Primary Care PTSD Screen for DSM-5 (PC-PTSD-5)

Foundational Context

PTSD is frequently underdetected in primary care despite its strong association with physical health conditions, chronic pain, sleep disturbance, anxiety, and depression. The original PC-PTSD aligned with DSM-IV criteria, and the PC-PTSD-5 was developed to reflect the updated symptom structure and diagnostic requirements of DSM-5.

In a large validation sample of U.S. veterans, Prins et al. (2016) demonstrated that the PC-PTSD-5 has strong sensitivity and specificity, especially when using a cutoff of three symptoms. Its streamlined design makes it ideal for rapid screening before administering a more comprehensive assessment (e.g., PCL-5). The PC-PTSD-5 is specifically optimized for medical settings where time and resources are limited but early identification is essential.

What the Assessment Measures

The PC-PTSD-5 assesses the presence of core PTSD symptoms experienced in the past month, including:

• Intrusive memories or nightmares
• Avoidance of trauma reminders
• Negative thoughts or feelings related to the trauma
• Hyperarousal or excessive startle response
• Functional impact or emotional distress

Each item reflects clinically meaningful symptom domains closely aligned with DSM-5 criteria.

Interpretation Guidelines

The PC-PTSD-5 yields a total score between 0–5, based on the number of “Yes” responses.

Recommended cutoff:

• ≥3 indicates a positive screen for probable PTSD and the need for further diagnostic evaluation.
  

Interpretation Notes:

• A positive screen does not confirm PTSD; the PC-PTSD-5 is a triage tool.
• Use in combination with a full PTSD assessment (e.g., PCL-5) or clinical interview.
• A score of 1–2 may still represent trauma-related distress that warrants further discussion.
• Screening should be contextualized with recent trauma exposure, functional impairment, cultural considerations, and comorbid conditions.
• Avoid administering the tool during acute crisis states where responses may be transiently elevated.

Psychometric Properties

Reliability

• High internal consistency for a 5-item screener
• Strong test–retest stability in primary care and veteran samples

Validity

• Strong sensitivity and specificity at the ≥3 cutoff (Prins et al., 2016)
• Very efficient predictor of PTSD in primary care populations
• Useful across diverse clinical settings and trauma populations
• Validated against gold-standard PTSD diagnostic interviews including CAPS-5

Administration Considerations

• Designed for primary care and can be administered verbally or via self-report
• Functions as a first-step screener before administering the PCL-5
• Should follow confirmation of a qualifying Criterion A trauma
• May require clinician support for individuals with avoidance, dissociation, or difficulty recalling events
• Works well in brief medical encounters, telehealth, and community health models

Limitations

• Not diagnostic on its own
• May under-identify individuals with avoidance or dissociative presentations
• False positives may occur in the context of depression, anxiety, or acute stress
• Limited detail on symptom severity or functional impairment
• Must be interpreted alongside clinical judgment and complete trauma history