Diagnostic accuracy of Posttraumatic Stress Disorder Checklist in blast-exposed military personnel

Abstract

Abstract-Researchers often extrapolate posttraumatic stress disorder (PTSD) status from PTSD Checklist (PCL) data. When doing so, cut points should be based on samples with similar characteristics. This study assessed PCL diagnostic accuracy and postconcussive symptom levels within 106 Iraq/ Afghanistan war Veterans and servicemembers with recent blast exposure. Two definitions of PTSD were applied: (1) "strict" Diagnostic and Statistical Manual of Mental Health Disorders (DSM), 4th edition (DSM-IV) criteria and (2) "relaxed" DSM-IV criteria dropping the A2 criterion as per the DSM, 5th edition. Using a structured interview for PTSD, we found moderate agreement with the PCL. Under strict criteria, PTSD prevalence was 16%, PCL cut point was 66 at peak kappa, and mean Rivermead Postconcussion Questionnaire (RPQ) score trended higher for those with PTSD than for those without PTSD (35.5 +/-11.2 vs 30.5 +/-10.7, respectively; p = 0.08). Under relaxed criteria, PTSD prevalence was 26.4%, PCL cut point was 58 at peak kappa, and those with PTSD had higher RPQ scores than those without PTSD (36.4 +/-11.2 vs 29.5 +/-10.2, respectively; p = 0.003). Participants diagnosed with blast-related mild traumatic brain injury (n = 90) did not differ from those without mild traumatic brain injury (n = 16) in symptom scores. In conclusion, persons with combat-related blast exposure need higher than conventional PCL cut points and those with PTSD have more severe postconcussive-type symptoms than those without PTSD.

A Systematic Review of the Posttraumatic Stress Disorder Checklist (PCL)

“…Arbisi et al (); Bliese et al (); Grubaugh et al (); Chiu et al (); Keen et al (); Sherman et al (); W. C. Walker et al (); Yeager & Magruder (); Yeager et al () 18. Arbisi et al (); Blanchard et al (); Bliese et al (); Chiu et al (); Dobie et al (); Grubaugh et al (); Harrington & Newman (); Sherman et al (); W. C. Walker et al (); Wright et al (); Yeager & Magruder (); Yeager et al () 19. Andrykowski et al (); Arbisi et al (); Bliese et al (); Chiu et al (); Forbes et al (); Grubaugh et al (); Keen et al (); Manne et al (); Sherman et al (); E. A. Walker et al (); Yeager & Magruder (); Yeager et al () 20.…”

“…Arbisi et al (); Bliese et al (); Chiu et al (); Grubaugh et al (); W. C. Walker et al (); Yeager & Magruder (); Yeager et al () 24. Andrykowski et al (); Arbisi et al (); Blanchard et al (); Bliese et al (); Chiu et al (); Dobie et al (); Forbes et al (); Grubaugh et al (); Keen et al (); Lang et al (); Lang & Stein (); Manne et al (); E. A. Walker et al (); W. C. Walker et al (); Wright et al (); Yeager & Magruder (); Yeager et al () 25. Arbisi et al (); W. C. Walker et al (); Yeager & Magruder (); Yeager et al () 26.…”

“…Andrykowski et al (); Arbisi et al (); Blanchard et al (); Bliese et al (); Chiu et al (); Dobie et al (); Forbes et al (); Grubaugh et al (); Keen et al (); Lang et al (); Lang & Stein (); Manne et al (); E. A. Walker et al (); W. C. Walker et al (); Wright et al (); Yeager & Magruder (); Yeager et al () 25. Arbisi et al (); W. C. Walker et al (); Yeager & Magruder (); Yeager et al () 26. Arbisi et al (); Grubaugh et al (); Keen et al (); W. C. Walker et al (); Yeager & Magruder (); Yeager et al () 27.…”

Characterizing effects of mild traumatic brain injury and posttraumatic stress disorder on balance impairments in blast-exposed servicemembers and Veterans using computerized posturography

“…Each participant's PTSD diagnosis was determined using "relaxed" DSM-IV criteria that ignored the A2 criterion and simulates DSM-V [30]. The PCL-C is a validated and widely used measure of self-reported PTSD symptom severity [39][40]. It should be noted that the items and Likert values on the civilian version are identical to the military version; the civilian version was chosen to avoid assuming that all individuals' most stressful life event was during combat.…”

“…It should be noted that the items and Likert values on the civilian version are identical to the military version; the civilian version was chosen to avoid assuming that all individuals' most stressful life event was during combat. For the PCL-C, ≥58 was used to define PTSD because this cutpoint gave the peak kappa value (k = 0.54, 81% correct classification rate) in analysis of its receiver operating characteristics versus the MINI within the 107 interviewed participants [39].…”