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2019 HSR&D/QUERI National Conference Abstract

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1156 — Validation of the PTSD Primary Care Screen

Lead/Presenter: Michelle Bovin,  National Center for PTSD
All Authors: Bovin MJ (National Center for PTSD at VA Boston and Boston University School of Medicine ), Kimerling R (National Center for PTSD and Center for Innovation to Implementation), Weathers FW (Auburn University) Prins A (National Center for PTSD and San Jose State University) Marx BP (National Center for PTSD at VA Boston and Boston University School of Medicine) Post EP (Office of Primary Care, VA Central Office and Ann Arbor VA) Schnurr PP (National Center for PTSD and Geisel School of Medicine at Dartmouth)

Objectives:
Given the high prevalence of PTSD in Veterans, VA mandates PTSD screening for all Veterans. Currently, VA uses the Primary Care PTSD screen (PC-PTSD) to identify Veterans with probable PTSD. This questionnaire is based on DSM-IV PTSD diagnostic criteria. In 2013, PC-PTSD was updated to reflect the DSM-5 diagnostic criteria. Although the new version—the PC-PTSD-5—reflects the new knowledge the field possesses about PTSD, VA continues to use the old version until a valid cutoff for the PC-PTSD-5 is established. To do so, the PC-PTSD-5 must be compared with a gold standard PTSD diagnostic interview, such as the CAPS-5, in a VA primary care setting. Therefore, study aims were three-fold: to establish a cutpoint for the PC-PTSD-5 in a primary care Veteran sample by validating it against the CAPS-5; to explore whether the optimal cutpoint for the PC-PTSD-5 varies across subgroups; and to gather data on the acceptability of the PC-PTSD-5.

Methods:
Across two VA sites, a consecutive sample of 399 primary care seeking Veterans completed the PC-PTSD-5 and were interviewed by a clinician using the CAPS-5.

Results:
Participants in the study were 84% male (n = 334) and averaged 61.28 years old (range is 21-93). According to the CAPS-5, 16.5% (n = 66) of participants met criteria for PTSD. Scores on the PC-PTSD-5 ranged from 0-5 (M = 1.71; SD = 1.85). Ninety-four percent of participants rated the PC-PTSD-5 questions "easy" or "very easy" to understand, and 97% rated the instructions "clear" or "very clear."

Implications:
Initial analyses suggest that this study captured a representative sample of primary care seeking Veterans—essential for accomplishing study objectives. Participants found the PC-PTSD-5 easy to understand. Signal detection analyses, which will allow us to determine the optimal cutpoint for the measure and examine its performance overall and in key subgroups, are ongoing and will be presented at the HSRandD meeting.

Impacts:
By identifying a valid cutpoint for the PC-PTSD-5, results will have an immediate impact on VA's ability to accurately identify and treat Veterans with PTSD. By improving our PTSD screening efforts, findings will enhance both PTSD research and clinical care for Veterans with PTSD.