Trauma checklist (PCL-C)

The PCL-C asks about symptoms in relation to generic stressful experiences, and can be used with any population. This version simplifies assessment based on multiple traumas, because symptom endorsements are not attributed to a specific event. In many circumstances, it is advisable to also assess traumatic event exposure to ensure that a respondent has experienced at least one event that meets DSM-IV Criterion A.

Administration and Scoring

The PCL is a self-report instrument that can be read by respondents themselves, or read to them either in person or over the phone. It can be completed in approximately 5-10 minutes.
The PCL-C can be scored in several ways: 1) Treat response categories 3–5 (Moderately or above) as symptomatic and responses 1– 2 (below Moderately) as non-symptomatic, then use the following DSM criteria for a diagnosis:

  • Symptomatic response to at least 1 'B' item (Questions 1–5),
  • Symptomatic response to at least 3 'C' items (Questions 6–12), and
  • Symptomatic response to at least 2 'D' items (Questions 13–17)

2) Add up the items to create total severity score. A Total symptom severity score (range 17-85) can be obtained by summing the scores from each of the 17 items that have response options ranging from 1 'Not at all' to 5 'Extremely'.
The gold standard for diagnosing PTSD is a structured clinical interview such as the clinician administered PTSD scale (CAPS). When necessary, the PCL can be scored to provide a presumptive diagnosis. This has been done in three ways:

  1. Determine whether an individual meets DSM-IV symptom criteria, as defined by at least 1 criterion B item (questions 1-5), 3 criterion C items (questions 6-12) and at least 2 criterion D items (questions 13-17). Symptoms rated as 'Moderately' or above (responses 3 through 5 on individual items) are counted as present.
  2. Determine whether the total severity score exceeds a given normative threshold (see table below).
  3. Combine methods (1) and (2) to ensure that an individual meets both the symptom pattern and severity threshold.
Choosing a cut-off score

Factors to be considered when choosing a PCL cut-off score include:

  • The goal of the assessment: A lower cut-off score is considered when screening for PTSD, or when it is desirable to maximise detection of possible cases. A higher cutoff score is considered when informing diagnosis or to minimise false positives.
  • The prevalence of PTSD in the target setting: Generally, the lower the prevalence of PTSD in a given setting, the lower the optimal cut-off score. In settings with expected high rates of PTSD, such as specialty mental health clinics, consider a higher cut-off score. In settings with expected low rates of PTSD such as primary care clinics, or in circumstances in which patients are reluctant to disclose mental health problems, consider a lower cut-off score.

Below are suggested cut-off score ranges based on prevalence and setting characteristics. Consider scores on the low end of the range if the goal is to screen for PTSD. Consider scores on the high end of the range if the goal is to aid in diagnosis of PTSD.

Suggested PCL cut-off scores

Estimated prevalence of PTSD

Suggested PCL cut-off score

Below 15%

(Primary care)

 

30-35

16-39%

(DVA primary care, specialised medical clinics)

 

36-44

Above 40%

(Specialist mental health clinics)

 

45-50

 

NB: these recommendations are general and approximate, and are not intended to be used for legal or policy purposes. Research is needed to establish optimal cut-off scores for a specific population.

Measuring change

Good clinical practice often involves monitoring client progress. Evidence suggests that a 5-10 point change is reliable (i.e. not due to chance) and a 10-20 point change is clinically meaningful (Monson et al., 2008). Therefore, we recommend using 5 points as a minimum threshold for determining whether an individual has responded to treatment and 10 points as a minimum threshold for determining whether the improvement is clinically meaningful.

or PTSD Checklist (DVA)

 

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Last modified: Friday, 7 April 2017, 1:45 PM