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Health Services Research & Development

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2005 HSR&D National Meeting Abstract


3048 — Screening for Post Traumatic Stress Disorder in VA Primary Care Patients with Depression Symptoms

Author List:
Gerrity MS (Portland VAMC)
Corson K (Portland VAMC)
Solodky J (Portland VAMC)
Dobscha Sk (Portland VAMC)

Objectives:
Unrecognized Post Traumatic Stress Disorder (PTSD) is common and may be an important factor in treatment resistant depression in VA primary care patients. Although brief screens exist, they have not been evaluated in depressed patients. Our objective was to evaluate a brief screen for PTSD in patients with depression.

Methods:
748 primary care patients being recruited for a depression study completed the Patient Health Questionnaire (PHQ-9) and PTSD screen: 1 trauma plus 3 symptom items if patients endorsed trauma. Each PTSD item was rated no=0 or yes=1. 398 (53%) patients with PHQ-9 scores >=10 enrolled in the study and completed the 17-item PTSD Symptom Checklist (PCL). Sensitivity, specificity, and likelihood ratios (LRs) were calculated for the PTSD screen using the PCL as the reference standard.

Results:
For the 398 study patients, mean age was 57 (SD, 11.4) years and mean PHQ score 13.3 (SD, 5). Three hundred forty-two (86%) reported witnessing or experiencing an event involving serious injury or death (actual or threatened). Using PCL cut-points of 30, 44, and 50, the prevalence of PTSD was 88%, 52%, and 37%, respectively. Using a conservative cut-point of PCL >= 50, the trauma item alone had a sensitivity of 87% and specificity of 17%. Among 342 patients endorsing the trauma item, a score of 1 on the remaining 3 items had a sensitivity of 82% and specificity of 37%, a score of 2 had a sensitivity of 60% and specificity of 71%, and a score of 3 had a sensitivity of 30% and specificity of 93%. LRs were 0.21, 0.62, 1.36, and 4.18 for scores of 0, 1, 2, and 3, respectively.

Implications:
Over one-third of depressed primary care patients are likely to have co-morbid PTSD, and most report trauma. Our screen has moderately useful LRs for scores of 0 and 3. The performance of our screen may reflect our sample, use of PCL as the reference, or yes/no item ratings.

Impacts:
Our 4–item PTSD screen may be useful in making decisions about mental health referral for depressed primary care patients with the highest and lowest scores. Modifying the item rating options may improve its test characteristics.


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