The aim of this study was to determine optimally efficient cutoff scores on the Posttraumatic Stress Disorder Checklist (PCL) for identifying full posttraumatic stress disorder (PTSD) and partial PTSD (P-PTSD) in active-duty Marines and Sailors. Participants were 1,016 Marines and Sailors who were administered the PCL and Clinician-Administered PTSD Scale (CAPS) 3 months after returning from Operations Iraqi and Enduring Freedom. PCL cutoffs were tested against three CAPS-based classifications: full PTSD, stringent P-PTSD, and lenient P-PTSD. A PCL score of 39 was found to be optimally efficient for identifying full PTSD. Scores of 38 and 33 were found to be optimally efficient for identifying stringent and lenient P-PTSD, respectively. Findings suggest that the PCL cutoff that is optimally efficient for detecting PTSD in active-duty Marines and Sailors is substantially lower than the score of 50 commonly used by researchers. In addition, findings provide scores useful for identifying P-PTSD in returning service members.
AdamsR. E.BoscarinoJ. A.GaleaS. (2006). Alcohol use, mental health status and psychological well-being 2 years after the World Trade Center attacks in New York City. American Journal of Drug and Alcohol Abuse, 32, 203-224. doi:10.1080/00952990500479522
2.
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: Author.
3.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: Author.
4.
BakerD. G.NashW. P.LitzB. T.GeyerM. A.RisbroughV. B.NievergeltC. M., . . . the MRS Team. (2012). Predictors of risk and resilience for posttraumatic stress disorder among ground combat Marines: Methods of the Marine Resiliency Study. Preventing Chronic Disease: Public Health Research, Practice, and Policy, 9, 110134. doi:10.5888/pcd9.110134
5.
BeckA. T.EpsteinN.BrownG.SteerR. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893-897. doi:10.1037/0022-006X.56.6.893
6.
BeckA. T.SteerR. A. (1991). Relationship between the Beck Anxiety Inventory and the Hamilton Anxiety Rating Scale with anxious outpatients. Journal of Anxiety Disorders, 5, 213-223. doi:10.1016/0887-6185(91)90002-B
7.
BeckA. T.SteerR. A. (1993). Beck Anxiety Inventory Manual. San Antonio, TX: Psychological Corporation.
8.
BeckA. T.SteerR. A.BrownG. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.
9.
BlakeD.WeathersF. W.NagyL. M.& KaloupekD. G.GusmanF. D.CharneyD. S.KeaneT. M. (1995). The development of a Clinician-Administered PTSD Scale. Journal of Traumatic Stress, 8, 75-90. doi:10.1002/jts.2490080106
10.
BlieseP. D.WrightK. M.AdlerA. B.CabreraO.CastroC. A.HogeC. W. (2008). Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat. Journal of Consulting and Clinical Psychology, 76, 272-281. doi:10.1037/0022-006X.76.2.272
11.
BreslauN.LuciaV. C.DavisG. C. (2004). Partial PTSD versus full PTSD: An empirical examination of associated impairment. Psychological Medicine, 34, 1205-1214. doi:10.1017/S0033291704002594
12.
CreamerM.McFarlaneA. C.BurgessP. (2005). Psychopathology following trauma: The role of subjective experience. Journal of Affective Disorders, 86, 175-182. doi:10.1016/j.jad.2005.01.015
13.
DozoisD. A.DobsonK. S.AhnbergJ. L. (1998). A psychometric evaluation of the Beck Depression Inventory–II. Psychological Assessment, 10, 83-89. doi:10.1037/1040-3590.10.2.83
14.
ForbesD.CreamerM.BiddleD. (2001). The validity of the PTSD checklist as a measure of symptomatic change in combat-related PTSD. Behaviour Research and Therapy, 39, 977-986. doi:10.1016/S0005-7967(00)00084-X
15.
GormanL. A.BlowA. J.AmesB. D.ReedP. L. (2011). National Guard families after combat: Mental health, use of mental health services, and perceived treatment barriers. Psychiatric Services, 62, 28-34. doi:10.1176/appi.ps.62.1.28
16.
HewittP. L.NortonG. (1993). The Beck Anxiety Inventory: A psychometric analysis. Psychological Assessment, 5, 408-412. doi:10.1037/1040-3590.5.4.408
17.
HogeC. W.CastroC. A.MesserS. C.McGurkD.CottingD. I.KoffmanR. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351, 13-22. doi:10.1056/NEJMoa040603
18.
JacobyW. G. (2000). Loess: A nonparametric, graphical tool for depicting relationships between variables. Electoral Studies, 19, 577-613.
19.
JakupcakM.ConybeareD.PhelpsL.HuntS.HolmesH. A.FelkerB.. . . McfallM. E. (2007). Anger, hostility, and aggression among Iraq and Afghanistan war veterans reporting PTSD and subthreshold PTSD. Journal of Traumatic Stress, 20, 945-954. doi:10.1002/jts.20258
20.
KaramE.AndrewsG.BrometE.PetukhovaM.RuscioA.SalamounM.. . . KesslerR. C. (2010). The role of criterion A2 in the DSM-IV diagnosis of posttraumatic stress disorder. Biological Psychiatry, 68, 465-473. doi:10.1016/j.biopsych.2010.04.032
21.
KeaneT. M.StreetA. E.StaffordJ. (2004). The assessment of military-related PTSD. In WilsonJ. P.KeaneT. M.WilsonJ. P.KeaneT. M. (Eds.), Assessing psychological trauma and PTSD (2nd ed., pp. 262-285). New York, NY: Guilford Press.
22.
KimP. Y.ThomasJ. L.WilkJ. E.CastroC. A.HogeC. W. (2010). Stigma, barriers to care, and use of mental health services among active duty and National Guard soldiers after combat. Psychiatric Services, 61, 572-588. doi:10.1176/appi.ps.61.6.582
23.
KraemerH. C. (1987). The methodological and statistical evaluation of medical tests: The Dexamethasone suppression test in psychiatry. Psychoneuroendocrinology, 12, 411-427.
24.
KraemerH. C. (1992). Evaluating medical tests: Objective and quantitative guidelines. Newbury Park, CA: Sage.
25.
LitzB. T.SteenkampM. M.NashW. P. (in press). Resilience and recovery in the military. In FeeneyN. (Ed.), Facilitating resilience and recovery following traumatic events (pp. 69–113). New York, NY: Guilford Press.
26.
MarshallR. D.OlfsonM.HellmanF.BlancoC.GuardinoM.StrueningE. L. (2001). Comorbidity, impairment, and suicidality in subthreshold PTSD. American Journal of Psychiatry, 158, 1467-1473. doi:10.1176/appi.ajp.158.9.1467
NashW. P. (2011). U.S. Marine Corps and Navy combat and operational stress continuum model: A tool for leaders. In RitchieE. C. (Ed.), combat and operational behavioral health (pp. 33–63). Washington, DC: Borden Institute.
29.
O’DonnellM. L.CreamerM.McFarlaneA. C.SiloveD.BryantR. A. (2010). Should A2 be a diagnostic requirement for posttraumatic stress disorder in DSM-V?Psychiatry Research, 176, 257-260. doi:10.1016/j.psychres.2009.05.012
30.
OsmanA.KopperB. A.BarriosF. X.OsmanJ. R.WadeT. (1997). The Beck Anxiety Inventory: Reexamination of factor structure and psychometric properties. Journal of Clinical Psychology, 53, 7-14. doi:10.1002/(SICI)1097-4679(199701)53:1<7::AID-JCLP2>3.0.CO;2-S
31.
PeredaN.ForeroC. G. (2012). Contribution of criterion A2 to PTSD screening in the presence of traumatic events. Journal of Traumatic Stress, 25, 587-591. doi:10.1002/jts.21736
32.
PietrzakR. H.GoldsteinM. B.MalleyJ. C.JohnsonD. C.SouthwickS. M. (2009). Subsyndromal posttraumatic stress disorder is associated with health and psychosocial difficulties in veterans of operations enduring freedom and Iraqi freedom. Depression and Anxiety, 26, 739-744. doi:10.1002/da.20574
33.
SchneidermanA. I.BraverE. R.KangH. K. (2008). Understanding sequelae of injury mechanisms and mild traumatic brain injury incurred during the conflicts in Iraq and Afghanistan: Persistent postconcussive symptoms and posttraumatic stress disorder. American Journal of Epidemiology, 167, 1446-1452. doi:10.1093/aje/kwn068
34.
SchnyderU.MoergeliH.KlaghoferR.BuddebergC. (2001). Incidence and prediction of posttraumatic stress disorder symptoms in severely injured accident victims. American Journal of Psychiatry, 158, 594-599. doi:10.1176/appi.ajp.158.4.594
35.
SheehanD. V.LecrubierY.SheehanK.AmorimP.JanavsJ.WeillerE.. . .DunbarG. C. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59(Suppl. 20), 22-33.
36.
SmithM.Epping-JordanJ. (2000). WHODAS II training manual: A guide to administration. Geneva, Switzerland: World Health Organization.
37.
ThomasJ. L.WilkJ. E.RiviereL. A.McGurkD.CastroC. A.HogeC. W. (2010). Prevalence of mental health problems and functional impairment among Active Component and National Guard soldiers 3 and 12 months following combat in Iraq. Archives of General Psychiatry, 67, 614-623. doi:10.1001/archgenpsychiatry.2010.54
38.
WeathersF. W.KeaneT. M.DavidsonJ. T. (2001). Clinician-Administered PTSD Scale: A review of the first ten years of research. Depression and Anxiety, 13, 132-156. doi:10.1002/da.1029
39.
WeathersF. W.LitzB. T.HermanD. S.HuskaJ. A.KeaneT. M. (1993, October). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the International Society for Traumatic Stress Studies, San Antonio, TX.
40.
WeathersF. W.RuscioA.KeaneT. M. (1999). Psychometric properties of nine scoring rules for the Clinician-Administered Posttraumatic Stress Disorder Scale. Psychological Assessment, 11, 124-133. doi:10.1037/1040-3590.11.2.124
41.
WeissD. S. (2004). Structured clinical interview techniques for PTSD. In WilsonJ. P.KeaneT. M.WilsonJ. P.KeaneT. M. (Eds.), Assessing psychological trauma and PTSD (2nd ed., pp. 103-121). New York, NY: Guilford Press.
42.
WilkinsK. C.LangA. J.NormanS. B. (2011). Synthesis of the psychometric properties of the PTSD checklist (PCL) military, civilian, and specific versions. Depression and Anxiety, 28, 596-606. doi:10.1002/da.20837
43.
YurgilK. A.BarkauskasD. A.VasterlingJ. J.NievergeltC. M.LarsonG. E.SchorkN. J.. . . BakerD. G. (2014). Association between traumatic brain injury and posttraumatic stress disorder in active-duty Marines. JAMA Psychiatry, 71, 149-157. doi:10.1001/jamapsychiatry.2013.3080
44.
ZlotnickC.FranklinC.ZimmermanM. (2002). Does “subthreshold” posttraumatic stress disorder have any clinical relevance?Comprehensive Psychiatry, 43, 413-419. doi:10.1053/comp.2002.35900
