Prins Annabel, Bovin Michelle J, Smolenski Derek J, Marx Brian P, Kimerling Rachel, Jenkins-Guarnieri Michael A, Kaloupek Danny G, Schnurr Paula P, Kaiser Anica Pless, Leyva Yani E, Tiet Quyen Q
National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA.
Department of Psychology, San Jose State University, One Washington Square, San Jose, CA, 95192, USA.
J Gen Intern Med. 2016 Oct;31(10):1206-11. doi: 10.1007/s11606-016-3703-5. Epub 2016 May 11.
Posttraumatic Stress Disorder (PTSD) is associated with increased health care utilization, medical morbidity, and tobacco and alcohol use. Consequently, screening for PTSD has become increasingly common in primary care clinics, especially in Veteran healthcare settings where trauma exposure among patients is common.
The objective of this study was to revise the Primary Care PTSD screen (PC-PTSD) to reflect the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for PTSD (PC-PTSD-5) and to examine both the diagnostic accuracy and the patient acceptability of the revised measure.
We compared the PC-PTSD-5 results with those from a brief psychiatric interview for PTSD. Participants also rated screening preferences and acceptability of the PC-PTSD-5.
A convenience sample of 398 Veterans participated in the study (response rate = 41 %). Most of the participants were male, in their 60s, and the majority identified as non-Hispanic White.
The PC-PTSD-5 was used as the screening measure, a modified version of the PTSD module of the MINI-International Neuropsychiatric Interview was used to diagnose DSM-5 PTSD, and five brief survey items were used to assess acceptability and preferences.
The PC-PTSD-5 demonstrated excellent diagnostic accuracy (AUC = 0.941; 95 % C.I.: 0.912- 0.969). Whereas a cut score of 3 maximized sensitivity (κ[1]) = 0.93; SE = .041; 95 % C.I.: 0.849-1.00), a cut score of 4 maximized efficiency (κ[0.5] = 0.63; SE = 0.052; 95 % C.I.: 0.527-0.731), and a cut score of 5 maximized specificity (κ[0] = 0.70; SE = 0.077; 95 % C.I.: 0.550-0.853). Patients found the screen acceptable and indicated a preference for administration by their primary care providers as opposed to by other providers or via self-report.
The PC-PTSD-5 demonstrated strong preliminary results for diagnostic accuracy, and was broadly acceptable to patients.
创伤后应激障碍（PTSD）与医疗保健利用率增加、发病率上升以及烟草和酒精使用有关。因此，在初级保健诊所中，PTSD筛查变得越来越普遍，尤其是在患者中创伤暴露较为常见的退伍军人医疗环境中。
本研究的目的是修订初级保健PTSD筛查量表（PC-PTSD）以反映精神疾病诊断与统计手册第5版（DSM-5）中PTSD的新标准（PC-PTSD-5），并检验修订后量表的诊断准确性和患者可接受性。
我们将PC-PTSD-5的结果与PTSD简短精神科访谈的结果进行了比较。参与者还对PC-PTSD-5的筛查偏好和可接受性进行了评分。
398名退伍军人的便利样本参与了该研究（回复率 = 41%）。大多数参与者为男性，60多岁，且大多数人认定为非西班牙裔白人。
PC-PTSD-5用作筛查量表，MINI国际神经精神科访谈中PTSD模块的修订版用于诊断DSM-5中的PTSD，五个简短的调查项目用于评估可接受性和偏好。
PC-PTSD-5显示出优异的诊断准确性（曲线下面积 = 0.941；95%置信区间：0.912 - 0.969）。截断分数为3时敏感性最高（κ[1] = 0.93；标准误 = 0.041；95%置信区间：0.849 - 1.00），截断分数为4时效率最高（κ[0.5] = 0.63；标准误 = 0.052；95%置信区间：0.527 - 0.731），截断分数为5时特异性最高（κ[0] = 0.70；标准误 = 0.077；95%置信区间：0.550 - 0.853）。患者认为该筛查量表可以接受，并表示更倾向于由其初级保健提供者进行施测，而不是由其他提供者或通过自我报告的方式。
PC-PTSD-5在诊断准确性方面显示出强劲的初步结果，并且被患者广泛接受。
