title: Clinical utility of the Primary Care--PTSD Screen among U.S. veterans who served since September 11, 2001.
abstract: Posttraumatic stress disorder (PTSD) is a prevalent anxiety disorder that is often undetected among primary care patients. The Department of Veterans Affairs has implemented the Primary Care-PTSD Screen (PC-PTSD) to screen for PTSD; however, minimal research has examined its utility. This study was designed to assess the diagnostic accuracy of the PC-PTSD among veterans who had served since 9/11/2001, including operations in Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom). Signal detection analyses were used to evaluate the performance of the PC-PTSD and two other screens, the Davidson Trauma Scale (DTS) and the SPAN, in a sample of 220 veterans with military service since 9/11/2001. The reference standard for PTSD was Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) diagnosis based upon structured clinical interview. The impact of demographic variables on test performance was examined. A cutting score of 3 on the PC-PTSD maximized efficiency (85%; sensitivity=0.83; and specificity=0.85). Although analyses supported the utility of the PC-PTSD (area under the curve (AUC)=0.875), the measure was outperformed by both the DTS (AUC=0.944) and the SPAN (AUC=0.931). Results suggest that the PC-PTSD is an acceptable screen for PTSD among veterans. Within primary care settings, the PC-PTSD may be most advantageously employed in the context of staged screening, given the measure's relative susceptibility to false positives.
authors.affiliation: VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC 27705, USA. Patrick.Calhoun2@va.gov
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Calhoun
authors.forename: Scott D
authors.initials: SD
authors.lastname: McDonald
authors.forename: Vito S
authors.initials: VS
authors.lastname: Guerra
authors.forename: A Meade
authors.initials: AM
authors.lastname: Eggleston
authors.forename: Jean C
authors.initials: JC
authors.lastname: Beckham
authors.forename: Kristy
authors.initials: K
authors.lastname: Straits-Troster
mesh_terms: D000328:Adult; D003130:Combat Disorders / Q000175:diagnosis*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data*; D012372:ROC Curve; D012016:Reference Values; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D014481:United States; D014728:Veterans