The validity of Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) as screening instrument with Kurdish and Arab displaced populations living in the Kurdistan region of Iraq

Hawkar Ibrahim,Azad Ali Ismail,Claudia Catani,Frank Neuner,Verena Ertl

doi:10.1186/s12888-018-1839-z

Abstract

BackgroundThe Posttraumatic Stress Disorder Checklist (PCL) is a valid and reliable self-report measure for the assessment of Posttraumatic Stress Disorder (PTSD). Recently the PCL was updated according to the DSM-5 criteria for PTSD. So far only a few studies have examined the psychometric properties of the PCL-5, and all of these are restricted to populations living in industrialized countries. The aim of this study was to determine the psychometric properties and diagnostic utility of the PCL-5 as a screening instrument for war-affected displaced Kurdish and Arab populations. The specific goal was to determine a contextually valid cut-off score for a probable diagnosis of PTSD.MethodsThe PCL-5 was translated into Arabic and two Kurdish dialects. Trained interviewers administered these translations as assisted self-reports to 206 adults living in camps for displaced people in Iraq, together with depression and war-exposure instruments. Two weeks later, 98 randomly chosen subjects were reassessed by expert clinical psychologists. In the absence of a gold-standard instrument with proven validity in this context, the expert interviewers applied the PCL-5 items in the form of a clinical interview and used a DSM-5-algorithm to determine a diagnosis of PTSD. Receiver operator characteristics (ROC) were performed to determine a valid cutoff-score.ResultsThe internal consistency of the PCL-5 was high (alpha = .85) and the instrument showed an adequate convergent validity. Using the cut-off score of 23, the PCL-5 achieved the optimal balance of sensitivity and specificity (area under the curve = .82, p < .001; sensitivity = .82, specificity = .70).ConclusionsGiven that the comparison of the two assessments included both a re-test interval and validation by different interviewers, our results indicate that the PCL-5 can be recommended as an assessment and screening instrument for Kurdish and Arab populations.

Highlights

The Posttraumatic Stress Disorder Checklist (PCL) is a valid and reliable self-report measure for the assessment of Posttraumatic Stress Disorder (PTSD)
Receiver operator characteristics (ROC) curves allow the identification of the best cut-off score for the test by determining the maximum of the area under the curve (AUC; [27])
Convergent validity To evaluate the convergent validity of the PTSD checklist for the DSM-5 (PCL-5) in the context of this study, we examined the relationship between known predictor variables of PTSD and the PCL-5

Summary

Introduction

The Posttraumatic Stress Disorder Checklist (PCL) is a valid and reliable self-report measure for the assessment of Posttraumatic Stress Disorder (PTSD). Studies on mental health and violence in Arab and Kurdish populations have applied translated versions of standardized western instruments for the assessment of violence and trauma related disorders the cut-off-score of these instruments have not been adjusted in the local context [8]. This procedure is critical, since, due to inevitable differences in subtle semantic nuances, the transference of a cutoff score across contexts and populations even with well-translated instruments may lead to considerable overor underestimations of prevalence rates [9, 10]

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