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Diagnostic performance of the PTSD checklist and the Vietnam Era Twin Registry PTSD scale

Published online by Cambridge University Press:  06 June 2014

K. Magruder ,
D. Yeager ,
J. Goldberg ,
C. Forsberg ,
B. Litz ,
V. Vaccarino ,
M. Friedman ,
T. Gleason ,
G. Huang  and
N. Smith
K. Magruder*
Affiliation:
Mental Health Service, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
D. Yeager
Affiliation:
Mental Health Service, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
J. Goldberg
Affiliation:
Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington, USA Department of Epidemiology, University of Washington, Seattle, Washington, USA
C. Forsberg
Affiliation:
Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington, USA
B. Litz
Affiliation:
Massachusetts Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts, USA Boston University School of Medicine, Boston, Massachusetts, USA
V. Vaccarino
Affiliation:
Departments of Epidemiology and Medicine, Emory University, Atlanta, Georgia, USA
M. Friedman
Affiliation:
Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, White River Junction, Vermont, USA Departments of Psychiatry and Pharmacology & Toxicology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
T. Gleason
Affiliation:
Cooperative Studies Program, Clinical Science Research and Development, VA Office of Research and Development, Washington, DC, USA
G. Huang
Affiliation:
Cooperative Studies Program, Clinical Science Research and Development, VA Office of Research and Development, Washington, DC, USA
N. Smith
Affiliation:
Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington, USA Department of Epidemiology, University of Washington, Seattle, Washington, USA
*
*Address for correspondence: Dr K. M. Magruder, Mental Health Service, Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC 29401, USA. (Email: [email protected])
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Abstract

Aims.

Self-report questionnaires are frequently used in clinical and epidemiologic studies to assess post-traumatic stress disorder (PTSD). A number of studies have evaluated these scales relative to clinician administered structured interviews; however, there has been no formal evaluation of their performance relative to non-clinician administered epidemiologic assessments such as the Composite International Diagnostic Interview (CIDI). We examined the diagnostic performance of two self-report PTSD scales, the PTSD checklist (PCL) and the Vietnam Era Twin Registry (VET-R) PTSD scale, compared to the CIDI.

Methods.

Data were derived from a large epidemiologic follow-up study of PTSD in 5141 Vietnam Era Veterans. Measures included the PCL, VET-R PTSD scale and CIDI. For both the PCL and VET-R PTSD scale, ROC curves, areas under the curve (AUC), sensitivity, specificity, % correctly classified, likelihood ratios, predictive values and quality estimates were generated based on the CIDI PTSD diagnosis.

Results.

For the PCL and VET-R PTSD scale the AUCs were 89.0 and 87.7%, respectively. Optimal PCL cutpoints varied from the 31–33 range (when considering sensitivity and specificity) to the 36–56 range (when considering quality estimates). Similar variations were found for the VET-R PTSD, ranging from 31 (when considering sensitivity and specificity) to the 37–42 range (when considering quality estimates).

Conclusions.

The PCL and VET-R PTSD scale performed similarly using a CIDI PTSD diagnosis as the criterion. There was a range of acceptable cutpoints, depending on the metric used, but most metrics suggested a lower PCL cutpoint than in previous studies in Veteran populations.

Keywords

AssessmentCIDIPCLPTSD
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 24 , Issue 5 , October 2015 , pp. 415 - 422
Copyright
Copyright © Cambridge University Press 2014 

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References

American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd Revised edn. American Psychiatric Association: Washington, DC.Google Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Andrykowski, M, Cordova, M, Studts, J, Miller, T (1998). Posttraumatic stress disorder after treatment for breast cancer: prevalence of diagnosis and use of the PTSD Checklist – Civilian Version (PCL-C) as a screening instrument. Journal of Consulting and Clinical Psychology 66, 586–590.CrossRefGoogle ScholarPubMed
Blake, D, Weathers, F, Nagy, L, Kaloupek, D, Klauminzer, G, Charney, D, Keane, T (1990). A clinician rating scale for assessing current and lifetime PTSD: the CAPS-1. Behavior Therapist 13, 187–188.Google Scholar
Blake, D, Weathers, F, Nagy, L, Kaloupek, D, Gusman, F, Charney, D, Keane, T (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress 8, 75–90.Google Scholar
Blanchard, E, Jones-Alexander, J, Buckley, T, Forneris, C (1996). Psychometric properties of the PTSD Checklist (PCL). Behaviour Research and Therapy 34, 669–673.Google Scholar
Bliese, P, Wright, K, Adler, A, Cabrera, O, Castro, C, Hoge, C (2008). Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat. Journal of Consulting and Clinical Psychology 76, 272–281.Google Scholar
Boscarino, J (2006). Posttraumatic stress disorder and mortality among U.S. Army veterans 30 years after military service. Annals of Epidemiology 16, 248–256.Google Scholar
Boscarino, J (2008). A prospective study of PTSD and early-age heart disease mortality among Vietnam veterans: implications for surveillance and prevention. Psychosomatic Medicine 70, 668–676.Google Scholar
Dobie, D, Kivlahan, D, Maynard, C, Bush, K, McFall, M, Epler, A, Bradley, K (2002). Screening for post-traumatic stress disorder in female Veteran's Affairs patients: validation of the PTSD checklist. General Hospital Psychiatry 24, 367–374.Google Scholar
Eisen, S, True, W, Goldberg, J, Henderson, W, Robinette, C (1987). The Vietnam Era Twin (VET) Registry: method of construction. Acta Geneticae Medicae et Gemellologiae (Roma) 36, 61–66.Google Scholar
Elhai, J, Gray, M, Kashdan, T, Franklin, C (2005). Which instruments are most commonly used to assess traumatic event exposure and posttraumatic effects?: a survey of traumatic stress professionals. Journal of Traumatic Stress 18, 541–545.Google Scholar
Foa, E, International Society for Traumatic Stress Studies (2009). Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies, 2nd edn. Guilford Press: New York.Google Scholar
Goldberg, J, True, W, Eisen, S, Henderson, W (1990). A twin study of the effects of the Vietnam War on posttraumatic stress disorder. Journal of the American Medical Association 263, 1227–1232.Google Scholar
Goldberg, J, Curran, B, Vitek, M, Henderson, W, Boyko, E (2002). The Vietnam Era Twin Registry. Twin Research 5, 476–481.Google Scholar
Henderson, W, Eisen, S, Goldberg, J, True, W, Barnes, J, Vitek, M (1990). The Vietnam Era Twin Registry: a resource for medical research. Public Health Reports 105, 368–373.Google Scholar
Hoge, C, Castro, C, Messer, S, McGurk, D, Cotting, D, Koffman, R (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine 351, 13–22.Google Scholar
Kessler, R, Chiu, W, Demler, O, Merikangas, K, Walters, E (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617–627.Google Scholar
Kraemer, H (1987). The methodological and statistical evaluation of medical tests: the dexamethasone suppression test in psychiatry. Psychoneuroendocrinology 12, 411–427.Google Scholar
Kraemer, H, Kupfer, D, Clarke, D, Narrow, W, Regier, D (2012). DSM-5: how reliable is reliable enough? American Journal of Psychiatry 169, 13–15.Google Scholar
Lang, A, Stein, M (2005). An abbreviated PTSD checklist for use as a screening instrument in primary care. Behaviour Research and Therapy 43, 585–594.Google Scholar
Lang, A, Laffaye, C, Satz, L, Dresselhaus, T, Stein, M (2003). Sensitivity and specificity of the PTSD checklist in detecting PTSD in female veterans in primary care. Journal of Traumatic Stress 16, 257–264.Google Scholar
Manne, S, Du Hamel, K, Gallelli, K, Sorgen, K, Redd, W (1998). Posttraumatic stress disorder among mothers of pediatric cancer survivors: diagnosis, comorbidity, and utility of the PTSD checklist as a screening instrument. Journal of Pediatric Psychology 23, 357–366.Google Scholar
McDonald, S, Calhoun, P (2010). The diagnostic accuracy of the PTSD checklist: a critical review. Clinical Psychology Review 30, 976–987.Google Scholar
Robins, L, Helzer, J, Croughan, J, Ratcliff, K (1981). National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. Archives of General Psychiatry 38, 381–389.Google Scholar
Robins, L, Wing, J, Wittchen, H, Helzer, J, Babor, T, Burke, J, Farmer, A, Jablenksi, A, Pickens, R, Regier, D (1988). The Composite International Diagnostic Interview. An epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry 45, 1069–1077.Google Scholar
Roy-Byrne, P, Arguelles, L, Vitek, M, Goldberg, J, Keane, T, True, W, Pitman, R (2004). Persistence and change of PTSD symptomatology – a longitudinal co-twin control analysis of the Vietnam Era Twin Registry. Social Psychiatry and Psychiatric Epidemiology 39, 681–685.Google Scholar
Schlenger, W, Caddell, J, Ebert, L, Jordan, B, Rourke, K, Wilson, D, Thalji, L, Dennis, J, Fairbank, J, Kulka, R (2002). Psychological reactions to terrorist attacks: findings from the National Study of Americans' Reactions to September 11. Journal of the American Medical Association 288, 581–588.Google Scholar
Schuster, M, Stein, B, Jaycox, L, Collins, R, Marshall, G, Elliott, M, Zhou, A, Kanouse, D, Morrison, J, Berry, S (2001). A national survey of stress reactions after the September 11, 2001, terrorist attacks. New England Journal of Medicine 345, 1507–1512.CrossRefGoogle ScholarPubMed
Spitzer, R, Williams, J, Gibbon, M, First, M (1990). Structured Clinical Interview for DSM-III-R, Patient Edition/Non-patient Edition,(SCID-P/SCID-NP). American Psychiatric Press: Washington, DC.Google Scholar
StataCorp (2009). Stata Statistical Software. StataCorp LP: College Station, TX.Google Scholar
True, W, Rice, J, Eisen, S, Heath, A, Goldberg, J, Lyons, M, Nowak, J (1993). A twin study of genetic and environmental contributions to liability for posttraumatic stress symptoms. Archives of General Psychiatry 50, 257–264.Google Scholar
Weathers, F, Litz, B, Herman, D, Huska, J, Keane, T (1993). The PTSD checklist: reliability, validity, and diagnostic utility. In Annual Meeting of the International Society for Traumatic Stress Studies. San Antonio, TX.Google Scholar
Weathers, F, Ford, J (1996). Psychometric properties of the PTSD checklist (PCL-C, PCL-S, PCL-M, PCL-PR). In BH Stamm, Editor, Measurement of stress, trauma, and adaptation, Sidran Press, Lutherville, MD.Google Scholar
Yeager, D, Magruder, K (2013). PCL scoring rules for elderly Veteran Affairs outpatients. American Journal of Geriatric Psychiatary 13, S1064–S7481. [Epub ahead of print].Google Scholar
Yeager, D, Magruder, K, Knapp, R, Nicholas, J, Frueh, B (2007). Performance characteristics of the posttraumatic stress disorder checklist and SPAN in Veterans Affairs primary care settings. General Hospital Psychiatry 29, 294–301.Google Scholar
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