Omar Bennett
Post-Traumatic Stress Disorder (PTSD) is a mental health condition that can develop after a person has been exposed to a traumatic event. The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) is a screening tool designed to identify individuals with probable PTSD. The PC-PTSD-5 consists of a series of questions about how a traumatic event has affected an individual in the past month, with responses scored on a scale from 0 to 5. But how many positive items constitute a positive PC-PTSD-5 screening test?
| Characteristics | Values |
|---|---|
| Cut-off score | 4 |
| Optimally sensitive cut-off score | 3 |
| Cut-off score for women | Lower than 4 |
| Cut-off score for men | 4 |
| Cut-off score for veterans | 3 |
| Number of items required for a positive result | 3 |
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What You'll Learn
- A score of 4 or more is recommended as the cut-off point
- The cut-off point is dependent on the purpose, population, and setting of the screening
- A lower cut-off point may be considered for women
- A higher cut-off point may be preferred to reduce false positives
- A cut-off score of 3 is the most sensitive, minimising false negatives
A score of 4 or more is recommended as the cut-off point
The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) is a screening tool designed to identify probable PTSD in respondents. The PC-PTSD-5 asks individuals to respond to five questions about how trauma has affected them in the past month. The questions are scored dichotomously as either 0 or 1 (no = 0; yes = 1).
The cut-off point is the minimum score that indicates a positive result for PTSD. A score of 4 or more is recommended as the cut-off point for the PC-PTSD-5. This recommendation is based on research that found a score of 4 to be the best overall cut point when considering sensitivity and specificity. At this score, the sensitivity was 85%, and the specificity was 84%. This means that a cut-off score of 4 optimally balances false negatives and false positives.
However, it is important to note that the performance parameters of the test will change according to the sample characteristics and screening purposes. For example, research has shown that while a cut-off score of 4 ideally balances false negatives and false positives for men, it results in high numbers of false negatives for women. Therefore, clinicians should consider the sample characteristics and screening purposes when selecting a cut-off point. In some cases, a lower cut-off point may be considered for women if evaluation resources are available.
Additionally, the purpose of the screening should also be considered when determining the cut-off point. For example, in settings where the prevalence of PTSD is likely to be substantially higher than primary care, such as mental health clinics, a more conservative approach may be preferred. This approach would involve utilizing either the optimally efficient or optimally specific cut-off scores to balance the detection of PTSD with the need to conserve resources required to address positive screens among patients with absent or subthreshold diagnoses.
In summary, while a score of 4 or more is generally recommended as the cut-off point for the PC-PTSD-5 screening test, it is important to consider the sample characteristics, screening purposes, and the potential costs of false positives and false negatives when interpreting the results.
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The cut-off point is dependent on the purpose, population, and setting of the screening
The cut-off point for a positive PC-PTSD screening test is dependent on several factors, including the purpose of the screening, the population being screened, and the setting in which the screening is taking place.
The PC-PTSD screening test is designed to identify individuals with probable PTSD, and those who screen positive require further assessment, preferably through a structured interview. However, in cases where a clinical interview is not feasible due to time and resource constraints, alternative assessment methods, such as validated self-report measures, may be utilized.
When determining the cut-off point, it is crucial to consider the specific population being screened. For example, research has shown that a cut-point of 4 effectively balances false negatives and false positives for men, but results in a high number of false negatives for women. As a result, practitioners may opt for a lower cut-off point for women in certain settings, provided that evaluation resources are available. Conversely, a higher cut-off point may be more suitable if false positives are likely to significantly impact clinician availability.
The purpose of the screening also plays a role in determining the cut-off point. For instance, in a study conducted among firefighters, the PC-PTSD-5 scale was adapted to a five-point Likert-type scale to evaluate the diagnostic properties of the instrument in this specific population. The cut-off point was then adjusted to optimize sensitivity and specificity for this particular group.
Furthermore, the setting in which the screening takes place can influence the cut-off point. For instance, in a study conducted in a large public hospital in the southeastern United States, the PC-PTSD-5 was evaluated against the PCL-5 to determine if it could serve as a brief alternative screening tool. The optimal cut-off scores were determined using chance-corrected test quality indices and item response theory (IRT) analyses, taking into account the unique characteristics of the patient population in that specific setting.
In summary, the cut-off point for a positive PC-PTSD screening test is not a fixed value but rather a dynamic threshold that is influenced by the purpose of the screening, the population being screened, and the setting in which the screening is administered. Clinicians must carefully consider these factors when selecting the appropriate cut-off point to ensure accurate identification of individuals with probable PTSD while minimizing false positives and false negatives.
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A lower cut-off point may be considered for women
The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) is a 5-item screen designed to identify individuals with probable PTSD in primary care settings. Respondents who endorse a trauma exposure can score between 0-5 on the PC-PTSD-5, with each "yes" response counting as one point.
Research suggests that a cut-off score of 4 balances false negatives and false positives for the overall sample and for men. However, a cut-off score of 4 resulted in high numbers of false negatives for women. This means that a lower cut-off score may be considered for women to ensure that fewer cases of PTSD are missed.
For example, a cut-off score of 3 for women would mean that a respondent who answers "yes" to three or more of the five questions would screen positive for PTSD. This lower cut-off score could help to identify more women who may be suffering from PTSD and ensure they receive the necessary support and treatment.
It is important to note that the optimal cut-off score may vary depending on the population and the purpose of the screening. For example, a lower cut-off score may be appropriate for screening purposes, while a higher cut-off score may be preferable when making a provisional diagnosis to minimize false positives.
Additionally, the characteristics of the respondent's setting and the availability of evaluation resources should also be considered when selecting a cut-off score. For instance, in settings with limited resources, a higher cut-off score may be preferred to avoid overburdening clinicians with false positives.
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A higher cut-off point may be preferred to reduce false positives
The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) is a 5-item screening tool designed to identify individuals with probable PTSD in primary care settings. Respondents are asked to answer questions about how trauma has affected them in the past month. The PC-PTSD-5 questionnaire begins with assessing lifetime exposure to traumatic events. If a respondent denies exposure, the PC-PTSD-5 is complete with a score of 0. If a respondent confirms exposure to trauma, they are instructed to respond to 5 additional yes/no questions. The PC-PTSD-5 questionnaire can result in a score of 0-5, with each "yes" response counting as one point.
A cut-off score of 4 has been recommended by some researchers, with sensitivity at 85% and specificity at 84%. However, this recommendation is not without criticism. For instance, research in a large sample of VA primary care patients found that a cut-off score of 4 ideally balanced false negatives and false positives for the overall sample and for men. However, for women, a cut-off score of 4 resulted in high numbers of false negatives.
Ultimately, the selection of a cut-off point should consider the characteristics of the sample and the screening purpose.
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A cut-off score of 3 is the most sensitive, minimising false negatives
The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) is a screening tool designed to identify probable PTSD in patients. The test consists of 5 questions about how trauma has affected patients in the past month, with a “yes” response scoring 1 point.
In a sample of veterans, a cut-off score of 3 identified 94.8% of participants diagnosed with PTSD, while a cut-off score of 4 identified 82.6%, and a cut-off score of 5 identified only 56.2%. Therefore, a cut-off score of 3 is the most inclusive and effective in capturing true positive cases of PTSD.
However, it is important to note that minimising false negatives can lead to an increase in false positives. For example, in the aforementioned veteran sample, 26.4% of respondents would be identified as having PTSD with a cut-off score of 3, which is significantly more than the 14.3% identified by the MINI as having PTSD. Thus, while a cut-off score of 3 is the most sensitive, it may also result in a higher number of false positives.
The optimal cut-off score may vary depending on the purpose, population, and setting of the screening program. In some cases, such as in mental health clinics with a higher expected prevalence of PTSD, a more conservative approach may be preferred to balance the detection of PTSD with the resources required to address positive screens. Therefore, it is essential to consider the benefits of case finding, the costs of false positives, and the base rate of PTSD when determining the cut-off score for the PC-PTSD-5.
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Frequently asked questions
The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) is a screening tool designed to identify probable PTSD in patients.
The optimal cutoff score is 3, as it minimises false negatives and identifies 94.8% of participants who were diagnosed with PTSD.
A cutoff score of 4 ideally balances false negatives and false positives for the overall sample and for men. However, for women, a cutoff score of 4 results in high numbers of false negatives.
The most sensitive cutoff score is 3, which identifies 94.8% of participants diagnosed with PTSD and minimises false negatives.
A positive result is indicated by a score of 3 or more, with higher scores suggesting a higher likelihood of PTSD.
