Given the high prevalence of posttraumatic stress disorder (PTSD) in Veterans, VA mandates that all Veterans be screened for PTSD annually for the first five years after military separation and every five years thereafter, unless the Veteran has had a PTSD diagnosis entered in his/her medical record in the past year (Vista Clinical Reminder User Manual, 2007). Screening typically takes place in primary care because the majority of patients who have received mental health diagnoses are seen there.
Currently, VA uses the Primary Care PTSD screen (PC-PTSD) to identify Veterans with probable PTSD. This 4-item questionnaire is based on the PTSD diagnostic criteria included in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). In 2013, the DSM-5 was introduced, which included a number of significant revisions to the PTSD diagnosis. In response, the PC-PTSD was updated to add (1) a trauma-specific stem that reflects changes made to PTSD Criterion A and (2) a new item that reflects the revisions made to the PTSD symptom criteria. The new instrument, the PC-PTSD-5, therefore reflects the new knowledge the field possesses about PTSD.
Despite this, VA continues to use the old version of the measure until a valid cutoff for the PC-PTSD-5 is established. Although initial pilot data for the PC-PTSD-5 indicate it is psychometrically sound, it has not yet been compared with a gold standard PTSD diagnostic interview, such as the Clinician Administered PTSD Scale for DSM-5 (CAPS-5), in a VA primary care setting.
The objectives of the study are to: (a) establish a cutpoint for the PC-PTSD-5 in a primary care Veteran sample by validating it against the CAPS-5; (b) explore whether the optimally sensitive cutpoint for the PC-PTSD-5 varies by gender, race, ethnicity, age, military sexual trauma (MST) status, traumatic brain injury (TBI), and psychiatric comorbidity; and (c) gather initial data on the acceptability of the PC-PTSD-5 to Veterans.
To achieve these objectives, we will conduct a two-session psychometric study of the PC-PTSD-5 using a sample of primary care treatment seeking Veterans, oversampling women to allow for group comparisons. Across two sites (Boston and Palo Alto [PA]), 405 Veterans will complete the PC-PTSD-5 and will be interviewed by a doctoral-level clinician, blind to the screening results, using the CAPS-5. Signal detection analyses, conducted on a weighted dataset to ensure generalizability, will allow us to determine the optimally sensitive cutpoint for the PC-PTSD-5 and examine its performance overall and in key subgroups.
We expect that this project will yield an optimally sensitive cutpoint for the PC-PTSD-5 that can be used across VA primary care clinics. In addition, we expect that we will determine whether subgroups of interest require unique cut scores on the instrument, and gain a better understanding of the acceptability of the measure.
Study results will have both immediate and long-term implications for VA. By identifying a valid cutpoint for the PC-PTSD-5, this study will have an immediate impact on VA's ability to accurately identify and treat Veterans with PTSD. In addition, the data obtained will provide the necessary foundation for future research on implementation and how to optimize PTSD screening in VA. By improving our PTSD screening efforts, the results of this study ultimately will enhance both PTSD research and clinical care for all individuals with PTSD.
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Mental, Cognitive and Behavioral Disorders
Diagnosis, TRL - Applied/Translational
Clinical Diagnosis and Screening, Ethnicity/Race, Gender Differences, PTSD