An abbreviated PTSD checklist for use as a screening instrument in primary care
Introduction
Many patients with emotional disorders receive their care exclusively in general medical settings (Regier et al., 1993). Recognizing the importance of increasing the rates of detection and treatment of depression in primary care, the US Preventive Services Task Force recently recommended that primary care providers routinely screen for depression (Agency for Healthcare Research and Quality, 2002). There is good reason to believe that many of the same benefits would be derived from screening for anxiety states as well. Like depression, anxiety is generally under-recognized and under-treated by general medical providers (Pini, Perkonnig, Tansella, & Wittchen, 1999).
There are a number of reasons why posttraumatic stress disorder (PTSD) is an important condition to be assessed in primary care. A significant number of patients are affected. In a national study of Israeli primary care patients, 7.5% of men and 10.5% of women were found to have PTSD (Taubman-Ben-Ari, Rabinowitz, Feldman, & Vaturi, 2001). Similarly, 11.8% of patients in a US primary care clinic were diagnosed with current PTSD (Stein, McQuaid, Pedrelli, Lenox, & McCahill, 2000). Traumatized individuals are over-represented in primary care partially because of the need for medical care for trauma-related physical injuries (Koss, Koss, & Woodruff, 1991), but chronic PTSD is associated with impaired functioning, increased medical complaints, higher long-term utilization of medical services and reduced quality of life (Kimerling & Calhoun, 1994; Koss et al., 1991; Schnurr, Friedman, Sengupta, Jankowski, & Holmes, 2000; Solomon & Davidson, 1997). Nonetheless, physicians in primary care recognize distress in only half of patients with PTSD and identify PTSD in specific much less frequently; only 2% of patients with presumptive PTSD based on a self-report measure were diagnosed with the disorder (Taubman-Ben-Ari et al., 2001).
The greatest barrier to increased screening in primary care is its feasibility for busy staff and providers. The shortest self-report measures that are validated for screening in primary care, such as the PTSD Checklist-civilian version (PCL-C) (Weathers, Litz, Huska, & Keane, 1994), take approximately 5 min to complete. If a provider is to screen for three or four mental health problems (e.g., depression, panic, PTSD, substance use disorders), the total time quickly rises to 20–30 min. Thus, if we are to advocate for increased screening in primary care (e.g., Lang & Stein, 2002), we must make available good and extremely short screening instruments.
Previous work has shown that the PCL-C has adequate psychometric properties for use with women in primary care (Dobie et al., 2002; Walker, Newman, Dobie, Ciechanowski, & Katon, 2002). The purpose of this paper is to describe the development a brief screening instrument for PTSD to be used with both men and women in primary care.
Section snippets
Study 1
The purpose of Study 1 was to generate an abbreviated screening instrument from the set of PCL-C items.
Study 2
The purpose of Study 2 was to test in a separate sample the psychometric properties of the screening tools that were generated in Study 1. One always expects a measure to perform more poorly in samples other than the one in which it was developed, so this study is important in evaluating the efficiency of the abbreviated measures.
Acknowledgements
This study was funded in part by the NIMH grant K23 MH063152 awarded to the first author.
References (21)
- et al.
Psychometric properties of the PTSD checklist (PCL)
Behaviour Research and Therapy
(1996) - et al.
Screening for post-traumatic stress disorder in female veteran’s affairs patientsValidation of the PTSD checklist
General Hospital Psychiatry
(2002) - et al.
Screening for anxiety in primary careWhy bother?
General Hospital Psychiatry
(2002) - et al.
Prevalence and 12-month outcome of threshold and subthreshold mental disorders in primary care
Journal of Affective Disorders
(1999) - et al.
Posttraumatic stress disorder in the primary care medical setting
General Hospital Psychiatry
(2000) - et al.
Validation of the PTSD checklist in an HMO sample of women
General Hospital Psychiatry
(2002) - Agency for Healthcare Research and Quality. (2002). Screening for depression: Recommendations and rationale. Retrieved...
- et al.
Short screening scale for SDSM-IV posttraumatic stress disorder
American Journal of Psychiatry
(1999) Psychometric study of a brief screen for PTSDAssessing the impact of multiple traumatic events
Assessment
(2001)- et al.
Somatic symptoms, social support, and treatment seeking among sexual assault victims
Journal of Consulting and Clinical Psychology
(1994)
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