Clinical Inquiries

What are the most practical primary care screens for post-traumatic stress disorder?

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References

Breslau’s short screen addresses 7 specific symptoms

Breslau’s 7-item screening scale (available at http://ajp.psychiatryonline.org/cgi/content/full/156/6/908#T2) is another empirically tested, brief, simple means of identifying PTSD symptoms in primary care patients.2 (See also: www.pubmedcentral.nih.gov/articlerender.fcgifiartid=1484617.) Each item addresses a specific symptom.

The screen has been validated in a VA primary care clinic (N=134). With a cutoff score of 4, it has a sensitivity of 85% and specificity of 84%, yielding a positive predictive value of 71% and negative predictive value of 98%.2 The likelihood of a score <3 is 0.04 and a score >5 is 13.5. Scores of 3 to 5 have an indeterminate likelihood value (1.8). Patients with a positive screen should undergo further evaluation by a mental health provider.2

Leave lengthy screens to mental health professionals

The CAPS and the civilian version of the PTSD Symptom Checklist (PCL-C), both with 17 items, are widely used as “screens” for PTSD.7 However, their length and the recommendation that they be administered by a mental health professional make them cumbersome and impractical for use in primary care.7

Recommendations

A 2007 point-of-care guide written for primary care clinicians recommends Breslau’s short screening scale and the PCPTSD screen for use in this setting.1 Both the National Center for PTSD and Department of Defense Clinical Guidelines on PTSD recommend initial and annual screening using the PC-PTSD, PTSD Brief Screen, or Short Screening Scale for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV) PTSD.8

Acknowledgements

The opinions and assertions contained herein are the private views of the authors and not to be construed as official, or as reflecting the views of the United States Air Force Medical Service or the United States Air Force at large.

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