U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, Massachusetts, USA.
Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.
J Trauma Stress. 2024 Apr;37(2):328-336. doi: 10.1002/jts.22999. Epub 2023 Dec 12.
The Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5) is a widely used self-report measure of PTSD symptoms that has demonstrated strong psychometric properties across settings and samples. Co-occurring hazardous alcohol use and PTSD are prevalent among veterans, and the effects of alcohol use may impact the performance of the PCL-5. However, this possibility is untested. In this study, we evaluated the PCL-5 diagnostic accuracy for veterans who did and did not screen positive for hazardous alcohol use according to the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Participants were 385 veterans recruited from Veterans Affairs primary care clinics. Results indicated that PCL-5 performance, AUC = .904, 95% CI [.870, .937], did not differ as a product of hazardous alcohol use. PCL-5 diagnostic utility was comparably high for veterans with, AUC = .904; 95% CI [.846, .962], and without, AUC = .904 95% CI [.861, .946], positive AUDIT-C screens. Although optimally efficient cutoff scores for veterans who screened positive were higher (i.e., 34-36) than for those with negative screens (i.e., 30), neither were significantly different from the overall PCL-5 cutoff score (i.e., 32), suggesting that neither veterans with nor without positive AUDIT-C screens require differential PCL-5 cutoff scores. The results do underscore the importance of using PCL-5 cutoff scores in concert with clinical judgment when establishing a provisional PTSD diagnosis and highlight the need for additional study of the impact of comorbidities on PCL-5 diagnostic accuracy and cutoff scores.
创伤后应激障碍（PTSD）检查表 DSM-5（PCL-5）是一种广泛使用的 PTSD 症状自评量表，在各种环境和样本中都具有很强的心理测量特性。共病危险饮酒和 PTSD 在退伍军人中很常见，饮酒的影响可能会影响 PCL-5 的表现。然而，这种可能性尚未得到验证。在这项研究中，我们根据酒精使用障碍识别测试-消费（AUDIT-C）评估了 PCL-5 在筛查出危险饮酒和未筛查出危险饮酒的退伍军人中的诊断准确性。参与者是从退伍军人事务初级保健诊所招募的 385 名退伍军人。结果表明，PCL-5 表现，AUC=.904，95%CI [.870，.937]，不受危险饮酒的影响。对于有，AUC=.904；95%CI [.846，.962]，和没有，AUC=.904 95%CI [.861，.946]，阳性 AUDIT-C 筛查的退伍军人，PCL-5 的诊断效用都很高。虽然对于筛查阳性的退伍军人来说，最佳效率的截断分数更高（即 34-36），但与阴性筛查的退伍军人相比，这并没有显著差异（即 30），也没有显著差异从总体 PCL-5 截断分数（即 32），这表明无论是阳性还是阴性 AUDIT-C 筛查的退伍军人都不需要不同的 PCL-5 截断分数。结果确实强调了在建立暂定 PTSD 诊断时，使用 PCL-5 截断分数与临床判断相结合的重要性，并突出了需要进一步研究共病对 PCL-5 诊断准确性和截断分数的影响。
