PTSD Screening and Assessments for Veterans Explained

Post-traumatic stress disorder (PTSD) affects 7% of veterans. According to the U.S. Department of Veterans Affairs, there are roughly 17 million veterans living in the United States. That means that over 1 million veterans are currently living with PTSD — a staggering amount. Despite the huge number of veterans living with PTSD, reports acknowledge that PTSD likely remains underdiagnosed in military settings due to limited mental health resources. This large population needs the help of behavioral and mental professionals. To that end, we want to equip you with the knowledge you need to properly conduct PTSD screening for veterans.

What causes PTSD in veterans?

It is known that soldiers can suffer temporary and long-term psychological effects from traumatic experiences in combat. Veterans returning from World War I were treated for a condition then known as “shell shock,” which resulted in behaviors such as extreme social withdrawal, nightmares, loss of initiative, and chronic apathy. Veterans of World War II and the Korean and Vietnam Wars have also experienced post-combat stress. Studies of Vietnam-era veterans show that PTSD can last for a decade or more for some veterans.

It’s important to note that PTSD resulting from military deployment is distinct from most cases of civilian PTSD. Active-duty personnel are repeatedly exposed to traumatic events where their lives are at risk or they are required to engage in combat, whereas civilian PTSD is typically the result of a single traumatic event.

It remains unclear why some individuals do not develop long-term stress reactions following a traumatic experience, while others do. It’s likely that a combination of individual factors, the nature of the experience, and comorbidities al play a part.

The symptoms of PTSD and how to diagnose it

A diagnosis of PTSD in veterans is based on the DSM-5 criteria, which include exposure to actual or threatened death, serious injury, or sexual violence through various means, such as direct experience, witnessing the event, or learning about it happening to a close family member or friend. Additionally, exposure to repeated details of a traumatic event can lead to a PTSD diagnosis.

For a diagnosis of PTSD, a person must exhibit clinically significant symptoms that impair their everyday functioning for at least one month after the trauma. These symptoms include:

• Persistent re-experiencing of the trauma
• Avoidance of trauma-related stimuli
• Hypervigilance
• Emotional numbness or detachment

If symptoms persist beyond three days but less than a month, the individual should be evaluated for acute stress disorder (ASD), which shares similarities with PTSD but differs in terms of symptom duration and functional impairment. These impacts highlight the importance of early PTSD screening for veterans to ensure timely intervention and support.

PTSD screening and assessment tools for veterans

Screening for PTSD in veterans is crucial, as evidence has shown that experiencing trauma can lead to psychological, behavioral, and physical issues. These reactions are consistent across different cultures, genders, and ages.

The use of screening tools offers a standardized and objective method to assess the likely presence of PTSD, typically taking between two to 10 minutes to complete. Although they do not provide a diagnosis, these tools can assist nonbehavioral healthcare clinicians, such as primary care physicians, in deciding whether to refer individuals for a diagnostic assessment by a specialist.

PC-PTSD-5

The Department of Defense/VA provides the updated version of the PC-PTSD, known as the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5).

The PC-PTSD-5 screening tool asks participants if they have lived through traumatic experiences, such as physical or sexual assault, war, serious accidents, natural disasters, witnessing violence, or experiencing the loss of a loved one through homicide or suicide.

If the response is “no,” the screening is complete and the likelihood of PTSD is low.

If the answer is “yes,” respondents are asked a series of five questions regarding the impact of the traumatic event(s) over the past month.

These questions align with DSM-5 PTSD symptoms, including whether the participant is having nightmares, avoiding reminders of the event, being hypervigilant, or feeling emotionally numb or guilty. Answering “yes” to three or more questions indicates a high likelihood of PTSD and necessitates further assessment with a more comprehensive tool.

CAPS-5

PTSD assessment tools are employed after screening identifies an individual as likely having PTSD. Assessments should be conducted and interpreted by qualified healthcare professionals.

The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) is regarded as the standard for assessing and diagnosing PTSD. It involves a 30-item structured interview that typically takes 45-60 minutes to complete.

Th CAPS-5 tool also covers an evaluation for dissociative type PTSD. It can achieve the following:

• Evaluate PTSD symptoms over the past week
• Establish a diagnosis of PTSD
• Establish a lifetime diagnosis of PTSD

PCL-5

Because of the extensive time and personnel commitments involved, the administration of the CAPS-5 may not always be feasible. In such cases, an alternative assessment tool, like the PTSD Checklist for DSM-5 (PCL-5), may be more practical.

The PCL-5 is a validated self-report questionnaire that consists of 20 items and can be completed in approximately 5-10 minutes. The questionnaire items align with DSM-5 PTSD symptoms. This tool is used for:

• Monitoring changes in symptoms before and after treatment
• Establishing a provisional diagnosis of PTSD

While earlier versions of the PCL were tailored for specific groups such as military (PCL-M), civilian (PCL-C), and specific (PCL-S), the PCL-5 is a single version that can be scored and interpreted in various ways. Therefore, assessment results should be evaluated by a clinician with expertise in PTSD assessment and treatment.