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The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility

The PTSD Checklist (PCL): Reliability, Validity, and Diagno stic
Frank W. Weathers, Brett T. Litz,
Debra S. Herman, Jennifer A. Huska, & Terence M. Keane
The PTSD Checklist (PCL) is a new self- repo r t rating sc al e for as ses sin g post-
trau ma tic stress disord er (PTSD). The PCL consists of 17 items which corre s po nd to th e
DSM-III-R sympt om s of PTSD. Exami n ee s are instruct ed to indicat e how much they have
been both ere d by eac h sy mpt o m in th e past mo nth using a 5-point (1- 5) scal e. The
anchor s for the severity ratin gs ar e identical to thos e used on the SCL-90- R (Deroga t is,
19 8 3), and range from "Not at all" to "Extre me ly." There ar e two versions of th e PCL:
the PCL-M, with reex per i en cing sym pto ms written specifically for military expe ri en c es, and
the PCL-C, with reexp erie nci ng symp to ms writt en gene rically to apply to any trau ma tic
ev ent . The PCL can be modified easily to fit specific ass es sm en t need s. For exa m pl e, in
order to ass es s symp to m severity repea te dl y in the cont ext of a treat men t protoc ol, the
time frame of one mont h can be chan g e d to "the past we ek" instea d of "the pa s t mont h."
Similarly, the wording of the items can be modified to reflect a specific trau m atic ev ent. In
the secon d study desc rib ed below the phras e "your military ex p erie nc es " was cha n ge d to
"your ODS exp erie n ce s. "
The PCL is useful in a variety of clinical and rese a rc h ass e ss me nt conte xts ,
especi ally when inform atio n ab o ut PTSD sympt om s is de si r ed but ad minist ering a
struct u re d inte r vi ew is not feasibl e . The PCL can be us ed as a continuo us mea su re of PTSD
sy mpt o m severity by sum min g scor es across the 17 ite m s. It also can be us e d to deriv e a
PTSD diagn osis by con si d erin g a score of 3 (Modera tel y) or gre at e r as a symp t om , then
followin g the DSM-III-R di a g no s tic rule (1 B sympt om , 3 C sym pto ms, and 2 D sy mpt o ms).
Method Subject s for the first st u d y were 123 male Vietna m the at er veter an s who cont a ct ed
the Natio nal Cent er for PTSD either for clinical servi c es or rese a rc h particip a tion.
Dem ogr ap hic inform atio n for this samp l e is shown in Table 1. In three separ at e session s,
two to thre e days apart, subj e cts compl e te d the PCL twice, comple t ed sev eral oth e r
qu esti o nn aire mea s ur es of PTSD and gener al psycho pa th ol o gy, and were adminis ter ed the
PTSD modul e of the Structur ed Clinical Interview for DSM-III-R (SCID). The preval en c e of
curren t PTSD was 54%. Sev eral an alyse s were conduc te d to evalua te the psycho m etri c
prop e rtie s of the PCL.
1. Mean PCL score s were 63. 6 (SD=14 .1) for PTSD subje cts and 34. 4 (SD =14 .1) for non-
PTSD su bj ects.
2. Test- retes t reli a bility was .96.
3. Inter nal consiste nc y (alpha coefficien t) wa s .93 for B sympt om s, .92 for C symp t om s, .92
for D sym p to ms , and .97 for all 17 sy mpt om s. Item- scal e total correlatio ns rang e d fro m .
62 - .87.
4. Conver g en t validity was demo ns tr at ed by strong correlatio ns betw e en the PCL and: the
Mississippi Scale (.93), the PK scale of the MMPI-2 (.77), th e Impact of Event Scal e (.90), and
the Comb at Expos ure Scale (.46).
5. Diagnos t i c utility was deter min ed by usin g PCL scor e s to predict PTSD diagn o ses deriv ed
fro m the SCID. The opti mally efficient cut off scor e was 50, which yielde d a sensitivity of .
82, a sp ecificity of .83, and a kappa of .64.
Method Subject s for the secon d st u dy were 1006 nation a lly surveye d male (88%) and
fem ale (12 %) vetera ns of the Persian Gulf the at er. Dem ogr ap hic infor m ati o n for this
sampl e also is shown in Tabl e 1.
The survey instru me nt include d the PCL and the Mississippi Scale, both of which
were modified to b e specific to the Persian gulf th eat er , and a mea su re of com ba t
ex p osu re . Approxima te ly half of the subjects com plet ed the surv ey wh e n the y wer e
seeking services (primarily psychot he ra py or be n efits couns eling) at a vet cente r , and half
com plet ed it at an Army base or throu g h their National Gu ar d or Reserv e unit.
1. Mean PCL score s were 64. 2 (SD=9.1 ) for PTSD subje c ts and 29. 4 (SD =11 .5) for non- PTSD
su bj ects .
2. Inter nal consiste nc y (alpha coefficien t) wa s .90 for B sympt om s, .89 for C symp t om s, .91
for D sym p to ms , and .96 for all 17 sy mpt om s. Item- scal e total correlatio ns rang e d fro m .
52 - .80.
3. Conver g en t validity was demo ns tr at ed by a stro ng correlatio n betw ee n th e PCL and the
Mississippi Scale (.85).
4. A principal co mpo n e nts analysis with varima x rotatio n yielded one large factor
acc o un ting for 59% of the varian ce, and one smaller fact o r acco unt i ng for 7% of the
varianc e. Loading most highly on the first factor were item s mea su ring reex pe rien cin g (B1-
B4), effortful avoidan ce (C1- C2), and hypera ro u sal (D4- D6). Loading most highly on the
second factor wer e item s mea su ring nu m bin g of resp o ns i v en ess (C4-C7) and hyper aro us al
(D1- D3).
1. The PCL is an easily administ er e d self-report rating scale for ass es sin g the 17 DSM-III-R
sy mpt o ms of PTSD.
2. The PCL h a s excell ent test- ret e st reliability over a 2- 3 day period.
3. Inter nal consiste nc y is very hig h for each of the thre e gro ups of items corresp on din g to
the DSM-III-R symp to m clust ers as well as for the full 17- item scale.
4. The PCL correlate s strongly with other me a su re s of PTSD, such as the Mississippi Scale,
the PK scale of the MMPI-2, and the Impact of Event Scale, and also correlat es mode ra t el y
with level of com ba t expos ur e.
5. Used as a contin uou s me as ur e, the PCL has good diag n os tic utility. In Vietna m com ba t
vet era ns a cutoff of 50 on th e PCL is a good predictor of a PTSD diag nos i s bas ed on th e
SCID PTSD modul e.
6. Princi p al comp on en ts an alysis rev eal ed on e large factor, consistin g prim arily of
re e xpe rie n cin g and hyp e rar ou sa l items , and on e much smaller factor, consisting prim a rily
of em o tion al numb i ng ite ms.
Table 1 -- Demo gr a ph ic and Psych o met ric Informa tion
Variable Vietna m
(n = 12 3) Persia n Gulf
(n = 10 0 6)
Age 43 .74 (2.69) 30 .46 (7.98)
Gend er
Men 10 0 .0% 82 .8%
Wom en 0.0% 12 .8%
Educatio n
< High School 10 .6% 1.8%
High School Degre e 24 .4% 56 .2%
So m e Colleg e 35 .0% 28 .3%
College 7 .3% 8.7%
> College 7.4% 4.5%
Single 26 .0% 33 .6%
Married 28 .4% 48 .2%
Divorced 27 .6% 9.7%
Separ a ted 13 .8% 6.1%
Widow e d 2.4% .9%
Army 48 .0% 63 .4%
Navy 13 .8% 9.3%
Air Force 7 .3% 15 .1%
Marines 29 .3% 10 .0%
Whit e 73 .2% 64 .1%
Black 22 .8% 17 .0%
Hisp a nic 2.4% 5.8%
Other 0.0% 5.8%
Mississippi Scale 106 .63 (27.59) 74 .13 (24. 2 4)
PTSD Checklist 50 .58 (20. 2 4) 34 .77 (16.8 3)
... This tool consists of 17 items with 5 options and is provided as a diagnostic aid tool by Weathers et al. (1992) for the National Center for Post-Traumatic Stress Disorder in the USA. Five items are related to re-experiencing traumatic symptoms, seven are related to emotional numbness and avoidance symptoms, and the other five are related to severe arousal symptoms. ...
... This scale has been standardized in Iran by Goodarzi (2003). In the study, the internal consistency of the questionnaire was 0.93, and in the study of Weathers et al. (1992), the homogeneity coefficient of 0.97 was reported for Vietnam War veterans. ...
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Amaç: Bu çalışmanın amacı bireylerin travmalarını ve travma sonrası belirtilerini belirleyen, DSM-5 ile uyumlu, geçerli ve güvenilir Çok Boyutlu Travma Ölçeği’nin geliştirilmesi ve bu ölçeğin psikometrik özelliklerinin incelenmesi amaçlanmaktadır.Yöntem: Çalışmanın örneklem grubu 18 yaş ve üzeri 1054 bireyden (843 kadın 211 erkek) oluşmaktadır. Veriler, demografik bilgi formu, Çocukluk Çağı Travmaları Ölçeği, Travma Sonrası Stres Bozukluğu Kontrol Listesi - Sivil Versiyon, Bilişsel Duygu Düzenleme Ölçeği, Stresle Başa Çıkma Tarzları Ölçeği ve Çok Boyutlu Travma Ölçeği kullanılarak toplanmıştır. Çok Boyutlu Travma Ölçeği’nin (ÇBTÖ) geçerliliğine ve güvenilirliğini dair gerekli analizler uygulanmıştır. Ölçek geliştirme basamakları titizlikle takip edilerek ölçüm aracının yapı geçerliliğini desteklemek amacıyla sırasıyla Açımlayıcı Faktör Analizi ve Doğrulayıcı Faktör Analizi uygulanmıştır.Bulgular: Elde edilen bulgular neticesinde ÇBTÖ’de yer alan ilk ölçek olan Çocukluk Çağı Travmaları Ölçeği’nde (ÇÇTÖ) 31 madde ve 6 alt boyuttan (duygusal ihmal/istismar, fiziksel istismar, fiziksel ihmal, cinsel istismar, ikincil travma ve diğer travmalar); ve ÇÇTÖ’de bulunan ikinci ölçek olan Travma Sonrası Belirtiler Ölçeği’nde (TSBÖ) 26 madde ve 6 alt boyuttan (kaçınma, yineleme, aşırı tepki, bilişsel bozulma, işlevsel bozulma ve çözülme belirtileri) oluşan toplamda 57 madde ve 12 alt boyutluk bir ölçüm aracı geliştirilmiştir. ÇÇTÖ için açıklanan toplam varyans %62,58 olarak bulunurken, cranbach alpha güvenilirlik katsayısı 0,87 olarak elde edilmiştir. TSBÖ için açıklanan toplam varyans %67,19 olarak saptanmış olup, cranbach alpha güvenilirlik katsayısı 0,94 olarak bulunmuştur. Alt boyutların güvenilirlik değerleri 0,50 – 0,91 arasında değişiklik göstermektedir. Ölçekte gerekli metotlar ile her alt boyuttan ayrı ayrı kesme puanı belirlenmiştir.Sonuç: 57 madde ve 12 alt boyuttan oluşan 5’li likert şeklinde tasarlanan, yüksek düzeyde geçerliliğe ve güvenilirliğe sahip “Çok Boyutlu Travma Ölçeği (ÇBTÖ)” literatüre kazandırılmıştır.
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