Factor Structure and Multi-Group Measurement Invariance of Posttraumatic Stress Disorder Symptoms Assessed by the PCL-5

The assessment of reliability generalisation of clinician-administered PTSD scale for DSM-5 (CAPS-5): a meta-analysis

Background

The CAPS-5 is a reliable instrument for assessing PTSD symptoms, demonstrating strong consistency, validity, and reliability after a traumatic event. However, further research is warranted to explore the divergent validity of the CAPS-5 and its adaptation to diverse cultural contexts.

Objective

In this meta-analysis, we endeavoured to comprehensively evaluate the reliability generalization of the CAPS-5 across diverse populations and clinical contexts.

Methods

A reliability generalization meta-analysis on the psychometric properties of CAPS-5 was conducted, encompassing 15 studies. The original versions' psychometric properties were systematically retrieved from databases including PubMed, PsychNet, Medline, CHAHL, ScienceDirect, Scopus, Web of Science, and Google Scholar, with a focus on studies published between 2013 and 2023. Two independent investigators evaluated study quality using QUADAS-2 and COSMIN RB, pre-registering the protocol in the Prospero database for transparency and minimizing bias risk.

Results

Meta-analysis reveals CAPS-5 global reliability (α = 0.92, 95% CI [0.90, 0.94]), z = 99.44, p < 0.05 across 15 studies, supporting consistent internal consistency. Subscale analysis shows variability in Reexperiencing (α = 0.82), Avoidance (α = 0.68), Cognition and Mood (α = 0.82), and Hyperarousal (α = 0.74), with an overall estimate of 0.77 (95% CI [0.70;0.83]). Language-dependent analysis highlights reliability variations (α range: 0.83 to 0.92) across Brazilian-Portuguese, Dutch, English, French, German, Korean, and Portuguese. Test-retest reliability demonstrates stability (r = 0.82, 95% CI [0.79; 0.85]), with overall convergent validity (r = 0.59, 95% CI [0.50;0.68]).

Conclusion

The meta-analysis affirms CAPS-5's robust global and subscale reliability across studies and languages, with stable test-retest results. Moderator analysis finds no significant impact, yet substantial residual heterogeneity remains unexplained. Our findings contribute intricate insights into the psychometric properties of this instrument, offering a more complete understanding of its utility in PTSD assessment.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023483748.

The Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5: A Systematic Review of Existing Psychometric Evidence

The PTSD Checklist for DSM-5 (PCL-5) is a widely used self-rated measure of DSM-5 PTSD symptoms. The goal of this systematic review was to synthesize research on the psychometric properties of the PCL-5 to guide clinical and research applications. We focused on reliability, validity, factor structure, optimal cutoff scores, and sensitivity to clinical change indices. A systematic review of the literature following PRISMA guidelines was conducted using PubMed, PsycINFO, CINAHL, and PTSDpubs with search terms capturing selected psychometric indices of the PCL-5. The inclusion criteria were: peer-reviewed publication in English; primary focus on the PCL-5 psychometrics; empirical study; and study with adult samples. The search yielded 265 studies; 56 papers (amounting to 64 studies) met inclusion criteria and were reviewed. Findings generally indicated evidence for: acceptable internal consistency and test-retest reliability; construct validity; a 7-factor Hybrid Model; recommended cutoff scores between 31-33; and ability to index sensitivity to clinical change. To further advance knowledge and applications of the PCL-5, we need more research on abbreviated versions of the PCL-5, bifactor modeling as applied to the PCL-5, as well as on PCL-5 item difficulty estimates, discrimination parameters, and clinical change score estimates.

DSM-5 Posttraumatic Stress Disorder Symptoms in Nonclinical Samples of Chinese and Pakistani Trauma-Exposed Adults: Factor Structure and Invariance Across Culture

The purpose of the current study was to examine the latent structure and cross-cultural measurement validity of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) posttraumatic stress disorder (PTSD) symptoms assessed by the PTSD Checklist for DSM-5. Participants comprised trauma-exposed Chinese and Pakistani undergraduate students (N = 495 and N = 186, respectively). Confirmatory factor analysis (CFA) indicated that a seven-factor hybrid model involving intrusion, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal factors provided good fit in both samples. This model fit significantly better than three alternative models including the DSM-5 four-factor model and six-factor anhedonia and externalizing behaviors models. The subsequent multigroup CFA showed that the best-fitting hybrid model demonstrated cross-cultural measurement invariance. Our findings provide further empirical support for the seven-factor PTSD hybrid model and its cross-cultural invariance, and have implications for understanding and application of DSM-5's PTSD symptoms.

Does a unique co-occurring OCD and PTSD factor structure exist?: Examination of overlapping OCD and PTSD symptom clusters

OCD and PTSD share many commonalities, including phenotypic and functional overlap in symptoms. Specifically, both disorders are characterized by unwanted, intrusive, anxiety/distress-eliciting intrusive thoughts and evoking behaviors intended to control, neutralize, suppress, or outright avoid intrusive thoughts and associated anxiety/distress. Extant factor analytic research supports a model of PTSD at odds with current DSM-5 criteria, and no examination of the factor structure of comorbid OCD+PTSD currently exists despite the noted overlap in symptomatology and high rates of comorbidity. Using a sample of 4073 patients diagnosed with OCD and/or PTSD enrolled in intensive treatment programs for OCD or PTSD, multigroup confirmatory factor analysis (MGCFA) and measurement invariance tests were run to determine the best fitting model of OCD and PTSD symptoms in patients with OCD+PTSD. Four models were compared across patients with OCD, PTSD, and OCD+PTSD: DSM-5 and 7-factor hybrid PTSD models with OCD symptoms structured as either combined or comorbid constructs. The comorbid hybrid model proved the best fit, and both hybrid models evidenced better fit than DSM-5 models. The current study lends additional support for the hybrid model of PTSD and suggests that there is no existence of a unique factor structure of OCD and PTSD symptoms in individuals with the comorbid conditions.