The validity of the PTSD Checklist as a measure of symptomatic change in combat related PTSD (2000)

National Centre for War-Related PTSD, Melbourne, Australia
Behaviour Research and Therapy (Impact Factor: 3.85). 09/2001; 39(8):977-986. DOI: 10.1016/S0005-7967(00)00084-X


Little research to date has examined the ability of self-report measures to assess changes in symptom severity and diagnostic status as a function of treatment. This study investigated the validity of the posttraumatic stress disorder (PTSD) checklist (PCL) as a measure of symptomatic change following programmatic treatment. A sample of 97 Vietnam veterans with combat-related PTSD was assessed using the clinician-administered PTSD scale (CAPS) and the PCL prior to, and 9 months following, participation in a PTSD treatment program. Using the CAPS as the “gold standard” measure of PTSD symptomatology, the PCL demonstrated high diagnostic accuracy pre- and posttreatment. However, significant variations in accuracy were evident in the ability of the PCL to determine the presence and severity of individual symptoms at each time point. In addition, as symptoms improved from pre- to posttreatment, and approached the threshold criteria, the PCL demonstrated reductions in diagnostic accuracy. As a measure of overall symptomatic change, the PCL underrated improvement in comparison to the CAPS. The results supported the use of an overall cut-off score of 50 on the PCL for a diagnosis, and an item score of 3 for symptom criterion, in this population.

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    • "Other terms commonly used included nervous disorder, neurasthenia, commotion, hysteria, weak heart, nervous disorder of the heart and insanity (Babington, 1997) We have used the term " shell shock " because it was both used in medical diagnosis and common parlance during the period covered by our research. Although our historical example is limited by time and context, issues of equitable pension determinations for those disabled by war and how to manage pension entitlements for those suffering from battle trauma that may not manifest in clearly definable symptoms are contemporary ones that remain contentious (Forbes et al., 2001; McDonald and Calhoun, 2010). We adopt an historical example purposely so the accounting issues are highlighted without the politicisation or emotion that is connected to contemporary discussion of post-traumatic stress disorder (Wessely and Deahl, 2003; Stubbs and Soroya, 1996; Bichescu et al., 2007), which is the contemporary equivalent of shell shock. "
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    ABSTRACT: This research is a qualitative analysis of the role of accounting in British disablement pensions awarded to men who sustained shell shock during their Army service in the First World War. It suggests that accounting classification of shell shock for pension determination purposes supported a view of shell shock which made men with shell shock scapegoats of a system that was often unsupportive. Accounting classification contributed to the lack of support by distancing pension decision-makers from the moral consequences of pension determinations. This was able to occur because the British government used accounting classification as part of a mechanism to avoid blame for its pension determination choices. This research contributes to an ongoing debate about the role of government by suggesting that the functions of government provide opportunities for accounting to simultaneously serve a neutral role as mere inscription while being a social and moral construct.
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    • "The PCL - M compares favorably with the gold - standard Clinician Administered PTSD Scale ( Forbes et al . , 2001 ) . Functional status was assessed using the widely used and well - validated 36 - item Short Form Health Survey ( SF - 36 ; Ware and Sherbourne , 1992 ) ."
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    ABSTRACT: Posttraumatic stress disorder (PTSD) symptoms can result in functional impairment among service members (SMs), even in those without a clinical diagnosis. The variability in outcomes may be related to underlying catecholamine mechanisms. Individuals with PTSD tend to have elevated basal catecholamine levels, though less is known regarding catecholamine responses to trauma-related stimuli. We assessed whether catecholamine responses to a virtual combat environment impact the relationship between PTSD symptom clusters and elements of functioning. Eighty-seven clinically healthy SMs, within 2 months after deployment to Iraq or Afghanistan, completed self-report measures, viewed virtual-reality (VR) combat sequences, and had sequential blood draws. Norepinephrine responses to VR combat exposure moderated the relationship between avoidance symptoms and scales of functioning including physical functioning, physical-role functioning, and vitality. Among those with high levels of avoidance, norepinephrine change was inversely associated with functional status, whereas a positive correlation was observed for those with low levels of avoidance. Our findings represent a novel use of a virtual environment to display combat-related stimuli to returning SMs to elucidate mind-body connections inherent in their responses. The insight gained improves our understanding of post-deployment symptoms and quality of life in SMs and may facilitate enhancements in treatment. Further research is needed to validate these findings in other populations and to define the implications for treatment effectiveness.
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    • "The cut-off score of PCL-S-50 was chosen to categorize the individuals. This cutoff was proposed by the developers of this instrument and has been subsequently used in other research studies with an 80% diagnostic power [Forbes, 2001]. This cut-off has a sensitivity of 0.78–0.82 "
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