Primary Care PTSD Screen for DSM-5 (PC-PTSD-5)

Introduction

According to the National Center for PTSD, the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) is a 5-item screen that was designed to identify individuals with probable PTSD in primary care settings. The measure begins with an item which assesses lifetime exposure to traumatic events. If a respondent denies exposure, the PC-PTSD-5 is complete with a score of 0. However, if a respondent indicates that they have had any lifetime exposure to trauma, the respondent is instructed to respond to 5 additional yes/no questions about how that trauma exposure has affected them over the past month.

Because the PC-PTSD-5 was designed to identify respondents with probable PTSD, those screening positive require further assessment, preferably with a structured interview such as the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Administration of a clinical interview is not always possible due to time and personnel requirements. In these cases, it is recommended that additional assessment is conducted using a validated self-report measure. Specifically, the PTSD Checklist for DSM-5 (PCL-5) is a psychometrically sound self-report questionnaire that can be used for this purpose.

Scoring

If a respondent endorses a trauma exposure, they can score a 0-5 on the PC-PTSD-5, which is a count of "yes" responses to the 5 questions about how the trauma has affected them in the past month. Research in a large sample of VA primary care patients found that a cut-point of 4 ideally balanced false negatives and false positives for the overall sample and for men. However, for women, a cut-point of 4 resulted in high numbers of false negatives. Practitioners may consider a lower cut-point for women in some settings if evaluation resources are available. In contrast, a higher cut-point may be preferable if resources are such that false positives will substantially decrease clinician availability. Because performance parameters will change according to sample, clinicians should consider sample characteristics and screening purposes when selecting a cut-point.

Scale

Sometimes things happen to people that are unusually or especially frightening, horrible, or traumatic.

For example:

• a serious accident or fire

• a physical or sexual assault or abuse

• an earthquake or flood

• a war

• seeing someone be killed or seriously injured

• having a loved one die through homicide or suicide.

Have you ever experienced this kind of event?
YES / NO

If no, screen total = 0. Please stop here.

If yes, please answer the questions below.

In the past month, have you...

1. Had nightmares about the event(s) or thought about the event(s) when you did not want to?
   YES / NO

2. Tried hard not to think about the event(s) or went out of your way to avoid situations that reminded you of the event(s)?
   YES / NO

3. Been constantly on guard, watchful, or easily startled?
   YES / NO

4. Felt numb or detached from people, activities, or your surroundings?
   YES / NO

5. Felt guilty or unable to stop blaming yourself or others for the event(s) or any problems the event(s) may have caused?
   YES / NO

Sum the points of questions #1-5 for a total of 5 points.

Results

1. No trauma exposure reported: The respondent did not report exposure to a traumatic event, so the five symptom items were not administered. The screen is negative.

2. Negative PTSD screen (0-2 symptoms): Fewer than 3 symptom items endorsed. Using the recommended cut-point of 3 or 4, this is a negative screen for probable PTSD. Clinical judgement still applies.

3. Borderline PTSD screen (3 symptoms). Consider further assessment.

4. Below the standard cutoff of 4, but at the cutoff of 3. A lower cutoff may be appropriate for women or when the goal is to avoid missing cases.

   1. According to the National Center for PTSD, "Research in a large sample of VA primary care patients found that a cut-point of 4 ideally balanced false negatives and false positives for the overall sample and for men. However, for women, a cut-point of 4 resulted in high numbers of false negatives. Practitioners may consider a lower cut-point for women in some settings if evaluation resources are available. In contrast, a higher cut-point may be preferable if resources are such that false positives will substantially decrease clinician availability. Because performance parameters will change according to sample, clinicians should consider sample characteristics and screening purposes when selecting a cut-point."

   2. Further assessment with a structured PTSD measure is indicated.

5. Positive PTSD screen (> 3 symptoms). Consider further assessment. According to the National Center for PTSD, "Research in a large sample of VA primary care patients found that a cut-point of 4 ideally balanced false negatives and false positives for the overall sample and for men." Further assessment with a structured PTSD measure is indicated.

Prins, A., Bovin, M. J., Kimerling, R., Kaloupek, D. G., Marx, B. P., Pless Kaiser, A., & Schnurr, P. P. (2015). The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). Available from https://www.ptsd.va.gov