Post-traumatic stress disorder screening test performance in civilian primary care.
OBJECTIVE
we determined the test performance characteristics of four brief post-traumatic stress disorder (PTSD) screening tests in a civilian primary care setting.


METHODS
this was a cross-sectional cohort study of adults attending a family medicine residency training clinic in the southeastern USA. Four hundred and eleven participants completed a structured telephone interview that followed an index clinic visit. Screening tests included: PTSD Symptom Checklist-Civilian Version (17 items), SPAN (four items), Breslau's scale (seven items) and Primary Care PTSD screen (PC-PTSD) (four items). A modified Clinician-Administered PTSD Scale was used to determine past month PTSD for comparison. Receiver operating characteristic analysis based on area under the curve (AUC) was used to assess diagnostic efficiency (>0.80 desired). Cut-off scores were selected to yield optimal sensitivity and specificity (>80%).


RESULTS
past month PTSD was substantial (women = 35.8% and men = 20.0%; P < 0.01). AUC values were PTSD Symptom Checklist (PCL) (0.897), SPAN (0.806), Breslau's scale (0.886) and PC-PTSD (0.885). Optimal cut-scores yielded the following sensitivities and specificities: PCL (80.0% and 80.7%; cut-off = 43), SPAN (75.9% and 71.6%; cut-off = 3), Breslau's scale (84.5% and 76.4%; cut-off = 4) and PC-PTSD (85.1% and 82.0%; cut-off = 3). Overall and gender-specific screening test performances were explored.


CONCLUSIONS
results confirm: (i) PTSD was common, especially among women; (ii) all four PTSD screening tests were diagnostically adequate; (iii) Two of four PTSD screening tests showed adequate sensitivity and specificity (>80%) and (iv) The PC-PTSD screening test (four items) appeared to be the best single screening test. There are few studies to establish the utility of PTSD screening tests within civilian primary care.
Freedy
John R
JR
Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29425, USA. freedyjr@musc.edu
Steenkamp
Maria M
MM
Magruder
Kathryn M
KM
Yeager
Derik E
DE
Zoller
James S
JS
Hueston
William J
WJ
Carek
Peter J
PJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011320:Primary Health Care; D011581:Psychological Tests; D012372:ROC Curve; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult