Test of a single-item posttraumatic stress disorder screener in a military primary care setting

Abstract

Background Posttraumatic stress disorder (PTSD) is prevalent in primary care, frequently goes undetected and can be highly debilitating when untreated. Objective We assessed the operating characteristics of a single-item PTSD screener (SIPS) for primary care and compared it to a commonly used four-item primary care PTSD screener (PC-PTSD). The SIPS asks: “Were you recently bothered by a past experience that caused you to believe you would be injured or killed … not bothered, bothered a little, or bothered a lot?” Methods A total of 3234 patients from three Washington, DC, area military primary care clinics completed the SIPS. Independent, blinded assessments using a structured diagnostic PTSD interview were completed in 213 of these patients. Results The SIPS yielded a reasonable range of likelihood ratios, suggesting capacity to discriminate between low- and high-probability PTSD patients. However, the SIPS sensitivity was only 76% for those reporting “bothered a little” and the four-item PC-PTSD yielded significantly better test characteristics on Receiver–Operator Curve analysis. Conclusion A single, user-friendly primary care PTSD screening question with three response options, while sensible and worth further investigation, failed to offer sound test characteristics for PTSD screening. Ways of improving SIPS performance are discussed.