Predicting Posttraumatic Stress Disorder Caseness Using the PTSD Checklist for DSM‐5 Among Patients Receiving Care for HIV

Abstract

This study assessed the ability of the Posttraumatic Stress Disorder (PTSD) Checklist for the DSM-5 to distinguish between caseness and noncaseness for PTSD among South Africans receiving care for HIV. The PCL-5 and the Structured Clinical Interview for DSM-5-Research Version (SCID-RV) module for PTSD were administered to 688 patients receiving antiretroviral therapy (ART) at two HIV care clinics in the greater Cape Town (South Africa) area. In total, nearly half of the sample (n = 324, 47.1%) reported experiencing an index traumatic event, and 101 participants (14.74%, 95% CI [12.17%, 17.62%]) met the diagnostic criteria for PTSD as measured using the SCID-RV. An ROC curve analysis suggested that a PCL-5 cutoff score of 32 yielded optimal sensitivity (0.88) and specificity (0.88), indicating that the measure was successful in determining caseness for PTSD 88% of the time and noncaseness 88% of the time. The AUC was 94.3%, 95% CI [92.6% to 96.1%], indicating high accuracy. The positive predictive value and negative predictive values were 56.3% and 97.7%, respectively, which suggests that the PCL-5 is an effective screening instrument to determine the presence of PTSD among South African ART users. Undetected and, thus, untreated PTSD may reduce quality of life, impede optimal adherence to ART, and increase the likelihood of risk behaviors among individuals living with HIV, contributing to further infections. The PCL-5 may be used for detection, referral, and treatment of PTSD as a way to enhance its management among individuals receiving HIV care.

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“…The PCL-5 is a 20-item self-report measure and has demonstrated good internal consistency (α = .96), test-retest reliability (r = .84), and convergent and discriminant validity (Bovin et al, 2015). The PCL-5 has also been found to predict accurate caseness for PTSD in a South African sample (n = 688) (Kagee et al, 2021). (Beck et al, 1996).…”

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“…Clinical thresholds were drawn from the relevant literature regarding clinical cutoffs for the EDE-Q, the PHQ-9, and the PCL-5 for diagnosing ED, major depressive disorder (MDD) and PTSD, respectively. Specifically, we used the following criteria to define subjects as below the clinical threshold or “in remission”: EDE-Q: two global scale cutoffs were used, one < 1.55 [ 61 ] and the other < 2.3 [ 45 ]; PHQ-9: cutoff of < 10 [ 48 ]; PCL-5: total score cutoff of < 33 [ 62 , 63 ]; STAI-S: score cutoff of ≤ 47.13; STAI-T: score cutoff of ≤ 45.68. Although no clear clinical thresholds have been established for STAI-S and STAI-T, we used the mean plus one standard deviation (SD) that has been published for females ages 19–39 years [ 49 ].…”

“…3 [45];(2) PHQ-9: cutoff of < 10[48];(3) PCL-5: total score cutoff of < 33[62,63]; (4) STAI-S: score cutoff of ≤ 47.13; (5) STAI-T: score cutoff of ≤ 45.68. Although no clear clinical thresholds have been established for STAI-S…”

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“…This method of determining traumatisation does not refer to caseness for posttraumatic stress disorder, as the PCL-5 is a screening rather than a diagnostic instrument. The PCL-5 has limited sensitivity and specificity when compared to a gold standard diagnostic assessment instrument such as the Structured Clinical Interview for the DSM5 (Kagee et al, 2022). In their study among users of antiretroviral therapy, Kagee et al found that the PCL-5 identified positive cases 56.3% of the time using the SCID-5 as the diagnostic gold standard for PTSD (Kagee et al, 2022).…”