title: Operating characteristics of the PTSD checklist in a military primary care setting.
abstract: The Department of Defense (DoD) is implementing universal behavioral health screening for all DoD health-care beneficiaries presenting to military primary care clinics. The PTSD Checklist-Civilian Version (PCL-C; Weathers, Litz, Herman, Huska, & Keane, 1993) is used for the identification of posttraumatic stress disorder (PTSD); however, the operating characteristics of the PCL-C remain unstudied in this population. This study examined the operating characteristics of the PCL-C in a sample of 213 patients from 3 Washington, D.C., area military primary care clinics. Blinded raters independently assessed PTSD using the PTSD Symptom Scale Interview (Foa, Riggs, Dancu, & Rothbaum, 1993) as the diagnostic criterion standard. The receiver operating characteristic curve revealed that PCL-C scores accounted for 92% of the area under the curve. A PCL-C score of 31 optimized sensitivity (0.93) and specificity (0.90), and the multilevel likelihood ratio was 5.50 (95% confidence interval [2.26, 13.37]). Internal consistency (0.97) and test-retest reliability (0.87 after a median 13 days) were strong. Results suggest that a PCL-C score of 31 is the optimal cutoff score for use in a military primary care setting serving active duty service members, dependents, and retirees. These findings offer military primary care providers preliminary data to interpret PCL-C scores and to inform treatment decisions as part of routine clinical practice.
authors.affiliation: DoD Deployment Health Clinical Center, Walter Reed National Military Medical Center.
authors.forename: Kristie L
authors.initials: KL
authors.lastname: Gore
authors.forename: Phoebe K
authors.initials: PK
authors.lastname: McCutchan
authors.forename: Annabel
authors.initials: A
authors.lastname: Prins
authors.forename: Michael C
authors.initials: MC
authors.lastname: Freed
authors.forename: Xian
authors.initials: X
authors.lastname: Liu
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Weil
authors.forename: Charles C
authors.initials: CC
authors.lastname: Engel
mesh_terms: D000328:Adult; D057189:Checklist / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000523:psychology; D008875:Middle Aged; D008887:Military Medicine / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*; D011594:Psychometrics; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000523:psychology; D014481:United States