Validation of a brief PTSD screener for underserved patients in federally qualified health centers

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. (C) 2016 Elsevier Inc. All rights reserved.