Performance characteristics of the Posttraumatic Stress Disorder Checklist and SPAN in Veterans Affairs primary care settings

Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29452, USA.
General Hospital Psychiatry (Impact Factor: 2.9). 07/2007; 29(4):294-301. DOI: 10.1016/j.genhosppsych.2007.03.004
Source: PubMed

ABSTRACT Posttraumatic stress disorder (PTSD) is a treatable disorder, and individuals with this condition may benefit from early detection. Many people with PTSD are not aware of its symptoms and do not seek treatment, making a brief and targeted screening program a worthwhile endeavor. For this reason, research aimed at improving screening instruments could yield substantial benefits.
The primary objective of this research was to assess the diagnostic performance of two popular PTSD screening assessments, the PTSD Checklist (PCL) and the SPAN, in a Veterans Affairs (VA) primary care setting. Additionally, we compared the screening performance of these two assessments by sex and race.
The PCL and SPAN were compared with a gold standard, the Clinician-Administered PTSD Scale. Receiver operating characteristic curves were used in conjunction with sensitivity and specificity measures to assess the performance of each screening assessment. These analyses are based on a large database (n=1076) that was derived from a multisite cross-sectional study conducted at four southeastern VA medical centers.
Results for the PCL support cutoff scores lower than those previously published, whereas results for the SPAN support the previously recommended cutoff score of 5 (sensitivity of 73.68% and specificity of 81.99%). We found no significant difference in areas under the curve (AUCs) by sex and by race between the PCL and SPAN. We did find that there was a highly significant difference (P<.0006) in overall diagnostic ability (as measured by the AUC) between the PCL (AUC=0.882) and SPAN (AUC=0.837), making the PCL the preferred screening tool, unless brevity is essential.
Clinicians and researchers should consider lower cutoff scores for the PCL, but the originally suggested cutoff score for the SPAN is appropriate.

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    • "For screening procedures where the goal is to identify as many cases as possible for referral to further assessment, our results suggest that a significantly lower cutoff value is appropriate. This is in line with earlier studies of nontreatment-seeking samples, such as samples from primary care settings (Dobie et al., 2002; Lang et al., 2003; Walker et al., 2002; Yeager et al., 2007), that have found statistically superior performance of the PCL with cutoff scores ranging between 30 and 38. Indeed, based on our results, we suggest that 37 might be an appropriate cutoff for screening in active military samples. "
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    ABSTRACT: This study aimed to assess the diagnostic accuracy of the Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C; Weathers, Litz, Herman, Huska, & Keane, 1993) and to establish the most accurate cutoff for prevalence estimation of posttraumatic stress disorder (PTSD) in a representative military sample compared to a clinical interview. Danish soldiers (N = 415; 94.4% male, mean age 26.6 years) were assessed with the PCL-C and the Structured Clinical Interview for the DSM-IV (SCID; First, Spitzer, Gibbon, & Williams, 2002) 2.5 years after their return from deployment to Afghanistan. Diagnostic accuracy of the PCL-C was assessed through receiver operating characteristic curve analysis. The PCL-C displayed high overall accuracy (area under the curve = .95, confidence interval [.92, .98]) and performed well (sensitivity > .70 and specificity ≥ .90), with cutoff scores ranging from 37 to 44. When including sensitivity values a little below .70 (.69), the PCL-C performed well for cutoff levels up to 53. Prevalence of PTSD varied considerably with the application of different cutoff values and scoring methods. Our results show that the PCL-C is a relevant and valid tool for screening for probable PTSD in active military samples. However, it is of great importance that cutoff scores be chosen based on the sample and the purpose of the particular study or screening. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Psychological Assessment 11/2013; 26(1). DOI:10.1037/a0034889 · 2.99 Impact Factor
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    • "In a validation study conducted among 352 postdeployment soldiers, Bliese et al. (2008) reported a weighted sensitivity and specificity of 0.76 and 0.92, respectively, using a cutoff score of 3. The Startle, Physiological Arousal, Anger, and Numbness instrument is another four-item self-report measure developed from the severity items of the Davidson Trauma Scale (Meltzer- Brody et al., 1999). Among veterans seen in a VA primary care setting, the sensitivity and specificity were 0.74 and 0.82, respectively, using a cutoff score of 5 and comparing the results to the Clinician-Administered PTSD Scale (Yeager et al., 2007). Gore and colleagues (2008) recently developed a single-item PTSD measure with a three-point response scale ranging from " not bothered " to " bothered a lot. "
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    ABSTRACT: Posttraumatic stress disorder (PTSD) is a psychiatric disorder that affects 7-8% of the general U.S. population at some point during their lifetime; however, the prevalence is much higher among certain subgroups, including active duty military personnel and veterans. In this article, we review the empirical literature on the epidemiology and screening of PTSD in military and veteran populations, including the availability of sensitive and reliable screening tools. Although estimates vary across studies, evidence suggests that the prevalence of PTSD in deployed U.S. military personnel may be as high as 14-16%. Prior studies have identified trauma characteristics and pre- and posttrauma factors that increase risk of PTSD among veterans and military personnel. This information may help to inform prevention and screening efforts, as screening programs could be targeted to high-risk populations. Large-scale screening efforts have recently been implemented by the U.S. Departments of Defense and Veterans Affairs. Given the prevalence and potential consequences of PTSD among veterans and active duty military personnel, development and continued evaluation of effective screening methods is an important public health need. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
    Psychological Services 11/2012; 9(4):361-382. DOI:10.1037/a0027649 · 1.08 Impact Factor
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    • "It has been suggested that gender differences in neuroticism, depression, and the effects of stressful experiences might partly explain the higher vulnerability of women to PTSD (Breslau, 2009), but this is unclear at this time. To date, one study suggests that the PTSD Checklist used among veterans seen in primary care clinics should have a lower cutoff score for female veterans (Lang et al., 2003), but few PTSD screening studies have reported differences by gender (Yeager et al., 2007). Our hypothesis was that the NYPRS would detect a significant difference by gender, given the scale's multi-dimensional structure . "
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    ABSTRACT: We previously developed a new posttraumatic stress disorder (PTSD) screening instrument-the New York PTSD Risk Score (NYPRS). Since research suggests different PTSD risk factors and outcomes for men and women, in the current study we assessed the suitability of male and female versions of this screening instrument among 3298 adults exposed to traumatic events. Using diagnostic test methods, including receiver operating characteristic (ROC) curve and bootstrap techniques, we examined different prediction domains, including core PTSD symptoms, trauma exposures, sleep disturbances, depression symptoms, and other measures to assess PTSD prediction models for men and women. While the original NYPRS worked well in predicting PTSD, significant interaction was detected by gender, suggesting that separate models are warranted for men and women. Model comparisons suggested that while the overall results appeared robust, prediction results differed by gender. For example, for women, core PTSD symptoms contributed more to the prediction score than for men. For men, depression symptoms, sleep disturbance, and trauma exposure contributed more to the prediction score. Men also had higher cut-off scores for PTSD compared to women. There were other gender-specific differences as well. The NYPRS is a screener that appears to be effective in predicting PTSD status among at-risk populations. However, consistent with other medical research, this instrument appears to require male and female versions to be the most effective.
    Psychiatry Research 05/2012; 200(2-3). DOI:10.1016/j.psychres.2012.04.022 · 2.68 Impact Factor
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