Test of a single-item posttraumatic stress disorder screener in a military primary care setting

Gore, Kristie L.; Engel, Charles C.; Freed, Michael C.; Liu, Xian; Armstrong, David W.

doi:10.1016/j.genhosppsych.2008.05.002

Next »General Hospital Psychiatry
Volume 30, Issue 5 , Pages 391-397, September 2008

Test of a single-item posttraumatic stress disorder screener in a military primary care setting☆

Kristie L. Gore, Ph.D.
- Deployment Health Clinical Center, Walter Reed Army Medical Center, Washington, DC 20307, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Corresponding author. Tel.: +1 202 356 1074; fax: +1 202 356 1090.
Charles C. Engel, M.D., M.P.H.
- Deployment Health Clinical Center, Walter Reed Army Medical Center, Washington, DC 20307, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
Michael C. Freed, Ph.D.
- Deployment Health Clinical Center, Walter Reed Army Medical Center, Washington, DC 20307, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
Xian Liu, Ph.D.
- Deployment Health Clinical Center, Walter Reed Army Medical Center, Washington, DC 20307, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
David W. Armstrong III, Ph.D., F.A.C.S.M.
- Deployment Health Clinical Center, Walter Reed Army Medical Center, Washington, DC 20307, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA

Received 28 January 2008; accepted 11 May 2008. published online 25 July 2008.

Abstract

Background

Posttraumatic stress disorder (PTSD) is prevalent in primary care, frequently goes undetected and can be highly debilitating when untreated.

Objective

We assessed the operating characteristics of a single-item PTSD screener (SIPS) for primary care and compared it to a commonly used four-item primary care PTSD screener (PC-PTSD). The SIPS asks: “Were you recently bothered by a past experience that caused you to believe you would be injured or killed … not bothered, bothered a little, or bothered a lot?”

Methods

A total of 3234 patients from three Washington, DC, area military primary care clinics completed the SIPS. Independent, blinded assessments using a structured diagnostic PTSD interview were completed in 213 of these patients.

Results

The SIPS yielded a reasonable range of likelihood ratios, suggesting capacity to discriminate between low- and high-probability PTSD patients. However, the SIPS sensitivity was only 76% for those reporting “bothered a little” and the four-item PC-PTSD yielded significantly better test characteristics on Receiver–Operator Curve analysis.

Conclusion

A single, user-friendly primary care PTSD screening question with three response options, while sensible and worth further investigation, failed to offer sound test characteristics for PTSD screening. Ways of improving SIPS performance are discussed.

Keywords: PTSD, Screening, Primary care

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☆ Disclaimer: The views expressed herein are those of the authors and do not necessarily represent the official policy or position of the Deployment Health Clinical Center, Walter Reed Army Medical Center, Uniformed Services University of the Health Sciences, Department of Defense or the United States Government.

PII: S0163-8343(08)00076-5

doi:10.1016/j.genhosppsych.2008.05.002

Next »General Hospital Psychiatry
Volume 30, Issue 5 , Pages 391-397, September 2008

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