The differential diagnostic accuracy of the PTSD Checklist among men versus women in a community sample

Abstract

We evaluated the specific version of the PTSD Checklist (PCL-S) as a screening tool for the recruitment of community-residing men and women with diverse trauma experiences. We administered the PCL-S via telephone in the context of participant recruitment, as well as in a laboratory setting preceding administration of the Clinician Administered PTSD Scale (CAPS), the gold standard PTSD assessment tool. In the laboratory, the PCL-S performed reasonably well for men and women, yielding overall diagnostic efficiency (ODE) values (representing percentage of cases accurately identified) of 0.78 and 0.73, respectively, for our recommended cut-points of 42 for men and 49 for women. In contrast, as a recruitment tool, the PCL-S yielded an acceptable ODE of 0.79 for men at the recommended cut-point of 47, but only an ODE of 0.56 (representing diagnostic efficiency no greater than chance) for women at the recommended cut-point of 50. A recruitment cut-point of 57 for women yields a similarly modest ODE of 0.61, but with substantial cost to sensitivity. These findings suggest that use of the PCL-S to screen for PTSD among potential study participants may lead to gender biased study results, even when separate diagnostic cut-points for men and women are used.

Assessing posttraumatic stress disorder with close others’ collateral reports: Convergence with self- and clinician reports.

“…The agreement between clinician and both versions of the PCL on PTSD diagnosis was relatively low, and a higher percentage of trauma-exposed individuals met criteria for PTSD according to the CAPS than either PCLs. Discrepancies between PTSD diagnostic status in these measures has been found previously (Parker-Guilbert, Leifker, Sippel, & Marshall, 2014) but in the opposite direction (greater percentage of PTSD according to the PCL). The discrepancy may imply that in future research and treatment when diagnostic status is critical to decisions (e.g., study/treatment eligibility, insurance claims), the CAPS (or a combination of CAPS and PCL) may be preferred over the use of the PCL alone.…”

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

“…Diagnostic validity . Seven studies (Adkins et al, ; Bliese et al, ; Chiu et al, ; Cook, Elhai, Cassidy, et al, ; Parker‐Guilbert, Leifker, Sippel, & Marshall, ; Pietrzak et al, ; Thoreson et al, ) provided evidence of diagnostic validity and efficiency of the PCL‐S. The studies used diverse sample sizes and characteristics, various criteria for diagnostic comparisons, and various PCL‐S cutoff scores to establish optimal sample‐dependent decision efficiency.…”

“…Diagnostic validity. Seven studies (Adkins et al, 2008;Cook, Elhai, Cassidy, et al, 2005;Parker-Guilbert, Leifker, Sippel, & Marshall, 2014;Pietrzak et al, 2012;Thoreson et al, 2010) provided The studies used diverse sample sizes and characteristics, various criteria for diagnostic comparisons, and various PCL-S cutoff scores to establish optimal sample-dependent decision efficiency. Across these seven studies, tested cutoff points ranged from 27 to 60 and, not surprisingly, the overall decision accuracy, sensitivity, specificity, positive predictive value, and negative predictive value varied widely across samples and proposed cutoff scores.…”

Sex differences in PTSD symptoms: A differential item functioning approach.

“…Therefore, this is an important limitation of the current findings because we were unable to test whether these preexisting–co-occurring conditions may account for differences in PTSD symptom endorsement in males and females. Further, because depressive and anxiety disorders are more prevalent among women than men (Kessler, Chiu, Demler, & Walters, 2005; Kessler, Chiu, Demler, Merikangas, & Walters, 2005), it is possible that the higher female endorsement may reflect a greater degree of generalized distress, as opposed to PTSD-specific distress (Parker-Guilbert, Leifker, Sippel, & Marshall, 2014).…”