The online version of this article (doi:10.1186/s12888-017-1304-4) contains supplementary material, which is available to authorized users.
The PTSD Checklist-civilian (PCL-C) is one of the most commonly used self-report measures of PTSD symptoms, however, little is known about its validity when used in pregnancy. This study aims to evaluate the reliability and validity of the PCL-C as a screen for detecting PTSD symptoms among pregnant women.
A total of 3372 pregnant women who attended their first prenatal care visit in Lima, Peru participated in the study. We assessed the reliability of the PCL-C items using Cronbach’s alpha. Criterion validity and performance characteristics of PCL-C were assessed against an independent, blinded Clinician-Administered PTSD Scale (CAPS) interview using measures of sensitivity, specificity and receiver operating characteristics (ROC) curves. We tested construct validity using exploratory and confirmatory factor analytic approaches.
The reliability of the PCL-C was excellent (Cronbach’s alpha =0.90). ROC analysis showed that a cut-off score of 26 offered optimal discriminatory power, with a sensitivity of 0.86 (95% CI: 0.78–0.92) and a specificity of 0.63 (95% CI: 0.62–0.65). The area under the ROC curve was 0.75 (95% CI: 0.71–0.78). A three-factor solution was extracted using exploratory factor analysis and was further complemented with three other models using confirmatory factor analysis (CFA). In a CFA, a three-factor model based on DSM-IV symptom structure had reasonable fit statistics with comparative fit index of 0.86 and root mean square error of approximation of 0.09.
The Spanish-language version of the PCL-C may be used as a screening tool for pregnant women. The PCL-C has good reliability, criterion validity and factorial validity. The optimal cut-off score obtained by maximizing the sensitivity and specificity should be considered cautiously; women who screened positive may require further investigation to confirm PTSD diagnosis.
Additional file 1: Posttraumatic Stress Disorders Checklist Civilian Version (PCL-C) cut-off score used in previous studies. (DOCX 35 kb)12888_2017_1304_MOESM1_ESM.docx
Additional file 2: Distribution of PCL-C scores according to clinician diagnosed PTSD status. (DOCX 20 kb)12888_2017_1304_MOESM2_ESM.docx
Additional file 3: Receiver Operating Characteristic (ROC) Curves of PCL-C Score. (DOCX 23 kb)12888_2017_1304_MOESM3_ESM.docx
Additional file 4: Sensitivity and specificity for PTSD diagnosis across various cut-off scores of Posttraumatic Stress Disorders Checklist Civilian Version (PCL-C) among subjects with lifetime sexual or physical abuse by intimate partner. (DOCX 17 kb)12888_2017_1304_MOESM4_ESM.docx
Additional file 5: Sensitivity and specificity for PTSD diagnosis across various cut-off scores of Posttraumatic Stress Disorders Checklist Civilian Version (PCL-C) among subjects without lifetime sexual or physical abuse by intimate partner. (DOCX 17 kb)12888_2017_1304_MOESM5_ESM.docx
Additional file 6 Item mapping for confirmatory factor analysis. (DOCX 16 kb)12888_2017_1304_MOESM6_ESM.docx
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- Validity of the posttraumatic stress disorders (PTSD) checklist in pregnant women
Maria Elena Medina-Mora
Marta B. Rondon
Sixto E. Sánchez
Michelle A. Williams
- BioMed Central