Recommended Screening Questions for PTSD
The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) is the recommended screening tool for PTSD, with a cutoff score of 4 maximizing diagnostic efficiency in both veteran and civilian populations. 1, 2
Primary Care PTSD Screen for DSM-5 (PC-PTSD-5)
The PC-PTSD-5 consists of the following five questions that can be efficiently administered in primary care settings:
- Have you ever experienced a serious accident, fire, disaster, assault, or other frightening or horrifying event?
- If YES, continue with questions 2-5
- If NO, screen is negative
In the past month, have you: 2. Had nightmares about the event(s) or thought about the event(s) when you did not want to? 3. 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)? 4. Been constantly on guard, watchful, or easily startled? 5. Felt numb or detached from people, activities, or your surroundings?
A score of 3 or more "yes" responses indicates a positive screen, with a score of 4 maximizing efficiency while maintaining excellent sensitivity (100%) and specificity (85.2%) 2.
Alternative Abbreviated Screening Options
For extremely time-limited settings, consider:
- Two-item screen: Focus on intrusive thoughts and avoidance behaviors 3
- Four-item abbreviated PCL-5: Shows good sensitivity but lower specificity than the full PCL-5 4
- PTSS-14: Useful for identifying those at risk of developing PTSD after recent trauma 5
Implementation Considerations
When to Screen
- During routine preventive health visits 6
- When patients present with symptoms that may indicate trauma exposure (sleep disturbances, anxiety, depression, substance use) 6
- Following known traumatic events 6
Patient Preferences
- Patients generally prefer PTSD screening to be administered by their primary care provider rather than through self-report 1
- Screening is generally well-accepted by patients when presented as a sign of caring 6
Special Populations
Children and Adolescents
- For adolescents, incorporate PTSD screening questions into the HEADSSS (Home, Education, Activities, Drugs, Sexuality, Suicide/depression, Safety) psychosocial interview 6
- The PTSD Reaction Index Brief Form is recommended for children with known trauma exposure 6
Cancer Survivors
- When screening cancer survivors, the Distress Thermometer alone lacks sufficient sensitivity and specificity 6
- Supplement with specific PTSD screening questions for more accurate assessment 6
Assessment Following Positive Screen
When a screen is positive (≥3 on PC-PTSD-5):
- Conduct a diagnostic assessment to confirm PTSD diagnosis using DSM-5 criteria 6
- Assess for:
Pitfalls to Avoid
- Cultural considerations: Be aware that screening tools may not be validated across all cultural groups; interpret results cautiously 6
- False positives: Some patients with positive screens may have adjustment disorders or other conditions rather than PTSD 6
- Underdetection: Relying solely on clinical impression without formal screening leads to underdetection of PTSD 6
- Overreliance on brief tools: Brief screening tools should be followed by more comprehensive assessment when positive 6
Remember that early identification and intervention for PTSD can significantly reduce morbidity, mortality, and improve quality of life outcomes for affected individuals.