What does the average score on a Post-Traumatic Stress Disorder (PTSD) screen indicate?

Understanding PTSD Screen Scores

The "average score" on a PTSD screen has no clinical meaning—what matters is whether the score exceeds the validated cutoff threshold for your specific screening tool, which indicates probable PTSD requiring further evaluation.

Score Interpretation Depends on the Screening Tool Used

The interpretation of PTSD screening scores varies dramatically based on which validated instrument you're using:

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

• Scores range from 0-5 (5 yes/no questions) 1, 2
• A score of ≥3 indicates probable PTSD and warrants further diagnostic evaluation 1
• In trauma-exposed populations, a cutoff of ≥4 maximizes sensitivity (100%) while maintaining acceptable specificity (85.2%) 2
• In substance-using populations, a cutoff of ≥5 may be more appropriate (sensitivity 62%, specificity 80%) 3
• This is a binary screening tool—you're either above or below the threshold 1, 2

PTSD Checklist for DSM-5 (PCL-5)

• Scores range from 0-80 (20 items rated 0-4) 1, 4
• A score of ≥33 indicates probable DSM-5 PTSD requiring clinical interview 3
• Approximately 45% of trauma-exposed primary care patients screen positive at this threshold 1
• A change of 9-12 points represents the minimal important difference (MID)—meaning score changes smaller than this likely don't reflect real clinical change 4
• Score changes of ≤5 points are not reliable and should not guide treatment decisions 4

Common Clinical Pitfalls

Avoid treating screening scores as diagnostic tools. A positive screen (above cutoff) indicates the need for a comprehensive clinical interview using DSM-5 criteria—it does not diagnose PTSD 5, 1, 2.

Don't average scores across populations or time points. The PC-PTSD-5 demonstrates excellent test-retest reliability (0.79-0.94) over short intervals, but individual scores fluctuate and should be interpreted at each assessment 4.

Recognize that cutoff scores may need adjustment based on your population. In predominantly Black, socioeconomically vulnerable, trauma-exposed populations, standard cutoffs may have different performance characteristics 1, 3.

Practical Application Algorithm

1. If using PC-PTSD-5 in general primary care: Score ≥3 → proceed to full diagnostic evaluation 1, 2

2. If using PC-PTSD-5 in substance use treatment settings: Score ≥5 → proceed to full diagnostic evaluation 3

3. If using PCL-5 for symptom severity tracking:

   • Score ≥33 indicates probable PTSD 3
   • Monitor for changes ≥9-12 points to assess treatment response 4
   • Ignore changes <5 points as measurement noise 4

4. For trauma-exposed patients in public healthcare settings: Consider using PC-PTSD-5 Item 1 alone (nightmares/intrusive memories) as it provides the most diagnostic information in this population 1