Post-traumatic stress disorder diagnostic accuracy rates in clinical settings: a systematic review and meta-analysis

This systematic review assesses the global diagnostic accuracy rate of post-traumatic stress disorder in primary and specialized mental healthcare by analyzing diagnostic accuracy and clinical challenges. Databases were searched for English-language studies published after 2000 that focused on post-traumatic stress disorder diagnostic accuracy, clinician bias, comorbidities, and standardized tools. Risk of bias was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation guidelines and the Cochrane Risk of Bias Tool for Non-Randomized Studies of Interventions. Studies were grouped by homogeneity into 3 categories for synthesis and meta-analysis: diagnostic accuracy in specialized mental healthcare, accuracy in primary healthcare, and clinician diagnostic capabilities. Forty-seven studies met inclusion criteria: 31 were included in the meta-analysis and 16 in the qualitative synthesis. Of those in the meta-analysis, 18 focused on specialized care, 9 on primary care, 2 reported on both, and 2 examined clinician diagnostic accuracy and bias. Although the 2 studies appearing in both care settings were counted once in the overall tally, they contributed separate estimates to each setting, resulting in 20 analyses for specialized care and 11 for primary care. The weighted mean post-traumatic stress disorder diagnostic accuracy was 55.6% in specialized mental healthcare, 48.2% in primary care, and 41.33% in studies examining clinician diagnostic accuracy and bias. Studies without specific accuracy rates consistently highlighted widespread underdiagnosis in both primary and specialized settings, driven by limited trauma inquiry, inconsistent screening, diagnostic overshadowing due to comorbidities, clinician knowledge gaps, and structural barriers within healthcare systems. Misdiagnosis commonly stems from limited clinician training, time constraints, minimal tool use, comorbidities, and systemic barriers. This review highlights the need for clinician education, routine post-traumatic stress disorder screening in primary care, and integrated mental health services. Diagnostic complexity was frequently linked to symptom overlap, underreporting, and cultural limitations of standard criteria. Longitudinal research is recommended.