Diagnostic Accuracy of the Primary Care PTSD for DSM-5 Screen (PC-PTSD-5) in Demographic and Diagnostic Subgroups of Veterans

Background

The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) is a screening instrument designed to identify patients with probable PTSD and is mandated to be used in VA primary care settings. However, validation of the diagnostic accuracy of the instrument is lacking in various demographic and diagnostic groups.

Objective

To evaluate the diagnostic accuracy of the PC-PTSD-5 in demographically and diagnostically stratified groups of VA primary care patients.

Design, Setting, and Participants

Based on a sample of 519 VA primary care patients (40.61% response rate), the PC-PTSD-5 was evaluated against a criterion measure, examining its sensitivity, specificity, and other diagnostic properties. Evaluations were conducted in demographically stratified patient groups, including gender, age, race/ethnicity, marital status, and education, as well as diagnostically stratified groups, in patients with and without a depression, alcohol use, and drug use disorder.

Main Measures

The MINI-International Neuropsychiatric Interview was the criterion measure against which the PC-PTSD-5 was evaluated.

Key Results

Among the 10 demographically stratified groups of patients, the PC-PTSD-5 demonstrated a sensitivity between 81.25% (95% C.I.: 54.35 – 05.95) and 100% (95% C.I.: 63.06 – 1000) and its specificity ranged from 80.54% (95% C.I.: 74.70 – 85.55) to 88.31% (95% C.I.: 83.45 – 92.15). Among the 6 diagnostically stratified groups of patients (with and without depression, alcohol use, and drug use disorders), the PC-PTSD-5 exhibited a sensitivity between 88.89% (95% C.I.: 65.29 – 98.62) and 95.92% (95% C.I.: 86.02 – 99.50), and its specificity varied from 60.00% (95% C.I.: 40.60 – 77.34) to 88.14% (95% C.I.: 84.50 – 91.19).

Conclusions

The PC-PTSD-5, suitable for a diverse range of VA primary care patients, shows satisfactory sensitivity and specificity across various demographic and diagnostic groups. Healthcare providers should be cautious of false positives in patients with depression or substance use disorders, given the potential symptom overlap with PTSD.