Article2010

Post-traumatic stress disorder screening test performance in civilian primary care

John R. Freedy · Maria M. Steenkamp · Kathryn M. Magruder · Derik Edward Yeager · James S. Zoller · William J. Hueston +1 more

150 citations0/0 files storedFamily Practice

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Posttraumatic Stress Disorder Research Traumatic Brain Injury Research Migration, Health and Trauma

Abstract

PURPOSE: we determined the test performance characteristics of four brief post-traumatic stress disorder (PTSD) screening tests in a civilian primary care setting. METHODS: this was a cross-sectional cohort study of adults attending a family medicine residency training clinic in the southeastern USA. Four hundred and eleven participants completed a structured telephone interview that followed an index clinic visit. Screening tests included: PTSD Symptom Checklist-Civilian Version (17 items), SPAN (four items), Breslau's scale (seven items) and Primary Care PTSD screen (PC-PTSD) (four items). A modified Clinician-Administered PTSD Scale was used to determine past month PTSD for comparison. Receiver operating characteristic analysis based on area under the curve (AUC) was used to assess diagnostic efficiency (>0.80 desired). Cut-off scores were selected to yield optimal sensitivity and specificity (>80%). RESULTS: past month PTSD was substantial (women = 35.8% and men = 20.0%; P < 0.01). AUC values were PTSD Symptom Checklist (PCL) (0.897), SPAN (0.806), Breslau's scale (0.886) and PC-PTSD (0.885). Optimal cut-scores yielded the following sensitivities and specificities: PCL (80.0% and 80.7%; cut-off = 43), SPAN (75.9% and 71.6%; cut-off = 3), Breslau's scale (84.5% and 76.4%; cut-off = 4) and PC-PTSD (85.1% and 82.0%; cut-off = 3). Overall and gender-specific screening test performances were explored. CONCLUSIONS: results confirm: (i) PTSD was common, especially among women; (ii) all four PTSD screening tests were diagnostically adequate; (iii) Two of four PTSD screening tests showed adequate sensitivity and specificity (>80%) and (iv) The PC-PTSD screening test (four items) appeared to be the best single screening test. There are few studies to establish the utility of PTSD screening tests within civilian primary care.

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References

2013Diagnostic and Statistical Manual of Mental Disorders 1995Posttraumatic Stress Disorder in the National Comorbidity Survey 2002The PHQ-9: A New Depression Diagnostic and Severity Measure 1995The development of a Clinician-Administered PTSD Scale 2004Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care 1996Psychometric properties of the PTSD checklist (PCL)1991Traumatic Events and Posttraumatic Stress Disorder in an Urban Population of Young Adults 2006Mental Health Problems, Use of Mental Health Services, and Attrition From Military Service After Returning From Deployment to Iraq or Afghanistan

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