Study Shows VA Screening Tool for PTSD, Based on DSM-5 Criteria, is Accurate and Acceptable
BACKGROUND:
The lifetime prevalence of PTSD in the US is 6%; however, among Veterans who receive VA healthcare, the prevalence is 12% for men and 19% for women. To ensure that individuals with PTSD are identified and provided with appropriate treatment services, in the VA system and in other settings, PTSD screening is conducted in primary care clinics because individuals with mental health symptoms are more likely to initially seek medical care. Thus, VA uses the Primary Care PTSD Screen (PC-PTSD) – a questionnaire designed for use in a primary care setting, which is based on criteria in the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). In 2013, the American Psychiatric Association presented revised PTSD diagnostic criteria in the DSM Fifth Edition (DSM-5). The PC-PTSD screen was then revised as the PC-PTSD-5 to reflect DSM-5 criteria. This cross-sectional, diagnostic accuracy study sought to determine whether the PC-PTSD-5 is a diagnostically accurate and acceptable measure for use in VA primary care clinics. Investigators enrolled Veterans from two VA medical centers from May 2017 to September 2018. Study participants (n=396, of which 333 were male) were screened using the PC-PTSD-5 and then interviewed using a well-validated, structured diagnostic interview for PTSD (the Clinician Administered PTSD Scale for DSM-5; CAPS-5). Investigators then examined the accuracy of the PC-PTSD-5 against the CAPS-5.
FINDINGS:
- The PC-PTSD-5 is an accurate and acceptable screening tool for use in VA primary care settings.
- Overall and for men, a cut point score of 4 best balanced false negatives and false positives. For women, this cut point resulted in higher numbers of false negatives, without as much reduction in the number of false positives as was observed among men.
- Most Veterans felt comfortable completing the screening, with a preference for administration by the individual’s own primary care practitioner.
IMPLICATIONS:
- Because performance parameters will change according to the sample, clinicians should consider sample characteristics and screening purposes when selecting a cut point. Regardless of the cut point, the PC-PTSD-5 has demonstrated utility in screening for PTSD in VA primary care settings. The prevalence of PTSD among patients seeking primary care –15% of men and 29% of women in this study cohort – underscores the importance of screening.
LIMITATIONS:
- Although Veterans were demographically representative of VA primary care users, non-response bias may limit generalizability to this population.
- Other sub-groups beyond and within gender may benefit from further study.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IIR 15-103). Drs. Bovin and Schnurr are part of VA’s National Center for PTSD in Boston, MA and White River Junction, VT, respectively.
Bovin M, Kimerling R, Weathers F, et al. Diagnostic Accuracy and Acceptability of the Primary Care Posttraumatic Stress Disorder Screen for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) among US Veterans. JAMA Network Open. February 4, 2020;4(2):e2036733.
