• The test should be simple, precise, and valid.
  • The test should lead to reduced morbidity.
  • Staffing and facilities for all aspects of the screening program must be adequate.
  • Benefits of screening should outweigh potential harms.

It is inherent in those criteria that the test used should detect the condition at an early stage and that treatment at an early stage is of more benefit than treatment at a later stage (Wilson and Jungner, 1968). It is generally accepted that screening for PTSD, depression, and other mental health problems is ineffective unless it is integrated into a total management program with adequate follow-up to confirm or refute a positive screening result and adequate capability to provide appropriate treatment. An illustrative example is depression, in which screening alone without follow-up care and treatment is unlikely to improve management and is believed to be associated with an unacceptable ratio of cost to benefit (Gilbody et al., 2006; Lang and Stein, 2005; U.S. Preventive Services Task Force, 2002). Similar considerations are likely to apply to PTSD screening.

Screening is not meant to replace assessment or diagnosis, but it can serve as a decision support tool. A person who has a positive screening result should undergo a clinical assessment that can be used by a trained clinician to make appropriate diagnoses—including diagnoses of comorbid conditions, such as depression or traumatic brain injury (TBI)—and to acquire additional information that is required to plan treatment. Such an assessment should take into account the symptoms that the person is experiencing and the severity of and functional impairment associated with the symptoms. Although it is widely believed that screening for PTSD among current and former service members is important for identifying affected people and directing them to treatment as early as possible to prevent chronic suffering and maladjustment, there is no strong evidence to support this belief.

Traumas associated with military service, such as combat and sexual assault, have been associated with a high prevalence of PTSD in this population, and several factors should be considered in implementing broad screening directives in this group (Kessler et al., 1995; Skinner et al., 2000). For a screening program to be effective, adequate resources need to be in place to support it, such as appropriate personnel and time (VA and DoD, 2010). The choice of instrument, method of delivery (such as self-report vs. clinician-administered), place of delivery (such as in the theater of war vs. on the home front), and intended use of the results of the screen are all important in designing a screening program.

Many PTSD screening instruments are available. The VA/DoD guideline notes there is insufficient evidence to recommend one PTSD screening



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