PTSD Diagnostic Validity in Veterans Affairs Electronic Records of Iraq and Afghanistan Veterans

Objective: Administrative planning and policy decisions frequently rely on diagnostic data extracted from large electronic databases. However, the accuracy of this diagnostic information is uncertain. The present study examined the degree to which various diagnoses of posttraumatic stress disorder (PTSD) within Department of Veterans Affairs (VA) electronic databases were concordant with PTSD diagnostic status determined by standardized diagnostic interview. Method: We interviewed 1,649 veterans of the Iraq and Afghanistan wars using the PTSD Module of the Structured Clinical Interview for DSM-IV (SCID). Participants also completed other interview-based and self-report measures of psychopathology and provided consent to access their electronic medical records (EMRs). Results: Concordance between database diagnosis and SCID diagnosis was 72.3% for current PTSD and 79.4% for lifetime PTSD. We observed associations between concordance status and combat exposure, PTSD symptom presentation, comorbid anxiety and depression, and psychosocial impairment. Veterans with false-negative PTSD diagnoses in the EMR were more likely to report lower levels of combat exposure, panic, and PTSD avoidance symptoms. Veterans with false-positive PTSD diagnoses in the EMR were more likely to report treatment seeking for emotional problems and less overall functional impairment. Conclusions: Although the majority of participants were concordant for PTSD status, over 25% of EMR diagnoses differed from those obtained in the diagnostic interview, with varying proportions of false positives and false negatives. Overall, those individuals with the most and least severe symptom presentations in the diagnostic interview were more likely to be accurately classified.