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J Gen Intern Med. 2007 Sep;22(9):1321-4. Epub 2007 Jul 17.

Screening for posttraumatic stress disorder in VA primary care patients with depression symptoms.

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  • 1Division of Hospital and Specialty Medicine, Portland VA Medical Center, Portland, OR, USA.



Unrecognized posttraumatic stress disorder (PTSD) is common and may be an important factor in treatment-resistant depression. Brief screens for PTSD have not been evaluated for patients with depression.


The objective was to evaluate a 4-item screen for PTSD in patients with depression.


Baseline data from a depression study were used to evaluate sensitivity, specificity, and likelihood ratios (LRs) using the PTSD checklist (PCL-17) as the reference standard.


Subjects are 398 depressed patients seen in Veterans Affairs (VA) primary care clinics.


The Patient Health Questionnaire (PHQ) for depression, PCL-17, and 4-item screen for PTSD were used.


Patients had a mean PHQ score of 14.8 (SD 3.7). Using a conservative PCL-17 cut point "(>50)", the prevalence of PTSD was 37%. PCL-17 scores were strongly associated with PHQ scores (r = 0.59, P < 0.001). Among the 342 (86%) patients endorsing trauma, a score of 0 on the remaining 3 symptom items had a LR = 0.21, score of 1 a LR = .62, score of 2 a LR = 1.36, and score of 3 a LR = 4.38.


Most depressed VA primary care patients report a history of trauma, and one third may have comorbid PTSD. Our 4-item screen has useful LRs for scores of 0 and 3. Modifying item rating options may improve screening characteristics.

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