Evidence suggests that the majority of Americans will experience a traumatic event at some
time during their lives and that approximately 8% will subsequently develop post-traumatic
stress disorder (PTSD). PTSD is one of the most common psychiatric sequellae of traumatic
experiences and is characterized by an intense emotional reaction to the traumatic event, and
followed by a persistent re-experiencing of the trauma, avoidance of things associated with
the trauma, numbed emotional responsiveness, and increased arousal. Rates among military
Veterans returning from deployments in Iraq and Afghanistan are much higher than that found in
the general population, as high as 20% by some estimates. Currently, about 400,000 Veterans
enrolled in VA carry a PTSD diagnosis.
Those who suffer from PTSD often have diminished functioning and a poorer quality of life as
evidenced by elevated rates of suicide, hospital admissions, poverty, and unemployment.
Significant medical morbidity is also common among those with PTSD and several agerelated
chronic medical conditions develop earlier. Moreover, people with PTSD have higher
prevalence rates of problematic health behaviors, and utilize medical care at higher rates than
those without PTSD. Although there are PTSD treatments available that have demonstrated
effectiveness among individuals with diagnosed PTSD, many people who have PTSD may not
be diagnosed and many who are diagnosed do not pursue mental health treatment. Of those who
do seek treatment, prolonged delays are common.
To minimize treatment delays and to maximize population reach, VA established a screening
program to identify PTSD in their patients as they present in primary care clinics. Such screening
programs may be helpful because primary care providers often have difficulty identifying PTSD
in their patients and PTSD is therefore frequently undertreated in the primary care setting. The
premise of this type of screening program is to identify individuals needing further evaluation
so as to facilitate mental health treatment engagement earlier in the course of the illness and to
identify patients for treatment who might not otherwise be identified as needing mental health
Recently, the Institute of Medicine (IOM) released a report examining the screening, diagnosis,
treatment, and rehabilitation services for military Veterans and service members with PTSD in
the Department of Veterans Affairs and the Department of Defense. As noted in the IOM report
and elsewhere, successful screening programs utilize instruments that are simple, valid, precise,
and acceptable both clinically and socially. To identify screening tools that are best suited to
primary care practice and to maximize relevance to the VA population, this evidence synthesis
report reviews the literature on the feasibility and diagnostic accuracy of screening tools used in
a primary care setting in the United States.