Performance characteristics of the Posttraumatic Stress Disorder Checklist and SPAN in Veteran Affairs primary care settings

Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29452, USA.
General Hospital Psychiatry (Impact Factor: 2.61). 07/2007; 29(4):294-301. DOI: 10.1016/j.genhosppsych.2007.03.004
Source: PubMed


Posttraumatic stress disorder (PTSD) is a treatable disorder, and individuals with this condition may benefit from early detection. Many people with PTSD are not aware of its symptoms and do not seek treatment, making a brief and targeted screening program a worthwhile endeavor. For this reason, research aimed at improving screening instruments could yield substantial benefits.
The primary objective of this research was to assess the diagnostic performance of two popular PTSD screening assessments, the PTSD Checklist (PCL) and the SPAN, in a Veterans Affairs (VA) primary care setting. Additionally, we compared the screening performance of these two assessments by sex and race.
The PCL and SPAN were compared with a gold standard, the Clinician-Administered PTSD Scale. Receiver operating characteristic curves were used in conjunction with sensitivity and specificity measures to assess the performance of each screening assessment. These analyses are based on a large database (n=1076) that was derived from a multisite cross-sectional study conducted at four southeastern VA medical centers.
Results for the PCL support cutoff scores lower than those previously published, whereas results for the SPAN support the previously recommended cutoff score of 5 (sensitivity of 73.68% and specificity of 81.99%). We found no significant difference in areas under the curve (AUCs) by sex and by race between the PCL and SPAN. We did find that there was a highly significant difference (P<.0006) in overall diagnostic ability (as measured by the AUC) between the PCL (AUC=0.882) and SPAN (AUC=0.837), making the PCL the preferred screening tool, unless brevity is essential.
Clinicians and researchers should consider lower cutoff scores for the PCL, but the originally suggested cutoff score for the SPAN is appropriate.

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Available from: Kathryn Marley Magruder
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    • "King et al. (2013) found the PCL-M (military version, which anchors symptoms to stressful military experiences) predicted PTSD similarly among men and women. In another study, the PCL-M demonstrated slightly better (though statistically nonsignificant) performance among men than women (Yeager et al., 2007). Other PTSD screening instruments have been found to perform better among men Contents lists available at ScienceDirect journal homepage: "
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    ABSTRACT: We evaluated the specific version of the PTSD Checklist (PCL-S) as a screening tool for the recruitment of community-residing men and women with diverse trauma experiences. We administered the PCL-S via telephone in the context of participant recruitment, as well as in a laboratory setting preceding administration of the Clinician Administered PTSD Scale (CAPS), the gold standard PTSD assessment tool. In the laboratory, the PCL-S performed reasonably well for men and women, yielding overall diagnostic efficiency (ODE) values (representing percentage of cases accurately identified) of 0.78 and 0.73, respectively, for our recommended cut-points of 42 for men and 49 for women. In contrast, as a recruitment tool, the PCL-S yielded an acceptable ODE of 0.79 for men at the recommended cut-point of 47, but only an ODE of 0.56 (representing diagnostic efficiency no greater than chance) for women at the recommended cut-point of 50. A recruitment cut-point of 57 for women yields a similarly modest ODE of 0.61, but with substantial cost to sensitivity. These findings suggest that use of the PCL-S to screen for PTSD among potential study participants may lead to gender biased study results, even when separate diagnostic cut-points for men and women are used.
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    • "For screening procedures where the goal is to identify as many cases as possible for referral to further assessment, our results suggest that a significantly lower cutoff value is appropriate. This is in line with earlier studies of nontreatment-seeking samples, such as samples from primary care settings (Dobie et al., 2002; Lang et al., 2003; Walker et al., 2002; Yeager et al., 2007), that have found statistically superior performance of the PCL with cutoff scores ranging between 30 and 38. Indeed, based on our results, we suggest that 37 might be an appropriate cutoff for screening in active military samples. "
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    ABSTRACT: This study aimed to assess the diagnostic accuracy of the Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C; Weathers, Litz, Herman, Huska, & Keane, 1993) and to establish the most accurate cutoff for prevalence estimation of posttraumatic stress disorder (PTSD) in a representative military sample compared to a clinical interview. Danish soldiers (N = 415; 94.4% male, mean age 26.6 years) were assessed with the PCL-C and the Structured Clinical Interview for the DSM-IV (SCID; First, Spitzer, Gibbon, & Williams, 2002) 2.5 years after their return from deployment to Afghanistan. Diagnostic accuracy of the PCL-C was assessed through receiver operating characteristic curve analysis. The PCL-C displayed high overall accuracy (area under the curve = .95, confidence interval [.92, .98]) and performed well (sensitivity > .70 and specificity ≥ .90), with cutoff scores ranging from 37 to 44. When including sensitivity values a little below .70 (.69), the PCL-C performed well for cutoff levels up to 53. Prevalence of PTSD varied considerably with the application of different cutoff values and scoring methods. Our results show that the PCL-C is a relevant and valid tool for screening for probable PTSD in active military samples. However, it is of great importance that cutoff scores be chosen based on the sample and the purpose of the particular study or screening. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Full-text · Article · Nov 2013 · Psychological Assessment
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    • "Our attention is called to the fact that DTS-SF shows somewhat better indicators than the original version. Although there is another short version called SPAN (named for its four items Startle, Physiological arousal, Anger and Numbness; Meltzer-Brody, Churchill, & Davidson, 1999), we did not find any validation study with EFA and/or CFA (Chen, Shen, Tan, Chou, & Lu, 2003; Seo et al., 2011; Yeager, Magruder, Knapp, Nicholas, & Frueh, 2007), which makes us doubt its construct validity. This represents an opportunity, as it is possible to apply a shorter version of DTS as valid as the original and with the same factor structure. "
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    ABSTRACT: On February 27, 2010 (F-27), an earthquake and tsunami occurred having a significant impact on the mental health of the Chilean population, leading to an increase in cases of post-traumatic stress disorder (PTSD). Within this context, validated for the first time in Chile was the Davidson Trauma Scale (DTS) using three samples (each one consisting of 200 participants), two of them random from the Chilean population. Reliability analyses (i.e., α=0.933), concurrent validity (63% of the items are significantly correlated with the criteria variable "degree of damage to home") and construct validity (i.e., CMIN = 3.754, RMSEA = 0.118, NFI = 0.808, CFI = 0.850 and PNFI = 0.689) indicate validity between regular and good for DTS. However, a new short version of the scale (DTS-SF) created using the items with heavier factor weights, presented better fits (CMIN = 2.170, RMSEA = 0.077, NFI = 0.935, CFI = 0.963, PNFI = 0.697). Finally, the usefulness of DTS and DTS-SF is discussed, the latter being briefer, valid and having better psychometric characteristics.
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