title: Validation of a brief PTSD screener for underserved patients in federally qualified health centers.
abstract: OBJECTIVE
  The objective was to validate the reliability and efficiency of alternative cutoff values on the abbreviated six-item Posttraumatic Stress Disorder (PTSD) Checklist (PCL-6) [1] for underserved, largely minority patients in primary care settings of Federally Qualified Health Centers (FQHCs).
  
  
  METHODS
  Using a sample of 760 patients recruited from six FQHCs in the New York City and New Jersey metropolitan area from June 2010 to April 2013, we compared the PCL-6 with the Clinician Administered PTSD Scale (CAPS) for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. We used reliability statistics for single cutoff values on PCL-6 scores. We examined the relationship between probabilities of meeting CAPS diagnostic criteria and PCL-6 scores by nonparametric regression.
  
  
  RESULTS
  PCL-6 scores range between 6 and 30. Reliability and efficiency statistics for cutoff between 12 and 26 were reported. There is a strong monotonic relationship between PCL-6 scores and the probability of meeting CAPS diagnostic criteria.
  
  
  CONCLUSIONS
  No single cutoff on PCL-6 scores has acceptable reliability on both false positive and false negative simultaneously. An ordinal decision rule (low risk: 12 or less, medium risk: 13 to 16, high risk: 17 to 25 and very high risk: 26 and above) can differentiate the risk of PTSD. A single cutoff (17 or higher as positive) may be suitable for identifying those with the greatest need for care given limited mental health capacity in FQHC settings.
authors.affiliation: RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA. Electronic address: bhan@rand.org.
authors.forename: Bing
authors.initials: B
authors.lastname: Han
authors.affiliation: RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.
authors.forename: Eunice C
authors.initials: EC
authors.lastname: Wong
authors.affiliation: RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.
authors.forename: Zhimin
authors.initials: Z
authors.lastname: Mao
authors.affiliation: RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA; VA HSR&D Center for the Study of Healthcare Provider Behavior, 16111 Plummer Street (152), North Hills, CA, 91343, USA.
authors.forename: Lisa S
authors.initials: LS
authors.lastname: Meredith
authors.affiliation: Clinical Directors Network (CDN), 5 W 37th St # 10, New York, NY, 10018, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cassells
authors.affiliation: Clinical Directors Network (CDN), 5 W 37th St # 10, New York, NY, 10018, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, 1300 Morris Park Ave, Bronx, NY, 10461, USA; Center for Clinical and Translational Sciences, The Rockefeller University, 1230 York Avenue, New York, NY, 10065, USA.
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Tobin
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D057189:Checklist; D003151:Community Health Centers; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009515:New Jersey; D009519:New York City; D011594:Psychometrics; D012044:Regression Analysis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis*; D035862:Vulnerable Populations
keywords: PCL-6; PTSD; Screening; Validation