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

Gerrity MS, Corson K, Dobscha SK. Screening for posttraumatic stress disorder in VA primary care patients with depression symptoms. Journal of general internal medicine. 2007 Sep 1; 22(9):1321-4.

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BACKGROUND: 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. OBJECTIVE: The objective was to evaluate a 4-item screen for PTSD in patients with depression. DESIGN: 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: Subjects are 398 depressed patients seen in Veterans Affairs (VA) primary care clinics. MEASURES: The Patient Health Questionnaire (PHQ) for depression, PCL-17, and 4-item screen for PTSD were used. RESULTS: 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. CONCLUSIONS: 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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