Evidence suggests that the majority of Americans will experience a
traumatic event at some time during their lives and that
approximately 8% will subsequently develop post-traumatic stress
disorder (PTSD). PTSD is one of the most common psychiatric
sequellae of traumatic experiences and is characterized by an
intense emotional reaction to the traumatic event, and followed by
a persistent re-experiencing of the trauma, avoidance of things
associated with the trauma, numbed emotional responsiveness, and
increased arousal. Rates among military Veterans returning from
deployments in Iraq and Afghanistan are much higher than that found
in the general population, as high as 20% by some estimates.
Currently, about 400,000 Veterans enrolled in VA carry a PTSD
diagnosis. Those who suffer from PTSD often have diminished
functioning and a poorer quality of life as evidenced by elevated
rates of suicide, hospital admissions, poverty, and unemployment.
Significant medical morbidity is also common among those with PTSD
and several agerelated chronic medical conditions develop earlier.
Moreover, people with PTSD have higher prevalence rates of
problematic health behaviors, and utilize medical care at higher
rates than those without PTSD. Although there are PTSD treatments
available that have demonstrated effectiveness among individuals
with diagnosed PTSD, many people who have PTSD may not be diagnosed
and many who are diagnosed do not pursue mental health treatment.
Of those who do seek treatment, prolonged delays are common. To
minimize treatment delays and to maximize population reach, VA
established a screening program to identify PTSD in their patients
as they present in primary care clinics. Such screening programs
may be helpful because primary care providers often have difficulty
identifying PTSD in their patients and PTSD is therefore frequently
undertreated in the primary care setting. The premise of this type
of screening program is to identify individuals needing further
evaluation so as to facilitate mental health treatment engagement
earlier in the course of the illness and to identify patients for
treatment who might not otherwise be identified as needing mental
health care. Recently, the Institute of Medicine (IOM) released a
report examining the screening, diagnosis, treatment, and
rehabilitation services for military Veterans and service members
with PTSD in the Department of Veterans Affairs and the Department
of Defense. As noted in the IOM report and elsewhere, successful
screening programs utilize instruments that are simple, valid,
precise, and acceptable both clinically and socially. To identify
screening tools that are best suited to primary care practice and
to maximize relevance to the VA population, this evidence synthesis
report reviews the literature on the feasibility and diagnostic
accuracy of screening tools used in a primary care setting in the
United States.We addressed the following key questions: Key
Question #1. What tools are used to screen for PTSD in primary care
settings, and what are their characteristics (i.e., length,
format/administration, response scale)? Key Question #2. What are
the psychometric properties and utility of the screening tools
(sensitivity, specificity, likelihood ratios, predictive values,
area under curve, reliability)? Key Question #3. What information
is there about the implementability (e.g., ease of administration,
patient satisfaction) of PTSD screening tools in primary care
clinics? Key Question #4. Do the psychometric properties and
utility of each of the screening tools differ according to age,
gender, race/ethnicity, substance abuse, or other comorbidities?
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