Accuracy of screening for posttraumatic stress disorder in specialty mental health clinics in the U.S. Veterans Affairs Healthcare System.
This study 1) describes the prevalence of positive PTSD screens among male, female, and OEF/OIF/OND veterans using various PTSD Checklist-Military version (PCL-M) criteria; 2) evaluates the sensitivity and specificity of various PCL-M criteria; and 3) identifies optimal screening criteria in predicting clinician-documented PTSD diagnoses. VA electronic medical records data from 327,093 veterans during 2008-2012 were analyzed. Receiver operating characteristic curve analyses compared PCL-M scores against clinician-documented PTSD diagnoses. Results showed that different PCL-M scoring criteria resulted in 62.0-84.5% of veterans screening positive for PTSD compared to 40.1% with a clinician-documented PTSD diagnosis. Sensitivity of the PCL-M ranged from 73.7 to 93.5% and specificity ranged from 21.6 to 45.8% for all veterans. The optimal PCL-M cut score according to Youden's index was ≥45 for male veterans, ≥35 for female veterans, and ≥38 for OEF/OIF/OND veterans. Self-report measures like the PCL-M may be a useful screening tool for identifying probable PTSD in VA specialty clinics, but they should be calibrated for different veteran subgroups and followed by structured clinical interviews.
United States Department of Veterans Affairs, New England Mental Illness Research, Education, and Clinical Center, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. Electronic address: Jack.Tsai@yale.edu.
Jack
J
Tsai
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, West Haven, CT, USA.
Robert H
RH
Pietrzak
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, West Haven, CT, USA; Veterans Affairs Northeast Program Evaluation Center, West Haven, CT, USA.
Rani A
RA
Hoff
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, West Haven, CT, USA; Veterans Affairs Northeast Program Evaluation Center, West Haven, CT, USA.
Ilan
I
Harpaz-Rotem
D000328:Adult; D057189:Checklist; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology*; D011237:Predictive Value of Tests; D015995:Prevalence; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*
Assessment/diagnosis; Epidemiology; Health services; Posttraumatic stress disorder; Trauma