Accuracy of screening for posttraumatic stress disorder in specialty mental health clinics in the U.S. Veterans Affairs Healthcare System

This study 1) describes the prevalence of positive PTSD screens among male, female, and OEF/OIF/OND veterans using various PTSD Checklist -Military version (PCL-M) criteria; 2) evaluates the sensitivity and specificity of various PCL-M criteria; and 3) identifies optimal screening criteria in predicting clinician documented PTSD diagnoses. VA electronic medical records data from 327,093 veterans during 20082012 were analyzed. Receiver operating characteristic curve analyses compared PCL-M scores against clinician-documented PTSD diagnoses. Results showed that different PCL-M scoring criteria resulted in 62.0-84.5% of veterans screening positive for PTSD compared to 40.1% with a clinician-documented PTSD diagnosis. Sensitivity of the PCL-M ranged from 73.7 to 93.5% and specificity ranged from 21.6 to 45.8% for all veterans. The optimal PCL-M cut score according to Youden's index was >= 45 for male veterans, >= 35 for female veterans, and >= 38 for OEF/OIF/OND veterans. Self-report measures like the PCL-M may be a useful screening tool for identifying probable PTSD in VA specialty clinics, but they should be calibrated for different veteran subgroups and followed by structured clinical interviews. Published by Elsevier Ireland Ltd.