Bing Han1, Eunice C Wong2, Zhimin Mao2, Lisa S Meredith3, Andrea Cassells4, Jonathan N Tobin5. 1. RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA. Electronic address: bhan@rand.org. 2. RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA. 3. RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA; VA HSR&D Center for the Study of Healthcare Provider Behavior, 16111 Plummer Street (152), North Hills, CA, 91343, USA. 4. Clinical Directors Network (CDN), 5 W 37th St # 10, New York, NY, 10018, USA. 5. Clinical Directors Network (CDN), 5 W 37th St # 10, New York, NY, 10018, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, 1300 Morris Park Ave, Bronx, NY, 10461, USA; Center for Clinical and Translational Sciences, The Rockefeller University, 1230 York Avenue, New York, NY, 10065, USA.
Abstract
OBJECTIVE: The objective was to validate the reliability and efficiency of alternative cutoff values on the abbreviated six-item Posttraumatic Stress Disorder (PTSD) Checklist (PCL-6) [1] for underserved, largely minority patients in primary care settings of Federally Qualified Health Centers (FQHCs). METHOD: Using a sample of 760 patients recruited from six FQHCs in the New York City and New Jersey metropolitan area from June 2010 to April 2013, we compared the PCL-6 with the Clinician Administered PTSD Scale (CAPS) for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. We used reliability statistics for single cutoff values on PCL-6 scores. We examined the relationship between probabilities of meeting CAPS diagnostic criteria and PCL-6 scores by nonparametric regression. RESULTS: PCL-6 scores range between 6 and 30. Reliability and efficiency statistics for cutoff between 12 and 26 were reported. There is a strong monotonic relationship between PCL-6 scores and the probability of meeting CAPS diagnostic criteria. CONCLUSION: No single cutoff on PCL-6 scores has acceptable reliability on both false positive and false negative simultaneously. An ordinal decision rule (low risk: 12 or less, medium risk: 13 to 16, high risk: 17 to 25 and very high risk: 26 and above) can differentiate the risk of PTSD. A single cutoff (17 or higher as positive) may be suitable for identifying those with the greatest need for care given limited mental health capacity in FQHC settings.
OBJECTIVE: The objective was to validate the reliability and efficiency of alternative cutoff values on the abbreviated six-item Posttraumatic Stress Disorder (PTSD) Checklist (PCL-6) [1] for underserved, largely minority patients in primary care settings of Federally Qualified Health Centers (FQHCs). METHOD: Using a sample of 760 patients recruited from six FQHCs in the New York City and New Jersey metropolitan area from June 2010 to April 2013, we compared the PCL-6 with the Clinician Administered PTSD Scale (CAPS) for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. We used reliability statistics for single cutoff values on PCL-6 scores. We examined the relationship between probabilities of meeting CAPS diagnostic criteria and PCL-6 scores by nonparametric regression. RESULTS:PCL-6 scores range between 6 and 30. Reliability and efficiency statistics for cutoff between 12 and 26 were reported. There is a strong monotonic relationship between PCL-6 scores and the probability of meeting CAPS diagnostic criteria. CONCLUSION: No single cutoff on PCL-6 scores has acceptable reliability on both false positive and false negative simultaneously. An ordinal decision rule (low risk: 12 or less, medium risk: 13 to 16, high risk: 17 to 25 and very high risk: 26 and above) can differentiate the risk of PTSD. A single cutoff (17 or higher as positive) may be suitable for identifying those with the greatest need for care given limited mental health capacity in FQHC settings.
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