Validation of the Danish PTSD Checklist for DSM-5 in trauma-exposed chronic pain patients using the Clinician-Administered PTSD Scale for DSM-5

Figures & data

Table 1. PTSD Checklist for DSM-5 (PCL-5) item mapping for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) post-traumatic stress disorder (PTSD) factor models.

Symptoms	DSM-5 (4 factors)	Dysphoria (4 factors) (Miller et al., 2013)	Dysphoric arousal (5 factors) (Elhai et al., 2011)	Anhedonia (6 factors) (Lui et al., 2014)	External behaviours (6 factors) (Tsai et al., 2014)	Hybrid (7 factors) (Armour et al., 2015)
B1: Memories	I	I	I	I	I	I
B2: Nightmares	I	I	I	I	I	I
B3: Flashbacks	I	I	I	I	I	I
B4: Emotional reactivity	I	I	I	I	I	I
B5: Physiological reactivity	I	I	I	I	I	I
C1: Internal avoidance	A	A	A	A	A	A
C2: External avoidance	A	A	A	A	A	A
D1: Amnesia	NACM	D	NACM	N	NACM	N
D2: Negative beliefs	NACM	D	NACM	N	NACM	N
D3: Blame	NACM	D	NACM	N	NACM	N
D4: Negative feelings	NACM	D	NACM	N	NACM	N
D5: Loss of interest	NACM	D	NACM	AN	NACM	AN
D6: Distant	NACM	D	NACM	AN	NACM	AN
D7: Numbing	NACM	D	NACM	AN	NACM	AN
E1: Irritability	AAR	D	DA	DA	EB	EB
E2: Risky behaviour	AAR	D	DA	DA	EB	EB
E3: Hypervigilance	AAR	AAR	AA	AA	AA
E4: Easily startled	AAR	AAR	AA	AA	AA	AA
E5: Concentration	AAR	D	DA	DA	DA	DA
E6: Sleep disturbance	AAR	D	DA	DA	DA	DA

Note. I, intrusions; A, avoidance; NACM, negative alterations in cognition and mood; AAR, alterations in arousal and reactivity; D, dysphoria; DA, dysphoric arousal; AA, anxious arousal; AN, anhedonia; EB, externalizing behaviours; N, negative affect.

Figure 1. Receiving operating characteristics (ROC) curve for the PTSD Checklist for DSM-5 (PCL-5) relative to the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) interview. Accuracy, as represented by the area under the curve, is .79 (95% CI = .69–.89).

Table 2. Post-traumatic stress disorder (PTSD) prevalence rates for different cut-off scores.

Cut-off	Prevalence	True positives	False positives	True negatives	False negatives
Interview	51 (60.7%)	51	–	33	–
PCL-5 cluster	47 (56.0%)	38	9	24	13
26	59 (70.2%)	44	15	18	7
27	58 (69.0%)	43	15	18	8
28	57 (67.9%)	43	14	19	8
29	57 (67.9%)	43	14	19	8
30	55 (65.5%)	41	14	19	10
31	53 (63.1%)	40	13	20	11
32	52 (61.9%)	39	13	20	12
33	52 (61.9%)	39	13	20	12
34	50 (59.5%)	39	11	22	12
35	48 (57.1%)	38	10	23	13
36	43 (51.2%)	35	8	25	16
37	42 (50.0%)	34	8	25	17
38	41 (48.8%)	33	8	25	18

Note. Interview = Clinician-Administered PTSD Scale for DSM-5 (CAPS-5); all cut-offs = PTSD Checklist for DSM-5 (PCL-5) score; PCL-5 cluster = at least one item within each PTSD symptom cluster (intrusion, avoidance), and at least two items within (negative cognitions and mood, hyperarousal) (PCL-5).

Table 3. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for different cut-off scores.

Cut-off	Sensitivity	Specificity	PPV	NPV	Overall performance
PCL cluster	0.75	0.73	0.81	0.65	0.74
26	0.86	0.55	0.75	0.72	0.74
27	0.84	0.55	0.74	0.69	0.73
28	0.84	0.58	0.75	0.70	0.74
29	0.84	0.58	0.75	0.70	0.74
30	0.80	0.58	0.75	0.66	0.71
31	0.78	0.61	0.75	0.65	0.71
32	0.76	0.61	0.75	0.63	0.70
33	0.76	0.61	0.75	0.63	0.70
34	0.76	0.67	0.78	0.65	0.73
35	0.75	0.70	0.79	0.64	0.73
36	0.69	0.76	0.81	0.61	0.71
37	0.67	0.76	0.81	0.60	0.70
38	0.65	0.76	0.80	0.58	0.69

Note. Interview = Clinician-Administered PTSD Scale for DSM-5 (CAPS-5); all cut-offs = PCL score; PCL cluster = at least one item within each PTSD symptom cluster (intrusion, avoidance), and at least two items within (negative cognitions and mood, hyperarousal) with a score ≥ 2 on the PTSD Checklist for DSM-5 (PCL-5).

Table 4. Model fit statistics for the alternative models of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) post-traumatic stress disorder (PTSD) symptoms following mixed traumatic exposure and accidents.

	χ^2	df	p	CFI	TLI	RMSEA (90% CI)
Full mixed sample (n = 566)
DSM-5 model	855.429	164	.000	.958	.952	.086 (.081–.092)
Dysphoria model	777.476	164	.000	.963	.957	.081 (.076–.087)
Dysphoric arousal model	705.696	160	.000	.967	.961	.078 (.072–.084)
Anhedonia model	457.390	155	.000	.982	.978	.059 (.053–.065)
External behaviours model	638.290	155	.000	.971	.964	.074 (.068–.080)
Hybrid model	338.074	149	.000	.987	.983	.051 (.044–.058)
Accident sample (n = 202)
DSM-5 model	383.812	164	.000	.961	.955	.081 (.071–.092)
Dysphoria model	347.384	164	.000	.968	.962	.074 (.064–.085)
Dysphoric arousal model	318.258	160	.000	.972	.967	.070 (.059–.081)
Anhedonia model	250.136	155	.000	.983	.979	.055 (.042–.067)
External behaviours model	301.939	155	.000	.974	.968	.069 (.057–.080)
Hybrid model	223.064	149	.000	.987	.983	.050 (.035–.063)

Note. Estimator = mean and variance-adjusted weighted least squares (WLSMV); χ², chi-squared goodness-of-fit statistic; df, degrees of freedom; p, statistical significance; CFI, Comparative Fit Index; TLI, Tucker–Lewis Index; RMSEA (90% CI), root mean square error of approximation with 90% confidence interval; estimator for the Bayesian Information Criterion = MLR.

The best fitting model is shown in bold.

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Data availability statement

The data used in the present study cannot be shared owing to the EU General Data Protection Regulation.