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The Trauma Screening Questionnaire (TSQ) is a brief, validated screening instrument developed by Brewin and colleagues in 2002 to identify individuals at risk of developing post-traumatic stress disorder (PTSD) following exposure to a traumatic event. It is specifically designed as an early detection tool to be used within the first weeks to months after trauma, enabling timely identification of those who may benefit from clinical assessment and early intervention.
PTSD is a debilitating psychiatric condition that can develop after exposure to events involving actual or threatened death, serious injury, or sexual violence. While most people exposed to trauma experience some acute stress symptoms, only a subset (approximately 5-20% depending on the type of trauma) go on to develop chronic PTSD. Early identification of at-risk individuals allows for targeted monitoring and evidence-based intervention, which can prevent the chronic disability associated with untreated PTSD.
The TSQ consists of 10 items derived directly from the DSM-IV PTSD diagnostic criteria, focusing on two key symptom clusters: re-experiencing (5 items) and arousal (5 items). Notably, the TSQ excludes avoidance and numbing symptoms, as these were found to be less predictive of subsequent PTSD in prospective studies. Each item is answered yes or no, making the questionnaire quick and straightforward to administer even in busy clinical or emergency settings.
The re-experiencing subscale asks about intrusive thoughts and memories, upsetting dreams, flashbacks (feeling as if the event is happening again), emotional distress when reminded of the event, and physical reactions to reminders (such as sweating, trembling, or heart racing). The arousal subscale covers sleep difficulties, irritability or anger outbursts, difficulty concentrating, heightened awareness of danger (hypervigilance), and exaggerated startle response.
A threshold score of 6 or more (out of 10) is used to identify a positive screen, indicating significant risk for developing PTSD. This cutoff was established through validation studies showing sensitivity of 85-95% and specificity of 78-85% for predicting subsequent PTSD diagnosis. The high sensitivity ensures that most individuals who will develop PTSD are identified, while acceptable specificity limits the burden of false-positive referrals.
The TSQ has been validated across diverse trauma populations including motor vehicle accidents, assault victims, survivors of terrorism and war, and medical trauma (such as ICU survivors and cancer patients). It has been translated into multiple languages and is recommended by several international guidelines, including NICE guidelines for PTSD, as a screening tool in trauma-exposed populations.
Optimal timing for TSQ administration is 3-4 weeks after the traumatic event, as earlier screening may capture normal acute stress responses that resolve spontaneously. A positive screen does not diagnose PTSD but indicates the need for comprehensive clinical assessment by a qualified mental health professional using structured diagnostic interviews.
The TSQ has 10 yes/no items scored 0 or 1. Items 1-5 assess re-experiencing symptoms (intrusive memories, nightmares, flashbacks, emotional and physical reactivity to reminders). Items 6-10 assess arousal symptoms (insomnia, irritability, poor concentration, hypervigilance, exaggerated startle). The total is the sum of all endorsed items. A score of 6 or more is a positive screen for probable PTSD.
A score of 6 or more out of 10 is a positive screen, suggesting significant risk for PTSD and indicating the need for comprehensive clinical evaluation. Scores of 0-3 suggest low risk. Scores of 4-5 are borderline and may warrant monitoring. Both subscale scores provide additional clinical information about predominant symptom patterns.
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Score of 7 with strong re-experiencing symptoms indicates positive screen requiring clinical PTSD assessment.
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Score of 4 below the threshold of 6. Monitor symptoms; they may resolve with time and support.
The TSQ is a 10-item yes/no screening tool developed by Brewin et al. (2002) to identify individuals at risk for PTSD after trauma. It focuses on re-experiencing and arousal symptoms and uses a cutoff of 6 or more to indicate a positive screen.
The optimal timing is 3-4 weeks after the traumatic event. Earlier administration may capture normal acute stress responses that resolve spontaneously. The scale can also be used at later timepoints to screen for delayed-onset PTSD.
A positive screen (score of 6 or more) indicates significant risk for developing PTSD and suggests the need for comprehensive clinical assessment by a mental health professional. It is not a diagnosis of PTSD but a flag for further evaluation.
Validation studies show sensitivity of 85-95% (catches most true cases) and specificity of 78-85% (acceptable false-positive rate). The positive predictive value varies with the base rate of PTSD in the screened population.
Research showed that avoidance and numbing symptoms were less predictive of subsequent PTSD when measured acutely. Re-experiencing and arousal symptoms better discriminate between those who will and will not develop PTSD in the early post-trauma period.
Yes. The TSQ has been validated across diverse trauma types including motor vehicle accidents, assault, terrorism, combat, medical trauma, and natural disasters. It is applicable to any population exposed to qualifying traumatic events.
The TSQ is a 10-item yes/no screening tool designed for brief initial screening. The PCL-5 is a more comprehensive 20-item scale with severity ratings (0-4) that maps to all DSM-5 PTSD criteria and is used for both screening and symptom monitoring.
Seek evaluation from a qualified mental health professional experienced in trauma. They will conduct a comprehensive assessment to determine if you meet criteria for PTSD and discuss evidence-based treatment options such as cognitive processing therapy or EMDR.
The TSQ was developed and validated for adults. For children and adolescents, age-appropriate screening tools such as the Child Trauma Screening Questionnaire (CTSQ) or the UCLA PTSD Reaction Index are more appropriate.
Yes. The TSQ has been translated into numerous languages including Spanish, French, Arabic, Chinese, Japanese, and many others. Translated versions have been validated in their respective populations with similar psychometric properties.
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