Excerpt

To minimize treatment delays and to maximize population reach, Veterans Affairs (VA) established a screening program to facilitate identification of post-traumatic stress disorder (PTSD) in their patients as they present in primary care clinics. Such screening programs may be helpful because primary care providers often have difficulty identifying PTSD in their patients and PTSD is frequently undertreated in the primary care setting. The premise of this type of screening program is to facilitate mental health treatment engagement earlier in the course of the illness and to engage patients in treatment who might otherwise not be identified as needing mental health care.

Recently, the Institute of Medicine (IOM) released a report examining the screening, diagnosis, treatment, and rehabilitation services for military Veterans and service members with PTSD in the Department of Veterans Affairs and the Department of Defense. As noted in the IOM report and elsewhere, successful screening programs utilize instruments that are simple, valid, precise, and acceptable both clinically and socially. To identify screening tools that are best suited to the primary care setting, this evidence synthesis report reviews the literature on the feasibility and diagnostic accuracy of screening tools used and evaluated with a gold standard in a primary care setting.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • BACKGROUND
  • METHODS
  • DATA SYNTHESIS
  • PEER REVIEW
  • RESULTS
  • FUTURE RESEARCH
• INTRODUCTION
• METHODS
  • TOPIC DEVELOPMENT
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESSMENT
  • RATING THE BODY OF EVIDENCE
  • DATA SYNTHESIS
  • PEER REVIEW
• RESULTS
  • LITERATURE FLOW
  • KEY QUESTION #1 What tools are used to screen for PTSD in primary care settings, and what are their characteristics (i.e., length, format/administration, response scale)?
  • KEY QUESTION #2 What are the psychometric properties and utility of the screening tools (sensitivity, specificity, likelihood ratios, predictive values, area under curve, reliability)?
  • KEY QUESTION #3 What information is there about the implementability (e.g., ease of administration, patient satisfaction) of PTSD screening tools in primary care clinics?
  • KEY QUESTION #4 Do the psychometric properties and utility of each of the screening tools differ according to age, gender, race/ethnicity, substance abuse, or other comorbidities?
• SUMMARY AND DISCUSSION
  • SUMMARY OF EVIDENCE BY KEY QUESTION
  • LIMITATIONS
  • CLINICAL CONSIDERATIONS
  • RECOMMENDATIONS FOR FUTURE RESEARCH
• REFERENCES
• APPENDIX A SEARCH STRATEGIES
• APPENDIX B STUDY SELECTION AND DATA EXTRACTION FORM
• APPENDIX C LEVELS OF EVIDENCE
• APPENDIX D PEER REVIEW COMMENTS/AUTHOR RESPONSES
• APPENDIX E EVIDENCE TABLE
• APPENDIX F SPECIFIC ASSOCIATION OF RCE LEVEL OF EVIDENCE RATINGS TO QUADAS ITEM RATINGS AS APPLIED IN THIS REVIEW

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Quality Enhancement Research Initiative, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, Minneapolis VA Medical Center, Minneapolis, MN, Timothy J. Wilt, M.D., M.P.H., Director

Suggested citation:

Spoont M, Arbisi P, Fu S, Greer N, Kehle-Forbes S, Meis L, Rutks I, Wilt TJ. Screening for Post-Traumatic Stress Disorder (PTSD) in Primary Care: A Systematic Review. VA-ESP Project #09-009; 2013.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Minneapolis VA Medical Center, Minneapolis, MN funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.