Psychometric Validation of Post-traumatic Stress Disorder Checklist for DSM– 5 (PCL-5) among Rwandan Undergraduate Students

Document Type : Original Article

Authors

1 Department of Clinical Psychology, Faculty of Medicine and Pharmacy, University of Rwanda, Kigali-Rwanda

2 Department of Clinical Psychology, Faculty of Medicine and Pharmacy, University of Rwanda, Kigali-RwandaKigali, Rwanda

3 Department of Mental Health & Behavior Research, Faculty of Medicine and Health Sciences, University of Rwanda, Kigali-Rwanda

10.30491/ijbs.2021.279520.1519

Abstract

Introduction: The Posttraumatic Stress Disorder Checklist for DSM– 5 (PCL-5) is one of the most commonly used tools in measuring PTSD symptoms. However, little is known about its validity in post-genocide Rwanda. This research therefore, aimed at determining psychometric properties and diagnostic utility of the PCL-5 scale among university students in Rwanda.
Method: A total of 143 participants completed PCL-5, the Harvard Trauma Questionnaire-part4 (HTQ-part4), and the Hopkins Symptom Checklist-25 (Anxiety [HSCL-A] and Depression [HSCL-D] subscales). The Cronbach's alpha coefficient and the Mean Item Inter-Correlation (MIIC) were computed to assess the tool reliability and Receiver Operator Characteristics (ROC) was performed to determine a valid cutoff-score.
Results: Findings indicated excellent internal consistency for PCL-5 total score and each of the four subscales. PCL-5 scores correlated strongly with scores on HTQ-part4, HSCL-D and HSCL-A, supporting convergent validity. The diagnostic accuracy of the scale was excellent (AUC=0.934, p<.001). The optimal cutoff score of ≥23 optimized sensitivity (0.887) while maintaining adequate specificity (0.889).
Conclusion: It can be concluded that PCL-5 has high validity, internal consistency, and psychometric properties when applied to the sample of Rwandan students.

Keywords


  1. Winokur A, Winokur DF, Rickels K, Cox DS. Symptoms of emotional distress in a family planning service: stability over a four-week period. Br J psychiatry J Ment Sci [Internet]. 1984;144:395–399. Available from: https://doi.org/10.1192/bjp.144.4.395
  2. Hoppen TH, Morina N. The prevalence of PTSD and major depression in the global population of adult war survivors: a meta-analytically informed estimate in absolute numbers. Eur J Psychotraumatol [Internet]. 2019;10:e1578637. Available from: https://doi.org/10.1080/20008198.2019.1578637
  3. Kessler RC, Aguilar-Gaxiola S, Alonso J, Chatterji S, Lee S, Ormel J, Ustün TB WPS. The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiol Psichiatr Soc [Internet]. 2009;18:23–33. Available from: https://doi.org/10.1017/s1121189x00001421
  4. Morina N, Wicherts JM, Lobbrecht J, Priebe S. Remission from post-traumatic stress disorder in adults: A systematic review and meta-analysis of long term outcome studies. Clin Psychol Rev. 2014;34:249–255.
  5. Nemeroff CB, Bremner JD, Foa EB, Mayberg HS, North CS, Stein, MB. Posttraumatic stress disorder: a state-of-the-science review. J Psychiatr Res [Internet]. 2006;40:1–21. Available from: https://doi.org/10.1016/j.jpsychires.2005.07.005
  6. Collins PY, Patel V, Joestl SS, March D, Insel TR, Daar AS, et al. Grand challenges in global mental health. Nature [Internet]. 2011;475:27–30. Available from: https://doi.org/10.1038/475027a
  7. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. American Psychiatric Association; 2015.
  8. Rahnedjat A. The role of thought control strategies on the symptoms of chronic Post-Traumatic Stress Disorders caused by war. Int J Behav Sci. 2015;8 (4):347–54.
  9. Verhey R, Chibanda D, Gibson L, Brakarsh J, Seedat S. Validation of the Posttraumatic Stress Disorder Checklist—5 (PCL-5) in a primary care population with high HIV prevalence in Zimbabwe. BMC Psychiatry [Internet]. 2018;18:109. Available from: https://doi.org/10.1186/s12888-018-1688-9
  10. Ng LC, Stevenson A, Kalapurakkel SS, Hanlon C, Seedat S, Harerimana B, et al. National and regional prevalence of posttraumatic stress disorder in sub-Saharan Africa: A systematic review and meta-analysis. PLoS Med [Internet]. 2020;17:e1003090. Available from: http://dx.doi.org/10.1371/journal.pmed.1003090
  11. Ministère de l’Administration Locale du DC et des AS. Dénombrement des victimes du génocide. Rapport final. Version revisée. Kigali; 2004.
  12. Mutuyimana C, Sezibera V, Nsabimana E, Mugabo L, Cassady C, Musanabaganwa C KY. PTSD prevalence among resident mothers and their offspring in Rwanda 25 years after the 1994 genocide against the Tutsi. BMC Psychol [Internet]. 2019;7. Available from: https://doi.org/10.1186/s40359-019-0362-4
  13. Wimalawansa SJ. Causes and risk factors for posttraumatic stress disorder:the importance of right diagnosis and treatment. Asian J Med Sci [Internet]. 2013;5:29–40. Available from: https://doi.org/10.3126/ajms.v5i2.85
  14. Frazier PA, Anders S, Perera S, Tomich P, Tennen H, Park, C, Tashiro T. Traumatic Events Among Undergraduate Students: Prevalence and Associated Symptoms. J Couns Psychol [Internet]. 2009;56:450–60. Available from: https://doi.org/10.1037/a0016412
  15. Elhai JD, Miller ME, Ford JD, Biehn TL, Palmieri PA, Frueh BC. Posttraumatic stress disorder in DSM-5: estimates of prevalence and symptom structure in a nonclinical sample of college students. J Anxiety Disord [Internet]. 2012;26. Available from: https://doi.org/10.1016/j.janxdis.2011.08.013
  16. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006;367:1747–57.
  17. Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP SP. The PTSD Checklist for DSM-5 (PCL-5). 2018; Available from: www.ptsd.va.gov
  18. McDonald SD, Calhoun PS. The diagnostic accuracy of the PTSD checklist: A critical review. Clin Psychol Rev. 2010;30:976–87.
  19. Ashbaugh AR, Houle-Johnson S, Herbert C, El-Hage W BA. Psychometric Validation of the English and French Versions of the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5. PLoS One [Internet]. 2016;11:e0161645. Available from: https://doi.org/10.1371/journal.pone.0161645
  20. Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. The posttraumatic stress disorder checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. J Trauma Stress. 2015;28:489–98.
  21. Sveen J, Bondjers K, Willebrand M. Psychometric properties of the PTSD Checklist for DSM-5: a pilot study. Eur J psychotraumatology, [Internet]. 2016;7:30165. Available from: https://doi.org/10.3402/ejpt.v7.30165
  22. Ibrahim H, Ertl V, Catani C, Ismail AA NF. The validity of Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) as screening instrument with Kurdish and Arab displaced populations living in the Kurdistan region of Iraq. BMC Psychiatry, [Internet]. 2018;18:259. Available from: https://doi.org/:10.1186/s12888-018-1839-z
  23. Ertl V, Pfeiffer A, Saile R, Schauer E, Elbert T, Neuner, F. Validation of a mental health assessment in an African conflict population. Psychol Assess. 2010;22:318–32.
  24. Rasmussen A, Verkuilen J, Ho E FY. Posttraumatic stress disorder among refugees: Measurement invariance of Harvard Trauma Questionnaire scores across global regions and response patterns. Psychol Assess [Internet]. 2015;27:1160–1170. Available from: https://doi.org/10.1037/pas0000115
  25. Biracyaza E, Mutabaruka J, Habimana S. Validation of Anxiety Sensitivity Index (ASI-16) on a Nonclinical Sample of Rwandans: A cross-sectional study. Int J Behav Sci. 2019;12:176–82.
  26. Brislin RW. Back-translation for cross-cultural research. J Cross Cult Psychol [Internet]. 1970;1:185–216. Available from: http//doi.org/10.1177/135910457000100301
  27. Weathers FW, Bovin M J, Lee DJ, Sloan D M, Schnur PP, Kaloupek DG, Keane TM, Marx BP. The Clinician-Administered PTSD Scale for DSM–5 (CAPS-5): Development and initial psychometric evaluation in military veterans. Psychol Assess [Internet]. 2013;30:383–395. Available from: https://doi.org/10.1037/pas0000486
  28. Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Gusman FD, Charney DS, et al. The development of a Clinician-Administered PTSD Scale. J Trauma Stress. 1995;8:75–90.
  29. Gray MJ, Litz BT, Hsu JL, Lombardo TW. Psychometric properties of the life events checklist. Assessment [Internet]. 2004;11:330–341. Available from: https://doi.org/10.1177/1073191104269954
  30. Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. The Hopkins Symptom Checklist (HSCL): A self-report symptom inventory. Behav Sci [Internet]. 1874;19:1–15. Available from: https://doi.org/10.1002/bs.3830190102
  31. Mollica RF, Wyshak G, de Marneffe D, Khuon F, Lavelle J. Indochinese versions of the Hopkins Symptom Checklist-25: a screening instrument for the psychiatric care of refugees. Am J Psychiatry [Internet]. 1987;144:497–500. Available from: https://doi.org/10.1176/ajp.144.4.497
  32. Mollica RF, Caspi-Yavin Y, Bollini P, Truong T, Tor S, Lavelle J. The Harvard Trauma Questionnaire: Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. J Nerv Ment Dis [Internet]. 1992;180:111–116. Available from: https://doi.org/10.1097/00005053-199202000-00008
  33. Mollica RF, Caspi-Yaspin Y, Lavelle J, Tor S, Yang T, Chan S. The Harvard Trauma (HTQ) Manual: Cambodian, Laotian, and Vietnamese versions. Torture. 1996;1:19–42.
  34. Nunnally JC. Psychometric Theory. 2nd ed. McGraw-Hill; 1978.
  35. Clark LA, Watson D. Constructing validity: Basic issues in objective scale developmentConstructing validity: Basic issues in objective scale development. Psychol Assess [Internet]. 1995;7:309–319. Available from: https://doi.org/10.1037/1040-3590.7.3.309
  36. Kraemer HC. Evaluating medical tests: Objective and quantitative guidelines. Sage; 1992.
  37. Cattell R. The scientific use of factor analysis in the behavioral and life sciences. Palgrave Macmillan; 1978.
  38. Brady KT, Killeen TK, Brewerton T, Lucerini S. Comorbidity of psychiatric disorders and posttraumatic stress disorder. J Clin Psychiatry. 2000;61:22–32.
  39. Portney LG, Watkins MP. Foundations of clinical research: Applications to practice. Pearson/Prentice Hall; 2009.
  40. Terhakopian A, Sinaii N, Engel CC, Schnurr PP, Hoge C W. Estimating population prevalence of posttraumatic stress disorder: An example using the PTSD checklist. J Trauma Stress. 2008;21:290–300.
  41. Perroud N, Rutembesa E, Paoloni-Giacobino E, Mutabaruka J, Mutesa L, Stenz L, Malafosse A, Karege F. The Tutsi genocide and transgenerational transmission of maternal stress: epigenetics and biology of the HPA axis. World J Biol Psychiatry. 2014;Early onli:1–12.
  42. Williams SL, Williams DR, Stein DJ, Seedat S, Jackson PB, Moomal H. Multiple traumatic events and psychological distress: the South Africa stress and health study. J Trauma Stress [Internet]. 2007;20:845–855. Available from: https://doi.org/10.1002/jts.20252