The impact of screening positive for hazardous alcohol use on the diagnostic accuracy of the PTSD Checklist for DSM‐5 among veterans

Abstract

AbstractThe Posttraumatic Stress Disorder (PTSD) Checklist for DSM‐5 (PCL‐5) is a widely used self‐report measure of PTSD symptoms that has demonstrated strong psychometric properties across settings and samples. Co‐occurring hazardous alcohol use and PTSD are prevalent among veterans, and the effects of alcohol use may impact the performance of the PCL‐5. However, this possibility is untested. In this study, we evaluated the PCL‐5 diagnostic accuracy for veterans who did and did not screen positive for hazardous alcohol use according to the Alcohol Use Disorders Identification Test–Consumption (AUDIT‐C). Participants were 385 veterans recruited from Veterans Affairs primary care clinics. Results indicated that PCL‐5 performance, AUC = .904, 95% CI [.870, .937], did not differ as a product of hazardous alcohol use. PCL‐5 diagnostic utility was comparably high for veterans with, AUC = .904; 95% CI [.846, .962], and without, AUC = .904 95% CI [.861, .946], positive AUDIT‐C screens. Although optimally efficient cutoff scores for veterans who screened positive were higher (i.e., 34–36) than for those with negative screens (i.e., 30), neither were significantly different from the overall PCL‐5 cutoff score (i.e., 32), suggesting that neither veterans with nor without positive AUDIT‐C screens require differential PCL‐5 cutoff scores. The results do underscore the importance of using PCL‐5 cutoff scores in concert with clinical judgment when establishing a provisional PTSD diagnosis and highlight the need for additional study of the impact of comorbidities on PCL‐5 diagnostic accuracy and cutoff scores.