Psychometric Properties and Confirmatory Factor Analysis of the Posttraumatic Stress Disorder Checklist for Chinese Survivors of Road Traffic Accidents

Abstract Objectives: To examine the psychometric properties and factor structure of the Chinese version of the Posttraumatic Stress Disorder Checklist. Participants and Methods: A total of 481 survivors of road traffic accidents completed the Posttraumatic Stress Disorder Checklist, Impact of Event Scale-Revised, and General Health Questionnaire 1 week after a road traffic accident. Their responses were studied to investigate the factor structure and validity of the Posttraumatic Stress Disorder Checklist. To examine the diagnostic utility of the Checklist, an independent sample of 45 road traffic accident survivors completed the Posttraumatic Stress Disorder Checklist and the Clinician-administered Post-traumatic Disorder Scale 1 month after their road traffic accidents. Results: A hierarchical 4-factor model was identified as providing the best account of the data for the Posttraumatic Stress Disorder Checklist. The diagnostic efficiency of the mixed scoring criteria, using a minimum symptom score of 4 with either a total score of 44 or 50, was confirmed as a means of screening for post-traumatic stress disorder. Conclusions: The Chinese version of the Posttraumatic Stress Disorder Checklist was found to have satisfactory reliability and validity. Key words: Accidents, traffic; Life change events; Questionnaires; Stress disorders, post-traumatic . (ProQuest: . denotes formula omitted.) Introduction According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV),1 the prevalence of acute stress disorder in individuals exposed to trauma ranges from 14 to 33%. In the adult population the lifetime prevalence of post-traumatic stress disorder (PTSD) found in community-based studies is approximately 8%. However, there are few psychometrically sound Chinese language PTSD-related assessment instruments for clinical and research use. Although the Chinese version of the Impact of Event Scale-Revised (IES-R) has been proven a useful means of examining traumatic stress, the items included do not bear a direct reference to the diagnostic criteria in the DSM-IV.2-6 The PTSD Checklist (PCL)7 is a 17-item, selfreported rating scale instrument that parallels DSM-IV's diagnostic criteria B, C, and D for PTSD. Thus, the PCL may yield information that has greater predictive validity on a diagnostic level than the IES-R. The PCL's structure may also enable researchers to draw more precise comparisons with data derived from PTSD-relevant interviews such as the Clinician-administered PTSD Scale (CAPS). 8 The PCL's diagnostic sensitivities and specificities in different languages have been demonstrated. This includes the English version,7,9,10 French version,11 and Spanish version.12 As it takes only a short period, roughly 5 minutes, to administer the PCL, it compares favourably with the 40 to 60 minutes needed for diagnostic interviews (e.g. CAPS), making the PCL a good candidate as a screening tool for PTSD. There is a need for PTSD-related assessment instruments in Chinese, so this study was conducted to investigate the psychometric properties of the Chinese version of the PCL and to provide preliminary results for guiding future use of the PCL as a valid and reliable PTSD assessment instrument in Chinese. This study aimed to examine the psychometric properties of the Chinese version of the PCL when applied to survivors of road traffic accidents (RTAs) attending accident and emergency (A&E) services. Data collected from 481 respondents 1 week after experiencing a RTA were used to study the internal consistency, reliability, and factor structure of the PCL. Given the personal impact, nature and recency of the event, data from RTA survivors at this point should enable us to understand the psychometric properties of the PCL. The concurrent validity of the PCL was examined by studying its relationship with self-reported measures of general psychological distress and posttraumatic stress, respectively. …