Systematic Review of PTSD Screening Instruments
About 80% of Americans will experience one or more traumatic events during their lifetimes, but only about 13% of women and 6% of men will develop PTSD. Chronic PTSD is associated with numerous adverse health and social consequences, including higher rates of diabetes and cardiovascular disease, as well as increased psychiatric hospitalizations and suicide. Effective treatments for PTSD are available, but can only take place if the disorder is diagnosed. Investigators in this study conducted a systematic review of self-report screening instruments for PTSD among primary care and high-risk populations. Out of nearly 2,500 citations, 23 studies met eligibility criteria, including 15 that were conducted in primary care settings in the U.S. and 8 that were conducted in community settings following a natural disaster or terrorism – or included high-risk Veterans in their cohorts. Study cohorts consisted of only women in 5 studies, only men in 2 studies, and only military personnel or Veterans in 12 studies. The 17-item PTSD-Checklist (PCL) was the most frequently studied screening instrument, overall, and the 4-item Primary Care Post-Traumatic Stress Disorder screener (PC-PTSD) was the most frequently studied short-screening instrument.
- The PC-PTSD and the PCL were the best performing instruments. Both show reasonable performance characteristics for use in primary care clinics or in community settings with high-risk populations. Both also are easy to administer and interpret, and can readily be incorporated into a busy practice.
- Two multi-condition instruments (My Mood Monitor, and the Provisional Diagnostic Interview-4 Anxiety) and three anxiety/general distress instruments (K6, GAD-7, and the Anxiety and Depression Detector) were evaluated in primary care settings, but performed less well than instruments that were specifically designed to detect PTSD.
- Both patients and physicians felt that screening facilitated discussion of mental health issues in the subsequent primary care visit, and 80% of primary care physicians reported that the screen was helpful in interactions with their patients.
- PTSD prevalence rates ranged from 5% in a community primary care sample to 35% in a sample of women Veterans who received care at VA facilities.
- Several studies had non-random sampling and/or verification bias, both of which may inflate the apparent effectiveness of the screening tools that were evaluated.
- Evidence regarding the performance characteristics of the screening instruments for important sub-populations (i.e., women, racial minorities) was missing, sparse, and/or inconsistent.
This study was funded through VA HSR&D's Quality Enhancement Research Initiative (QUERI) Evidence-Based Synthesis Program. Drs. Spoont and Kehle-Forbes are part of HSR&D's Center for Chronic Disease Outcomes Research in Minneapolis, MN. Dr. Williams is director of the Durham Evidence-based Synthesis Program.
Spoont M, Williams J, Kehle-Forbes S, et al. Does This Patient have Post-Traumatic Stress Disorder? Rational Clinical Examination Systematic Review. JAMA. August 4, 2015;314(5):501-510.