, and they used calculating weighted kappa values to evaluate diagnostic performance.

Results showed high levels of diagnostic accuracy for the PC-PTSD-5 for the overall sample, men and women. For the overall sample and for men, a cut point of four ideally balanced false negatives and false positives. For women, a cut point of three fit better, although it increased the number of false positives. Participants considered the PC-PTSD-5 to be highly acceptable.

“Regardless of the cut point, the PC-PTSD-5 has demonstrated utility in screening for PTSD in VA primary care settings,” Bovin and colleagues wrote. “The prevalence of PTSD among patients seeking primary care — 15% of men and 29% of women in our sample — underscores the importance of screening. PTSD is a treatable condition, with numerous treatment options. Screening is an essential step toward getting patients the care they need.”