Brief report: Utility of a short screening scale for DSM-IV PTSD in primary care

Abstract

OBJECTIVE:To evaluate Breslau's 7-item screen for posttraumatic stress disorder (PTSD) for use in primary care. DESIGN:One hundred and thirty-four patients were recruited from primary care clinics at a large medical center. Participants completed the self-administered 7-item PTSD screen. Later, psychologists blinded to the results of the screen-interviewed patients using the Clinician Administered PTSD Scale (CAPS). Sensitivity, specificity, and likelihood ratios (LR) were calculated using the CAPS as the criterion for PTSD. RESULTS:The screen appears to have test-retest reliability (r =.84), and LRs range from 0.04 to 13.4. CONCLUSIONS:Screening for PTSD in primary care is time efficient and has the potential to increase the detection of previously unrecognized PTSD. tion to PTSD in medical settings is key to providing treatment to this population, because primary care, rather than specialty mental health services, is the point of contact with the health care system for the majority of individuals with PTSD. 9Improving detection of PTSD is a necessary first step to addressing the health and mental health burden experienced by these patients. Several approaches to screening have recently been proposed, ranging from the use of full-length psychometric self-report measures 10,11 to the development of brief, stand-alone screening instruments. 4,12 Ideally, a screen for PTSD would balance the ability to detect cases with the resources required to evaluate and treat cases that screen positive. The current study focuses on a 7-item screen for DSM-IV PTSD developed by Breslau et al. 13 We evaluate the utility of the Breslau screen to identify PTSD in primary care settings.Breslau et al. 13 proposed a 7-item, empirically derived screening scale from interview items that best discriminated individuals with a diagnosis of PTSD in a large epidemiological telephone survey. The screen was designed to follow an event checklist or other assessment of trauma exposure. Their data indicated that cutoff scores of 4 or 5 (the authors' recommend 4) best balanced the screen's sensitivity, the ability to detect patients with PTSD, and specificity, the ability to detect patients who do not have PTSD. Providing follow-up referrals or evaluations to individuals with screen scores of 4 and higher would maximize the number of PTSD cases identified while minimizing the resources allocated to false positive cases. The authors suggest that future studies evaluate the screen using direct comparisons with clinical assessments and populations that include patients over 45 years of age. We investigate the utility of the Breslau screen by direct comparisons with clinical assessments in a VA primary care population with an unrestricted age range. Furthermore, we eliminate the need for a separate assessment of trauma exposure by adding an introductory stem that is brief and reliable as a general reference for exposure. 4 Thus, the screen, as used in the current study, may be administered to patients as a brief stand-alone self-report instrument to i...

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