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

Document Type : Original Article


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


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.


  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:
  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:
  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:
  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:
  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:
  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:
  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:
  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:
  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:
  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:
  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:
  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:
  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:
  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:
  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:
  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:
  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//
  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:
  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:
  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:
  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:
  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:
  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:
  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: