Developing an optimal short-form of the PTSD Checklist for DSM-5 (PCL-5)

Depress Anxiety. 2019 Sep;36(9):790-800. doi: 10.1002/da.22942. Epub 2019 Jul 29.


Background: Although several short-forms of the posttraumatic stress disorder (PTSD) Checklist (PCL) exist, all were developed using heuristic methods. This report presents the results of analyses designed to create an optimal short-form PCL for DSM-5 (PCL-5) using both machine learning and conventional scale development methods.

Methods: The short-form scales were developed using independent datasets collected by the Army Study to Assess Risk and Resilience among Service members. We began by using a training dataset (n = 8,917) to fit short-form scales with between 1 and 8 items using different statistical methods (exploratory factor analysis, stepwise logistic regression, and a new machine learning method to find an optimal integer-scored short-form scale) to predict dichotomous PTSD diagnoses determined using the full PCL-5. A smaller subset of best short-form scales was then evaluated in an independent validation sample (n = 11,728) to select one optimal short-form scale based on multiple operating characteristics (area under curve [AUC], calibration, sensitivity, specificity, net benefit).

Results: Inspection of AUCs in the training sample and replication in the validation sample led to a focus on 4-item integer-scored short-form scales selected with stepwise regression. Brier scores in the validation sample showed that a number of these scales had comparable calibration (0.015-0.032) and AUC (0.984-0.994), but that one had consistently highest net benefit across a plausible range of decision thresholds.

Conclusions: The recommended 4-item integer-scored short-form PCL-5 generates diagnoses that closely parallel those of the full PCL-5, making it well-suited for screening.

Keywords: diagnosis; military personnel; psychological tests/psychometrics; trauma- and stressor-related disorders.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Checklist / methods*
  • Checklist / standards*
  • Diagnostic and Statistical Manual of Mental Disorders*
  • Factor Analysis, Statistical
  • Female
  • Humans
  • Male
  • Mass Screening
  • Military Personnel
  • Psychometrics
  • Sensitivity and Specificity
  • Stress Disorders, Post-Traumatic / diagnosis*