Disclosures: The authors report no relevant financial disclosures.
April 27, 2021
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DSM-4, DSM-5 checklists successfully assess PTSD among veteran, military populations

Disclosures: The authors report no relevant financial disclosures.
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Both the PTSD Checklist-Civilian and PTSD Checklist for DSM-5 versions successfully assessed the disorder among veteran and military populations, according to results of a diagnostic study published in JAMA Network Open.

“Although [prior] studies provide promising evidence that the [two] instruments have similar psychometric properties, questions remain about the ability to make meaningful clinical comparisons across time for military, veteran and civilian populations,” Cynthia A. LeardMann, MPH, of the Deployment Health Research Department at the Naval Health Research Center in California, and colleagues wrote. “In [one] study, for example, approximately 30% of soldiers who met criteria using [one] measure did not meet criteria using the other measure, despite highly comparable psychometric properties. Furthermore, both versions of the instrument are still used in research and clinical settings.”

Army veteran at clinic
Source: Adobe Stock

Significant differences between the two instruments include the PTSD Checklist for DSM-5 (PCL-5) having three additional items that evaluate the novel DSM-5 symptoms persistent trauma-related negative emotions, persistent blame and reckless or self-destructive behavior. Further, the PCL-5 modified the wording of 13 items to match with changes in the DSM-5 that sought to clarify symptom expression.

LeardMann and colleagues aimed to determine the PCLs’ ability to compare and assess PTSD according to DSM-4 and DSM-5 criteria in a study that analyzed data collected in October 2019 as part of the Millennium Cohort Study, a population-based U.S. military cohort study. The researchers restricted the present study’s population to 1,921 initial web responders (mean age, 50.1 years) of the 2019 survey cycle who were randomly assigned to one of four survey groups. Participants in each group completed the PCL-Civilian and PCL for DSM-5 versions, which were counterbalanced to control for order effects. The researchers used survey data to evaluate PTSD according to the PCL-C and PCL-5, major depressive disorder according to the Patient Health Questionnaire, generalized anxiety according to the Generalized Anxiety Disorder scale and problem drinking according to the Patient Health Questionnaire. Assessed demographic and military characteristics included age, marital status, race/ethnicity, sex, education, pay grade, service branch, enrollment panel and military service status.

Results showed 70.7% of participants were men, 85.3% were non-Hispanic white, 75% were married and 61.9% had a bachelor’s degree or higher. Further, 15.4% had probably PTSD based on DSM-4 criteria with PCL-C vs. 14.9% based on DSM-5 criteria with PCL-5. LeardMann and colleagues noted that both PCLs had significant agreement for probable PTSD according to DSM-4 criteria and DSM-5 criteria, with estimated PTSD sum scores exhibited “excellent agreement” with observed scores. The researchers used an established crosswalk and found PCL-5 sum scores assessed via the PCL-C were similar to observed PCL-5 scores. A total of 16 of 17 corresponding items between the two instruments exhibited significant agreement. When the researchers appended two additional PCL-C items to the PCL-5, estimates remained nearly the same. Both the PCL-C and PCL-5 exhibited nearly identical associations with comorbid conditions.

“The current findings add to an increasing body of literature suggesting that the PCL-5 can be used to estimate DSM-IV PTSD and the PCL-C can be used to estimate DSM-5 PTSD,” LeardMann and colleagues wrote. “These results provide strong support for the transition from the 17-item PCL to the 20-item PCL-5 without losing the ability to monitor trends and associated comorbidities over time.”