The PC-PTSD-5 is a five-item screen for probable post-traumatic stress disorder aligned with DSM-5 criteria. It opens with a trauma-exposure gate: respondents who have never experienced a traumatic event score 0 and answer nothing further. Those who have then answer five yes/no questions about the past month, covering intrusion (nightmares, unwanted thoughts), avoidance, hypervigilance and startle, numbing or detachment, and trauma-related guilt or blame.
The total is simply the number of "yes" responses, 0 to 5. It takes under a minute and is designed for primary care and general medical settings, where trauma exposure is common but rarely volunteered. It is a case-finding gate, not a severity measure: a positive screen indicates the need for structured assessment, typically the PCL-5 followed by a diagnostic interview.
02 - Origin & purpose
Where it comes from.
The screen was developed at the US Department of Veterans Affairs National Center for PTSD by Annabel Prins and colleagues, published in 2016 as a revision of the four-item PC-PTSD (Prins et al., 2003), which was built against DSM-IV criteria and mandated for routine screening across VA and Department of Defense clinics. The DSM-5 revision reworked the trauma-exposure stem and added a fifth item capturing guilt and blame, reflecting the new negative-alterations-in-cognition-and-mood cluster.
The purpose is efficient universal screening. PTSD prevalence in veteran primary care runs at two to three times the general-population rate, and untreated PTSD is associated with higher healthcare utilisation and medical morbidity. A screen this short can be administered verbally by any clinician within an ordinary consultation - and in the validation study patients said they preferred exactly that, being asked by their own doctor rather than filling in a form.
03 - Scoring & cutoffs
How scoring works.
Count the "yes" responses (0-5); a "no" at the trauma gate scores 0. There is no single mandated cut-point - the choice is a trade-off documented unusually clearly in the validation work. A cut of 3 is optimally sensitive (0.95) and suits primary care screening, where missing cases is the greater harm. A cut of 4 is optimally efficient (sensitivity 0.83, specificity 0.91) and suits higher-prevalence settings where false positives strain resources. A cut of 5 maximises specificity (0.97). A large national VA study (Bovin et al., 2021) subsequently recommended 4 overall, with 3 in women.
Score
Severity
Interpretation
0–2
Negative screen
Below the cutoff. PTSD is unlikely on this screen.
3–5
Positive screen
At or above the cutoff of 3. Probable PTSD; assess further with the PCL-5 or a structured interview.
04 - Validation evidence
How well it performs.
In the development study (Prins et al., 2016; 398 veterans in VA primary care, PTSD prevalence 14.3% against a modified MINI interview), overall diagnostic accuracy was excellent: AUC 0.941 (95% CI 0.912-0.969), similar to the PHQ-9's performance for depression. At the optimally sensitive cut of 3, sensitivity was 0.95, specificity 0.85 and negative predictive value 0.99 - a score below 3 makes PTSD very unlikely in a primary-care population. At a cut of 4, sensitivity was 0.83 with specificity 0.91. The earlier four-item PC-PTSD showed good test-retest reliability (r = 0.83). Bovin and colleagues (2021) replicated strong accuracy and acceptability in a national VA sample, recommending a cut of 4 (3 for women), and Lathan and colleagues (2023) extended the evidence to a trauma-exposed, socioeconomically vulnerable civilian population.
Measures perceived stress, not PTSD - a different construct despite the adjacent name.
06 - When to use it
Right tool, wrong tool.
The PC-PTSD-5 earns its place as a first-stage gate: cheap enough to ask everyone, accurate enough that a negative screen is genuinely reassuring in primary care. Its value collapses the moment it is asked to do more than that - grade severity, track treatment or stand in for a diagnosis.
Reach for it when
-Universal or targeted screening in primary care and general medical settings
-Re-screening at intervals in populations with high trauma exposure
Reach for something else when
-Measuring symptom severity or monitoring treatment response - it has no severity gradient worth tracking (use the PCL-5)
-Diagnosis - a positive screen is a prompt for assessment, never a label
-Children and adolescents
-Specialist mental-health settings with high PTSD prevalence, where a higher cut-point (4 or 5) is usually more defensible than 3
07 - Confidence & precision
Reading the score with care.
As a five-point count of yes/no answers, the PC-PTSD-5 has no meaningful SEM or minimal clinically important difference; precision is better expressed through predictive values, which depend on the base rate. In the development sample (prevalence 14.3%), a score below 3 carried a negative predictive value of 0.99, while the positive predictive value at 3 was 0.51 - about half of positive screens will not have PTSD on interview, which is expected and acceptable for a first-stage screen. In lower-prevalence settings PPV falls further; plan the follow-up pathway before deploying the screen.
08 - Limitations
What it cannot tell you.
The development sample was a convenience sample of predominantly older male veterans, and the diagnostic criterion was a DSM-IV MINI module modified for DSM-5 rather than a validated DSM-5 interview such as the CAPS-5. Optimal cut-points vary by population and sex - evidence in civilian, female and younger groups is growing but thinner. The trauma-exposure gate means under-reporting of trauma silently produces false negatives. It cannot grade severity or track change, and a positive screen says nothing about which trauma or how impairing the symptoms are.
[3]Prins A, Ouimette P, Kimerling R, et al. The primary care PTSD screen (PC-PTSD): development and operating characteristics. Prim Care Psychiatry. 2003;9(1):9-14. (2003) ↩
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