Psychometric properties of the PTSD Checklist for DSM-5 in a sample of trauma exposed mental health service users

Figures & data

Table 1. Studies of the PCL-5 diagnostic accuracy by country, population sample and reference standard

Study	Country	Population sample	N	Internal consistency PCL-5 total Cronbach’s alpha	Test-retest reliability	Summary of convergent and discriminant validity findings	Reference standard	Optimal cut-off
Bovin et al, 2015	USA	Treatment seeking military veterans	140	.96	.84 at 22–48 days	Associated correlations were consistent with predicted observations for a wide battery of measures.	CAPS-5	31–33
Hall et al., 2019	Macao	Filipino migrant workers	131	.95	.58 at 10 days	The PCL-5 correlated moderately with the scores measures of depression and generalised anxiety and more weakly with measures of pain and social support	PTSD Module Neuro-psychiatric Interview (MINI) for DSM-5	25
Ho et al, 2016	USA	Military veterans	390	.97	Not reported	Convergent and discriminant validity were not investigated	CAPS-5	37
Krüger-Gottschalk et al., 2017	Germany	A trauma exposed treatment seeking sample	352	.95	.91 at 3 weeks	Correlation with the CAPS-5 was.77. Investigation of discriminant validity was not reported	CAPS-5	33
Murphy et al., 2017	UK	Treatment seeking military veterans	242	Not reported	Not reported	Convergent and discriminant validity were not investigated	CAPS-5	34
Pereira-Lima et al., 2019	Brazil	Psychiatric outpatients	85	.96	.87 at 10–30 days	Convergent and discriminant validity were not investigated	SCID interview for DSM-5	36
Verhey et al., 2018	Zimbabwe	Primary care sample with high rates of HIV	204	.92	Not reported	Convergent and discriminant validity were not investigated	CAPS-5	33
Wortmann et al., 2016*	USA	Treatment seeking military personnel	912	.91	Not reported	Observed correlations were consistent with predicted observations for a wide battery of measures.	PSS-I	42

*This study reported cut off scores for a number of different scoring methods for the PSS-I. This cut-off was based on a “stringent scoring rule”, which conformed to DSM-5 criteria.

Table 2. Descriptive characteristics of sample

Characteristic	Sample = 273
Age (mean, SD) Range	47.5 (12.7) 18–77
Gender Female Male	134 (49.1%) 139 (50.9%)
Ethnic background Caucasian Mixed Race Asian Other	258 (94.5%) 10 (3.7%) 2 (0.7%) 3 (1.1%)
Marital status Married or cohabiting Single Divorced/separated Widower Unknown	137 (50.2%) 70 (25.6%) 56 (20.5%) 8 (2.9%) 2 (0.7%)
Educational attainment Left school without qualification Left school with secondary school qualifications Vocational or other qualifications Completed a university degree or higher education Missing	23 (8.4%) 100 (36.6%) 83 (30.4%) 66 (24.2%) 1 (0.4%)
Employment status In employment Not working or retired	93 (34.1%) 180 (65.9%)
Participant self-identified worst trauma Natural disaster Fire or explosion Transportation accident Serious accident Exposure to toxic substances Childhood physical abuse Physical assault Assault with a weapon Childhood sexual abuse Sexual assault Other unwanted or uncomfortable sexual experiences Combat or exposure to war Held in captivity Life threatening illness or injury Severe human suffering Sudden violent death Sudden unexpected death of someone close Serious harm of death you caused Other	2 (0.7%) 12 (4.4%) 26 (9.5%) 4 (1.4%) 0 (0%) 15 (5.5%) 20 (7.3%) 16 (5.9%) 46 (16.8%) 19 (7.0%) 1 (0.4%) 42 (15.4%) 7 (2.6%) 17 (6.2%) 5 (1.8%) 15 (5.5%) 16 (5.9%) 4 (1.4%) 6 (2.2%)

Table 3. Convergent and discriminant validity correlations for the PCL-5 and other measures

Measure	1	2	3	4	5	6	7	8	9	10	11	12
1. PCL-5	1.00
2. CAPS-5	.73**	1.00
3. PTCI – negative self-cognitions	.74**	.67**	1.00
4. PTCI – negative world	.64**	.53**	.71**	1.00
5. PTCI – self blame	.36**	.41**	.46**	.36**	1.00
6. PHQ – depression	.74**	.65**	.74**	.54**	.35**	1.00
7. GAD-7	.69**	.54**	.60**	.51**	.25**	.74**	1.00
8. PHQ – panic	.57**	.51**	.44**	.37**	.21**	.51**	.53**	1.00
9. IIP – interpersonal problems	.55**	.50**	.61**	.51**	.30**	.54**	.42**	.26**	1.00
10. Somatoform	.52**	.41**	.43**	.35**	.21**	.55**	.56**	.52**	.31**	1.00
11. EQ-5D – general health	.59**	.44**	.50**	.39**	.17**	.60**	.52**	.40**	.34**	.56**	1.00
12. AUDIT – alcohol	.11	.03	.14*	.12*	.08	.10	.17**	.13*	.14*	.06	−.04	1.00

** Correlation is significant at the 0.01 level (2-tailed).

* Correlation is significant at the 0.05 level (2-tailed).

Table 4. Diagnostic utility of the PCL-5 by cut off score at diagnosing PTSD diagnosis based on the CAPS 5

Cut off	Sensitivity	Specificity	PPV	NPV	Efficiency	κ (0)	κ (.5)	κ (1)
25.5	.98	.39	.75	.91	.77	.28	.42	.86
26.5	.98	.41	.76	.91	.78	.30	.45	.87
27.5	.97	.41	.76	.89	.78	.30	.44	.83
28.5	.96	.43	.76	.84	.77	.30	.43	.76
29.5	.96	.47	.77	.85	.79	.34	.47	.77
30.5	.95	.47	.77	.83	.78	.34	.46	.74
32.0	.95	.51	.78	.84	.80	.38	.50	.76
33.5	.95	.52	.79	.85	.80	.39	.52	.77
34.5	.95	.53	.79	.85	.81	.40	.53	.77
35.5	.94	.53	.79	.83	.80	.40	.52	.74
36.5	.92	.56	.80	.79	.80	.42	.52	.68
37.5	.92	.60	.81	.80	.81	.46	.55	.70
38.5	.92	.61	.82	.79	.81	.47	.56	.68
39.5	.92	.64	.83	.80	.82	.50	.58	.69
40.5	.91	.65	.83	.79	.82	.51	.58	.68
41.5	.89	.68	.84	.77	.82	.54	.59	.65
42.5	.89	.71	.85	.77	.82	.57	.61	.65
43.5	.88	.72	.86	.76	.82	.58	.61	.63
44.1	.87	.73	.86	.74	.82	.59	.60	.61
44.6	.86	.73	.86	.73	.81	.59	.59	.59
45.5	.84	.73	.85	.71	.80	.58	.56	.55
46.5	.81	.73	.85	.67	.78	.57	.53	.50
47.5	.79	.75	.86	.66	.78	.58	.52	.48
48.5	.79	.77	.87	.67	.79	.62	.55	.49
49.5	.78	.77	.87	.65	.78	.61	.53	.47
PCL-diagnostic variable	.93	.57	.80	.81	.80	.43	.53	.70

PPV = positive predictive value; NPV = negative predictive value; κ (0) = quality of specificity; κ (.5) = quality of efficiency; κ (1) = quality of sensitivity. Level of PTSD = 65.3%.

Figure 1. ROC curve for the PCL-5 compared to the CAPS-5 diagnosis of PTSD (AUC = 0.86; CI 0.80 − 0.91)

Hall, B. J., Yip, P., Garabiles, M. R., Lao, C. K., Chan, E., & Marx, B. P. (2019). Psychometric validation of the PTSD checklist-5 among female Filipino migrant workers. European Journal of Psychotraumatology, 10(1), 1571378.

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Krüger-Gottschalk, A., Knaevelsrud, C., Rau, H., Dyer, A., Schäfer, I., Schellong, J., & Ehring, T. (2017). The German version of the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Psychometric properties and diagnostic utility. BMC Psychiatry, 17(1), 379.

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Pereira-Lima, K., Loureiro, S. R., Bolsoni, L. M., Apolinario da Silva, T. D., & Osório, F. L. (2019). Psychometric properties and diagnostic utility of a Brazilian version of the PCL-5 (complete and abbreviated versions). European Journal of Psychotraumatology, 10(1), 1581020.

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Verhey, R., Chibanda, D., Gibson, L., Brakarsh, J., & Seedat, S. (2018). Validation of the posttraumatic stress disorder checklist - 5 (PCL-5) in a primary care population with high HIV prevalence in Zimbabwe. BMC Psychiatry, 18(1), 109.

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Wortmann, J. H., Jordan, A. H., Weathers, F. W., Resick, P. A., Dondanville, K. A., Hall-Clark, B., … Litz, B. T. (2016). Psychometric analysis of the PTSD checklist-5 (PCL-5) among treatment-seeking military service members. Psychological Assessment, 28(11), 1392–1403.

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Data availability statement

The data that support the findings of this study are available on reasonable request from the corresponding author. The data are not publicly available due to their containing information that could compromise the privacy of research participants.