Screening positively for PTSD: Examining the role of avoidance for public safety personnel

Public safety personnel (PSP) frequently screen positive for posttraumatic stress disorder (PTSD) based on the PTSD Checklist for DSM-5 (PCL-5). Approximately 30% of Canadian paramedics who might otherwise screen positively for PTSD using the PCL-5 may not because avoidance items are not endorsed, arguably as a function of their service requirements (e.g., necessity of revisiting trauma scenes). Studies suggesting such limitations used only paramedic participants, thus limiting generalizability. The present study was designed to examine how PCL-5 avoidance items interact with positive PTSD screens using data from large samples of PSP (n = 5,813) and the general population (n = 2,631).

Prevalence of positive PTSD screens was calculated for PSP sectors, the total PSP sample, and the general population. Differences in PTSD screening prevalences based on removing each of the four symptom cluster requirements were compared among and between PSP groups and the general population.

Removing the avoidance criterion increased positive PTSD screens for the PSP sample (p = .03, V = .04); specifically, positive PTSD screens increased among correctional workers, firefighters, paramedics, and Royal Canadian Mounted Police (all ps < .05), but not municipal/provincial police and public safety communicators.

Aligning with Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision diagnostic criteria, removal of each cluster increased positive PTSD screens in the general population (ps < .01), suggesting PSP may be strictly limited by avoidance items due to service requirements. Results indicated ∼2% (∼100,000 PSP across Canada, the United States, and Australia) may be currently experiencing symptoms of PTSD, but not screening positively; thus PSP may benefit from PCL-5 revisions to better identify their avoidance behaviors. (PsycInfo Database Record (c) 2025 APA, all rights reserved).