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Screening for Posttraumatic Stress Disorder in VA Primary Care Patients with Depression Symptoms

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Abstract

Background

Unrecognized posttraumatic stress disorder (PTSD) is common and may be an important factor in treatment-resistant depression. Brief screens for PTSD have not been evaluated for patients with depression.

Objective

The objective was to evaluate a 4-item screen for PTSD in patients with depression.

Design

Baseline data from a depression study were used to evaluate sensitivity, specificity, and likelihood ratios (LRs) using the PTSD checklist (PCL-17) as the reference standard.

Subjects

Subjects are 398 depressed patients seen in Veterans Affairs (VA) primary care clinics.

Measures

The Patient Health Questionnaire (PHQ) for depression, PCL-17, and 4-item screen for PTSD were used.

Results

Patients had a mean PHQ score of 14.8 (SD 3.7). Using a conservative PCL-17 cut point “(>50)”, the prevalence of PTSD was 37%. PCL-17 scores were strongly associated with PHQ scores (r = 0.59, P < 0.001). Among the 342 (86%) patients endorsing trauma, a score of 0 on the remaining 3 symptom items had a LR = 0.21, score of 1 a LR = .62, score of 2 a LR = 1.36, and score of 3 a LR = 4.38.

Conclusions

Most depressed VA primary care patients report a history of trauma, and one third may have comorbid PTSD. Our 4-item screen has useful LRs for scores of 0 and 3. Modifying item rating options may improve screening characteristics.

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Acknowledgment

The authors wish to acknowledge Jeffrey Solodky BA and Nancy Cuilwik BS for assistance with reviewing the literature and for screening patients for the DEP-PC study. The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service Project MHI 20-020. The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Conflict Of Interest Statement

All 3 authors received grant support from the Department of Veterans Affairs Health Services Research and Development Service. Aside from this support, there are no potential conflicts of interest.

Author information

Authors and Affiliations

  1. Division of Hospital and Specialty Medicine, Portland VA Medical Center, Portland, OR, USA

    Martha S. Gerrity MD, MPH, PhD

  2. Department of Medicine, Oregon Health & Science University, Portland, OR, USA

    Martha S. Gerrity MD, MPH, PhD

  3. Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA

    Kathryn Corson PhD & Steven K. Dobscha MD

  4. Columbia Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland VA Medical Center, P.O. Box 1034 (R&D-66), Portland, OR, 97207, USA

    Martha S. Gerrity MD, MPH, PhD, Kathryn Corson PhD & Steven K. Dobscha MD

Authors
  1. Martha S. Gerrity MD, MPH, PhD
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  2. Kathryn Corson PhD
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  3. Steven K. Dobscha MD
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Corresponding author

Correspondence to Steven K. Dobscha MD.

Appendices

Appendix A

Table 4 Sensitivity, specificity and area under the curve of 4-item screen at various PCL-17 cut points for patients who reported trauma (N = 342)
Full size table

Appendix B

Table 5 Sensitivity, specificity and area under the curve of 4-item screen at various PCL-15 cut points for patients who reported trauma (N = 342)
Full size table

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Gerrity, M.S., Corson, K. & Dobscha, S.K. Screening for Posttraumatic Stress Disorder in VA Primary Care Patients with Depression Symptoms. J GEN INTERN MED 22, 1321–1324 (2007). https://doi.org/10.1007/s11606-007-0290-5

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  • DOI: https://doi.org/10.1007/s11606-007-0290-5

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