Clinical Inquiries

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

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EVIDENCE-BASED ANSWER

The 4-item Primary Care Post-Traumatic Stress Disorder screen (PC-PTSD) is a simple and effective tool to identify symptoms of post-traumatic stress disorder (PTSD) in primary care patients (strength of recommendation [SOR]: B, 1 good-quality prospective cohort study and 1 good-quality retrospective cohort study). The 7-item Breslau screen also predictably identifies patients with PTSD symptoms (SOR: B, 1 good-quality prospective cohort study).

Evidence summary

About 8% of the US population will develop symptoms of PTSD at some point in their lives—usually as the result of a traumatic event, such as combat, a natural disaster, accident, or physical or sexual assault.1 Primary care settings tend to be the principal point of contact for patients with PTSD, although such patients rarely identify themselves as suffering from the disorder.2,3

Detailed diagnostic interviews and assessments are generally impractical in primary care.4 Brief, easy-to-complete screening tools can help clinicians identify patients with primary symptoms of PTSD.4

4-item screen assesses key characteristics of PTSD

The PC-PTSD (TABLE) is a 4-item screen that assesses the underlying characteristics specific to PTSD: re-experiencing, numbing, avoidance, and hyperarousal.4 It’s designed to be understandable to patients with an eighth-grade reading level and has been validated in a Department of Veterans Affairs (VA) primary care population (N=188).4

With a cutoff score of 3, the PCPTSD has a sensitivity of 78% and specificity of 87%, compared with the gold-standard Clinician-Administered PTSD Scale (CAPS).4 Positive responses warrant further evaluation of trauma symptoms and completion of the CAPS by a mental health provider to determine whether the patient may have PTSD or other trauma-related problems.5-7

TABLE
The primary care PTSD screen (PC-PTSD)4

In your life, have you ever had any experience that was so frightening, horrible, or upsetting that, in the past month, you…
1. Have had nightmares about it or thought about it when you did not want to?
YES NO
2. Tried hard not to think about it or went out of your way to avoid situations that reminded you of it?
YES NO
3. Were constantly on guard, watchful, or easily startled?
YES NO
4. Felt numb or detached from others, activities, or your surroundings?
YES NO

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Evidence-based answers from the Family Physicians Inquiries Network

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