Rationale:

• PTSD is one of several adverse outcomes that may follow exposure to a traumatic stressor, and it is relatively common in primary medical settings.
• Ten percent of primary care patients have troublesome traumatic stress symptoms and 2.5% have the full diagnosis; however, it may not be the focus of attention.
• Systematic screening may detect at-risk individuals who do not acknowledge the extent of their symptoms and who may avoid seeking treatment.

Evidence:

• The incidence of PTSD ranges from 4% to more than 60% depending on the specific event. Exposed individuals also have higher rates of depressive and anxiety disorders, substance abuse, somatic complaints, and interpersonal violence. Several questionnaires can help to identify individuals at risk for posttraumatic psychopathology (1; 2; 3; 7; 8; 9; 10).
• The PTSD Checklist is the only screening tool that has been tested in a primary care setting. Its sensitivity in 400 family practice patients was only 32%, suggesting that improved screening approaches are needed in primary care (8; 11). More recently, the psychometric properties of the PTSD Checklist were studied in 142 older adult primary care patients, identifying a score of 37 as the cutoff with optimal sensitivity and specificity, which is lower than that typically used in other studies, including the prior family practice study (12).

Comments:

• Effective screening of individuals exposed to traumatic stressors must address several types of potential symptoms. Assessment tools that require less than 5 minutes of physician time can assist with this task.