A Brief Screening Instrument to Detect Posttraumatic Stress Disorder in Outpatient Gynecology

Meltzer-Brody, Samantha MD, MPH*; Hartmann, Katherine MD, PhD†§; Miller, William C. MD, PhD, MPH‡§; Scott, Jewel*; Garrett, Joanne PhD‡; Davidson, Jonathan MD¶

doi: 10.1097/01.AOG.0000140683.43272.85
Original Research

OBJECTIVE: Posttraumatic stress disorder (PTSD) is a serious anxiety disorder triggered by the experience of trauma. One in 4 individuals exposed to trauma will develop PTSD. Victims of trauma are frequent users of health care, but screening is rarely done and most sequelae remain undetected. Our objectives were 1) to document the prevalence of a trauma history among women seeking routine gynecologic care and 2) to evaluate a 4-item screening instrument for PTSD for triaging women with a trauma history for further evaluation.

METHODS: We conducted a cross-sectional survey of women presenting to the University of North Carolina outpatient gynecology clinic for an annual examination. Written surveys included medical history and health status, trauma history (including type), and PTSD symptoms using the screening instrument. Patients with trauma who agreed to further participation received a structured clinical interview to diagnose PTSD.

RESULTS: Seventy-six percent of patients (N = 292) completed the survey, and 88 (30%) reported a history of 1 or more traumatic event or events. Thirty-two of the 88 completed the psychiatric assessment, and 25 of 32 (78%) met Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria for PTSD. Mean age was 34 years, 49% were African American, and 46% were unmarried. Compared with the structured clinical interview, the screening instrument performed with a sensitivity of 72% (95% confidence interval [CI] 0.51–0.88) and a specificity of 71% (95% CI 0.29–0.96), corresponding to a positive likelihood ratio of 2.52 (95% CI 0.76–8.34) and a negative likelihood ratio of 0.39 (95% CI 0.18–0.86).

CONCLUSION: Trauma was common in this population. Including a screening instrument for trauma and PTSD on clinic intake surveys has promise for use as a triage tool. Use of such an instrument could meaningfully increase detection of PTSD among women receiving routine preventive care.

LEVEL OF EVIDENCE: III

A brief screening instrument for trauma and posttraumatic stress disorder in gynecology settings could meaningfully increase detection of the disorder among women receiving routine care.

From the Departments of *Psychiatry, †Obstetrics and Gynecology, and ‡Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; §Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, North Carolina; and ¶Department of Psychiatry, Duke University Medical Center, Durham, North Carolina

Supported by The Robert Wood Johnson Foundation.

Financial Disclosure Jonathan Davidson, MD, receives royalties from sales of the SPAN through its publisher, Multi-Health Systems Inc.

Address reprint requests to: Samantha Meltzer-Brody, MD, MPH, Assistant Professor, Department of Psychiatry, University of North Carolina at Chapel Hill, Campus Box # 7160, Chapel Hill, NC 27955; e-mail: Samantha_Meltzer-Brody@med.unc.edu.

Received March 29, 2004. Received in revised form June 18, 2004. Accepted July 1, 2004.

© 2004 by The American College of Obstetricians and Gynecologists.