Outcome Measure
PTSD Checklist for DSM-5
What it measures?
- The 20 symptoms of Post-Traumatic Stress Disorder, as outlined in the Diagnostic & Statistical Manual of Psychological Disorders, 5th Edition (DSM-5).
- Re-experiencing symptoms, such as involuntary distressing dreams, memories, thoughts and feelings related to a traumatic event(s).
- Avoidance symptoms, such as efforts to avoid internal or external reminders of the traumatic event(s).
- Negative alterations in cognitions and mood, such as negative mood states, lack of positive emotions, and exaggerated negative beliefs about onself, the world, and others.
- Hyperarousal symptoms, such as hypervigilance, exaggerated startle response, sleep difficulties, irritability and concentration problems.
Who is it for?
Adults aged 18 years +
Instrument Quality
- The PCL-5 has undergone extensive psychometric validation, and is one of the most widely used self-report screening measures for PTSD (for a systematic review see Bressler, Erford & Dean (2018).
Structure
- 20 items
- 5-point Likert Scale
- Respondents are asked to what extent (0 = "Not at all"; 4 = "Extremely") they have been bothered by each symptom during the past month (e.g. "Repeated, disturbing and unwanted memories of the stressful experience")
Scoring instructions
- Sum item responses for the full-scale and each subscale to derive the full-scale and subscale scores.
| Subscale | Item number |
|---|---|
Intrusion |
1,2,3,4,5 |
Negative Cognition & Mood |
8,9,10,11,12,13,14 |
Full-scale (PCL-5) |
1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20 |
Avoidance |
6,7 |
Hyperarousal |
15,16,17,18,19,20 |
Score Interpretation
What higher scores mean?
- More severe PTSD symptomatology. A provisional diagnosis of PTSD may be made if scores are sufficiently elevated. The optimal cut-off score will vary according to the service and population. As a general guideline, cut-off scores of 38 (Weathers et al., 2013) and 33 (Bovin et al., 2015) have been endorsed as sufficient for a provisional PTSD diagnosis.
How to assess symptom severity & change?
| Description | Score Range | |
|---|---|---|
| Below normative mean | 0 | |
| Normative mean | 5.6 | |
| 1 SD above normative mean | 10.5 | |
| 2 SD above normative mean | 15.4 | |
| Maximum | 20 |
| Description | Score Range | |
|---|---|---|
| Below normative mean | 0 | |
| Normative mean | 7.1 | |
| 1 SD above normative mean | 14 | |
| 2 SD above normative mean | 20.9 | |
| Maximum | 28 |
Severity ranges
Non-clinical mean and sd values based on sample of 838 English-speaking Canadian university students (Ashbaugh et al., 2016)
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Mean
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 12.91 | Based on a large (N = 912) American sample of military service members seeking PTSD treatment while stationed at garrison (Wortmann et al., 2016). |
| Normative | 7.1 | Based on a sample of 838 English-speaking Canadian university students (Ashbaugh, Houle-Johnson, Herbert, El-Hage & Brunet, 2016). |
Standard Deviation
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 6.59 | Based on a large (N = 912) American sample of military service members seeking PTSD treatment while stationed at garrison (Wortmann et al., 2016). |
| Normative | 6.9 | Based on a sample of 838 English-speaking Canadian university students (Ashbaugh, Houle-Johnson, Herbert, El-Hage & Brunet, 2016). |
| Description | Score Range | |
|---|---|---|
| Below normative mean | 0 | |
| Normative mean | 20.9 | |
| Post-traumatic Stress Disorder (PTSD) | >=31 | Provisional Diagnosis |
| 1 SD above normative mean | 38.6 | |
| 2 SD above normative mean | 56.3 | |
| Maximum | 80 |
Severity ranges
Non-clinical mean and sd values based on sample of 838 English-speaking Canadian university students (Ashbaugh et al., 2016)
Provisional diagnosis
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Mean
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 42.41 | Based on a large (N = 912) American sample of military service members seeking PTSD treatment while stationed at garrison (Wortmann et al., 2016). |
| Normative | 20.9 | Based on a sample of 838 English-speaking Canadian university students (Ashbaugh, Houle-Johnson, Herbert, El-Hage & Brunet, 2016). |
Standard Deviation
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 15.06 | Based on a large (N = 912) American sample of military service members seeking PTSD treatment while stationed at garrison (Wortmann et al., 2016). |
| Normative | 17.7 | Based on a sample of 838 English-speaking Canadian university students (Ashbaugh, Houle-Johnson, Herbert, El-Hage & Brunet, 2016). |
Reliability
| Value | Comments |
|---|---|
| 0.82 | Based on a sample of 278 trauma-exposed college students (Blevins, Weathers, Davis, Witte & Domino, 2015). Value reported is test-retest reliability. |
| Description | Score Range | |
|---|---|---|
| Below normative mean | 0 | |
| Normative mean | 2.7 | |
| 1 SD above normative mean | 5.1 | |
| 2 SD above normative mean | 7.5 | |
| Maximum | 8 |
Severity ranges
Non-clinical mean and sd values based on sample of 838 English-speaking Canadian university students (Ashbaugh et al., 2016)
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Mean
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 4.88 | Based on a large (N = 912) American sample of military service members seeking PTSD treatment while stationed at garrison (Wortmann et al., 2016). |
| Normative | 2.7 | Based on a sample of 838 English-speaking Canadian university students (Ashbaugh, Houle-Johnson, Herbert, El-Hage & Brunet, 2016). |
Standard Deviation
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 2.35 | Based on a large (N = 912) American sample of military service members seeking PTSD treatment while stationed at garrison (Wortmann et al., 2016). |
| Normative | 2.4 | Based on a sample of 838 English-speaking Canadian university students (Ashbaugh, Houle-Johnson, Herbert, El-Hage & Brunet, 2016). |
| Description | Score Range | |
|---|---|---|
| Below normative mean | 0 | |
| Normative mean | 5.5 | |
| 1 SD above normative mean | 13.45 | |
| 2 SD above normative mean | 16.1 | |
| Maximum | 24 |
Severity ranges
Non-clinical mean and sd values based on sample of 838 English-speaking Canadian university students (Ashbaugh et al., 2016)
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Mean
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 14.07 | Based on a large (N = 912) American sample of military service members seeking PTSD treatment while stationed at garrison (Wortmann et al., 2016). |
| Normative | 5.5 | Based on a sample of 838 English-speaking Canadian university students (Ashbaugh, Houle-Johnson, Herbert, El-Hage & Brunet, 2016). |
Standard Deviation
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 4.68 | Based on a large (N = 912) American sample of military service members seeking PTSD treatment while stationed at garrison (Wortmann et al., 2016). |
| Normative | 5.3 | Based on a sample of 838 English-speaking Canadian university students (Ashbaugh, Houle-Johnson, Herbert, El-Hage & Brunet, 2016). |
Instrument developers
- Weathers, F.W., Litz, B.T., Keane, T.M., Palmieri, P.A., Marx, B.P., & Schnurr, P.P. (2013). The PTSD Checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD at www.ptsd.va.gov
Refrences
Ashbaugh, A. R., Houle-Johnson, S., Herbert, C., El-Hage, W., & Brunet, A. (2016). Psychometric validation of the English and French versions of the posttraumatic stress disorder checklist for DSM-5 (PCL-5). PloS One, 11(10) Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and Initial Psychometric Evaluation. J Trauma Stress. 2015 Dec;28(6):489-98. doi: 10.1002/jts.22059. Epub 2015 Nov 25. PMID: 26606250. Bovin, M. J., Marx, B. P., Weathers, F. W., Gallagher, M. W., Rodriguez, P., Schnurr, P. P., & Keane, T. M. (2016). Psychometric properties of the PTSD checklist for diagnostic and statistical manual of mental Disorders–Fifth edition (PCL-5) in veterans. Psychological Assessment, 28(11), 1379 Bressler, R., Erford, B. T., & Dean, S. (2018). A Systematic Review of the Posttraumatic Stress Disorder Checklist (PCL). Journal of Counseling & Development, 96(2), 167–186. https://doi.org/10.1002/jcad.12190 Marx, B. P., Lee, D. J., Norman, S. B., Bovin, M. J., Sloan, D. M., Weathers, F. W., Keane, T. M., & Schnurr, P. P. (2022). Reliable and clinically significant change in the clinician-administered PTSD Scale for DSM-5 and PTSD Checklist for DSM-5 among male veterans. Psychological Assessment, 34(2), 197–203. https://doi.org/10.1037/pas0001098 Wortmann JH, Jordan AH, Weathers FW, Resick PA, Dondanville KA, Hall-Clark B, Foa EB, Young-McCaughan S, Yarvis JS, Hembree EA, Mintz J, Peterson AL, Litz BT. Psychometric analysis of the PTSD Checklist-5 (PCL-5) among treatment-seeking military service members. Psychol Assess. 2016 Nov;28(11):1392-1403. doi: 10.1037/pas0000260. Epub 2016 Jan 11. PMID: 26751087.
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Severity ranges
Non-clinical mean and sd values based on sample of 838 English-speaking Canadian university students (Ashbaugh et al., 2016)
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Mean
Standard Deviation