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Depress Anxiety. 2019 Sep;36(9):790-800. doi: 10.1002/da.22942. Epub 2019 Jul 29.

Developing an optimal short-form of the PTSD Checklist for DSM-5 (PCL-5).

Author information

1
Department of Psychology, Harvard University, Cambridge, Massachusetts.
2
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
3
Center for Research on Computation and Society, John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts.
4
National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts.
5
Department of Psychiatry, Boston University School of Medicine, Massachusetts.
6
Department of Psychiatry, University of California San Diego, La Jolla, California.
7
Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California.
8
VA San Diego Healthcare System, San Diego, California.
9
Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Abstract

BACKGROUND:

Although several short-forms of the posttraumatic stress disorder (PTSD) Checklist (PCL) exist, all were developed using heuristic methods. This report presents the results of analyses designed to create an optimal short-form PCL for DSM-5 (PCL-5) using both machine learning and conventional scale development methods.

METHODS:

The short-form scales were developed using independent datasets collected by the Army Study to Assess Risk and Resilience among Service members. We began by using a training dataset (n = 8,917) to fit short-form scales with between 1 and 8 items using different statistical methods (exploratory factor analysis, stepwise logistic regression, and a new machine learning method to find an optimal integer-scored short-form scale) to predict dichotomous PTSD diagnoses determined using the full PCL-5. A smaller subset of best short-form scales was then evaluated in an independent validation sample (n = 11,728) to select one optimal short-form scale based on multiple operating characteristics (area under curve [AUC], calibration, sensitivity, specificity, net benefit).

RESULTS:

Inspection of AUCs in the training sample and replication in the validation sample led to a focus on 4-item integer-scored short-form scales selected with stepwise regression. Brier scores in the validation sample showed that a number of these scales had comparable calibration (0.015-0.032) and AUC (0.984-0.994), but that one had consistently highest net benefit across a plausible range of decision thresholds.

CONCLUSIONS:

The recommended 4-item integer-scored short-form PCL-5 generates diagnoses that closely parallel those of the full PCL-5, making it well-suited for screening.

KEYWORDS:

diagnosis; military personnel; psychological tests/psychometrics; trauma- and stressor-related disorders

PMID:
31356709
PMCID:
PMC6736721
[Available on 2020-09-01]
DOI:
10.1002/da.22942

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