The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5): Development and Evaluation Within a Veteran Primary Care Sample

doi:10.1007/s11606-016-3703-5

. 2016 Oct;31(10):1206-11.

doi: 10.1007/s11606-016-3703-5. Epub 2016 May 11.

The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5): Development and Evaluation Within a Veteran Primary Care Sample

Annabel Prins^{1

2}, Michelle J Bovin^{3

4}, Derek J Smolenski⁵, Brian P Marx^{3

4}, Rachel Kimerling^{6

7}, Michael A Jenkins-Guarnieri⁸, Danny G Kaloupek^{3

4}, Paula P Schnurr^{9

10}, Anica Pless Kaiser^{3

4}, Yani E Leyva¹¹, Quyen Q Tiet^{6

7

12

13}

Affiliations

¹ National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA. Annabel.Prins@sjsu.edu.
² Department of Psychology, San Jose State University, One Washington Square, San Jose, CA, 95192, USA. Annabel.Prins@sjsu.edu.
³ National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.
⁴ Boston University School of Medicine, Boston, MA, USA.
⁵ National Center for Telehealth and Technology, Joint Base Lewis-McChord, WA, 98433, USA.
⁶ National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA.
⁷ Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.
⁸ Private Practice, Tacoma, WA, USA.
⁹ National Center for PTSD, White River Junction VA Medical Center, White River Junction, VT, USA.
¹⁰ Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
¹¹ Research Division, San Francisco VA Medical Center, San Francisco, CA, USA.
¹² Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
¹³ California School of Professional Psychology, Alliant International University, San Francisco, CA, USA.

PMID: 27170304
PMCID: PMC5023594
DOI: 10.1007/s11606-016-3703-5

The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5): Development and Evaluation Within a Veteran Primary Care Sample

Annabel Prins et al. J Gen Intern Med. 2016 Oct.

. 2016 Oct;31(10):1206-11.

doi: 10.1007/s11606-016-3703-5. Epub 2016 May 11.

Authors

Affiliations

¹ National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA. Annabel.Prins@sjsu.edu.
² Department of Psychology, San Jose State University, One Washington Square, San Jose, CA, 95192, USA. Annabel.Prins@sjsu.edu.
³ National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.
⁴ Boston University School of Medicine, Boston, MA, USA.
⁵ National Center for Telehealth and Technology, Joint Base Lewis-McChord, WA, 98433, USA.
⁶ National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA.
⁷ Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.
⁸ Private Practice, Tacoma, WA, USA.
⁹ National Center for PTSD, White River Junction VA Medical Center, White River Junction, VT, USA.
¹⁰ Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
¹¹ Research Division, San Francisco VA Medical Center, San Francisco, CA, USA.
¹² Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
¹³ California School of Professional Psychology, Alliant International University, San Francisco, CA, USA.

PMID: 27170304
PMCID: PMC5023594
DOI: 10.1007/s11606-016-3703-5

Abstract

Background: Posttraumatic Stress Disorder (PTSD) is associated with increased health care utilization, medical morbidity, and tobacco and alcohol use. Consequently, screening for PTSD has become increasingly common in primary care clinics, especially in Veteran healthcare settings where trauma exposure among patients is common.

Objective: The objective of this study was to revise the Primary Care PTSD screen (PC-PTSD) to reflect the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for PTSD (PC-PTSD-5) and to examine both the diagnostic accuracy and the patient acceptability of the revised measure.

Design: We compared the PC-PTSD-5 results with those from a brief psychiatric interview for PTSD. Participants also rated screening preferences and acceptability of the PC-PTSD-5.

Participants: A convenience sample of 398 Veterans participated in the study (response rate = 41 %). Most of the participants were male, in their 60s, and the majority identified as non-Hispanic White.

Measures: The PC-PTSD-5 was used as the screening measure, a modified version of the PTSD module of the MINI-International Neuropsychiatric Interview was used to diagnose DSM-5 PTSD, and five brief survey items were used to assess acceptability and preferences.

Key results: The PC-PTSD-5 demonstrated excellent diagnostic accuracy (AUC = 0.941; 95 % C.I.: 0.912- 0.969). Whereas a cut score of 3 maximized sensitivity (κ[1]) = 0.93; SE = .041; 95 % C.I.: 0.849-1.00), a cut score of 4 maximized efficiency (κ[0.5] = 0.63; SE = 0.052; 95 % C.I.: 0.527-0.731), and a cut score of 5 maximized specificity (κ[0] = 0.70; SE = 0.077; 95 % C.I.: 0.550-0.853). Patients found the screen acceptable and indicated a preference for administration by their primary care providers as opposed to by other providers or via self-report.

Conclusions: The PC-PTSD-5 demonstrated strong preliminary results for diagnostic accuracy, and was broadly acceptable to patients.

Keywords: DSM-5; PTSD; primary health care; screening.

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Conflict of interest statement

The authors declare no conflicts of interest.

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References

1. Breslau N. The epidemiology of trauma, PTSD, and other posttrauma disorders. Trauma Violence Abuse. 2009;10(3):198–210. doi: 10.1177/1524838009334448. - DOI - PubMed
1. Freedy JR, Steenkamp MM, Magruder KM, et al. Post-traumatic stress disorder screening test performance in civilian primary care. Fam Pract. 2010;27(6):615–24. doi: 10.1093/fampra/cmq049. - DOI - PubMed
1. Magruder KM, Frueh BC, Knapp RG, et al. Prevalence of posttraumatic stress disorder in veterans affairs primary care clinics. Gen Hosp Psychiatry. 2005;27(3):169–79. doi: 10.1016/j.genhosppsych.2004.11.001. - DOI - PubMed
1. Milanak ME, Gros DF, Magruder KM, Brawman-Mintzer O, Frueh BC. Prevalence and features of generalized anxiety disorder in department of veteran affairs primary care settings. Psychiatry Res. 2013;209(2):173–9. doi: 10.1016/j.psychres.2013.03.031. - DOI - PMC - PubMed
1. Olfson M, Shea S, Feder A, et al. Prevalence of anxiety, depression, and substance use disorders in an urban general medicine practice. Arch Fam Med. 2000;9(9):876–83. doi: 10.1001/archfami.9.9.876. - DOI - PubMed

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[1] Breslau N. The epidemiology of trauma, PTSD, and other posttrauma disorders. Trauma Violence Abuse. 2009;10(3):198–210. doi: 10.1177/1524838009334448. - DOI - PubMed

[2] Breslau N. The epidemiology of trauma, PTSD, and other posttrauma disorders. Trauma Violence Abuse. 2009;10(3):198–210. doi: 10.1177/1524838009334448. - DOI - PubMed

[3] Freedy JR, Steenkamp MM, Magruder KM, et al. Post-traumatic stress disorder screening test performance in civilian primary care. Fam Pract. 2010;27(6):615–24. doi: 10.1093/fampra/cmq049. - DOI - PubMed

[4] Freedy JR, Steenkamp MM, Magruder KM, et al. Post-traumatic stress disorder screening test performance in civilian primary care. Fam Pract. 2010;27(6):615–24. doi: 10.1093/fampra/cmq049. - DOI - PubMed

[5] Magruder KM, Frueh BC, Knapp RG, et al. Prevalence of posttraumatic stress disorder in veterans affairs primary care clinics. Gen Hosp Psychiatry. 2005;27(3):169–79. doi: 10.1016/j.genhosppsych.2004.11.001. - DOI - PubMed

[6] Magruder KM, Frueh BC, Knapp RG, et al. Prevalence of posttraumatic stress disorder in veterans affairs primary care clinics. Gen Hosp Psychiatry. 2005;27(3):169–79. doi: 10.1016/j.genhosppsych.2004.11.001. - DOI - PubMed

[7] Milanak ME, Gros DF, Magruder KM, Brawman-Mintzer O, Frueh BC. Prevalence and features of generalized anxiety disorder in department of veteran affairs primary care settings. Psychiatry Res. 2013;209(2):173–9. doi: 10.1016/j.psychres.2013.03.031. - DOI - PMC - PubMed

[8] Milanak ME, Gros DF, Magruder KM, Brawman-Mintzer O, Frueh BC. Prevalence and features of generalized anxiety disorder in department of veteran affairs primary care settings. Psychiatry Res. 2013;209(2):173–9. doi: 10.1016/j.psychres.2013.03.031. - DOI - PMC - PubMed

[9] Olfson M, Shea S, Feder A, et al. Prevalence of anxiety, depression, and substance use disorders in an urban general medicine practice. Arch Fam Med. 2000;9(9):876–83. doi: 10.1001/archfami.9.9.876. - DOI - PubMed

[10] Olfson M, Shea S, Feder A, et al. Prevalence of anxiety, depression, and substance use disorders in an urban general medicine practice. Arch Fam Med. 2000;9(9):876–83. doi: 10.1001/archfami.9.9.876. - DOI - PubMed

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The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5): Development and Evaluation Within a Veteran Primary Care Sample

Affiliations

The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5): Development and Evaluation Within a Veteran Primary Care Sample

Authors

Affiliations

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