Comparison of Posttraumatic Stress Disorder Checklist Instruments From <i>Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition </i>vs <i>Fifth Edition</i> in a Large Cohort of US Military Service Members and Veterans
Authors: Cynthia A. LeardMann, Hope Seib McMaster, Steven Warner, Alejandro P. Esquivel, Ben Porter, Teresa M. Powell, Xin M. Tu, William W. Lee, Rudolph P. Rull, Charles W. Hoge, Satbir K. Boparai, Felicia R. Carey, Sheila F. Castañeda, Toni Rose T. Geronimo-Hara, Isabel G. Jacobson, Claire A. Kolaja, Rayna K. Matsuno, Deanne C. Millard, Anna C. Rivera, Beverly D. Sheppard, Daniel W. Trone, Jennifer L. Walstrom
Journal: JAMA Network Open (2021)

<h3>Importance</h3> The definition of posttraumatic stress disorder (PTSD) changed markedly between the<i>Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)</i>and<i>DSM-5</i>, creating challenges for studies and in medical settings spanning this transition. <h3>Objective</h3> To evaluate the ability to compare and assess PTSD, based on<i>DSM-IV</i>and<i>DSM-5</i>criteria, using PTSD Checklists (PCLs). <h3>Design, Setting, and Participants</h3> This diagnostic study was conducted with survey data collected in October 2019, from the Millennium Cohort Study, a population-based US military cohort study. The population for the present study was restricted to a subset of initial web responders of the 2019 survey cycle, randomly assigned to 1 of 4 survey groups. <h3>Exposures</h3> Each group received the<i>DSM-IV</i>and<i>DSM-5</i>PCL (PCL–Civilian [PCL-C] version and PCL for<i>DSM-5</i>[PCL-5]). PCL instruments were counterbalanced to control for order effects. <h3>Main Outcomes and Measures</h3> Survey data were used to assess PTSD (using the PCL-C and PCL-5), major depressive disorder (using the Patient Health Questionnaire), generalized anxiety (using the Generalized Anxiety Disorder scale), and problem drinking (using the Patient Health Questionnaire). Demographic and military characteristics included age, sex, race/ethnicity, marital status, education, service branch, pay grade, enrollment panel, and military service status. <h3>Results</h3> Among the 1921 participants (mean [SD] age, 50.1 [12.5] years), 1358 (70.7%) were men, 1638 (85.3%) were non-Hispanic White individuals, 1440 (75.0%) were married, and 1190 (61.9%) had at least a bachelor's degree; 295 (15.4%) had probable PTSD according to<i>DSM-IV</i>criteria with PCL-C compared with 286 (14.9%) using<i>DSM-5</i>criteria with PCL-5 (κ = 0.77). There was substantial agreement between PCLs for probable PTSD based on<i>DSM-IV</i>criteria (295 [15.4%] with PCL-C; 316 [16.4%] with PCL-5; κ = 0.80) and<i>DSM-5</i>criteria (286 [14.9%] with PCL-5; 258 [13.4%] with PCL-C; κ = 0.77). Estimated PTSD sum scores showed excellent agreement with observed scores. Using an established crosswalk, PCL-5 sum scores estimated with the PCL-C were similar to observed PCL-5 scores. Of the 17 corresponding items between the 2 instruments, 16 had substantial agreement. Appending 2 additional PCL-C items to the PCL-5 did not significantly alter estimates. The PCL-C and PCL-5 had nearly identical associations with comorbid conditions. <h3>Conclusions and Relevance</h3> The findings of this diagnostic study suggest that PTSD can be successfully assessed and compared over time with either PCL instrument in veteran and military populations.