Post-traumatic stress disorder (PTSD) is a serious mental health condition associated with a range of negative health effects, including neurobiological impacts (Sherin & Nemeroff, 2011). The PCL-5 is a widely used self-rated assessment tool that provides both diagnostic and symptom severity assessment (Cohen et al., 2014). Clinicians and research specialists commonly administer the PCL-5 to screen for probable PTSD and track the severity of symptoms in various patient populations, as it is important to measure the effects of PTSD when treating its symptoms or comorbid disorders.
What is the PCL-5?
The Post-Traumatic Stress Disorder Checklist for DSM-5 is a 20-item self report measure that assesses the presence and severity of PTSD symptoms (Weathers et al., 2013). Items on the PCL-5 correspond with diagnostic and statistical manual (DSM-5) criteria for PTSD.
It takes approximately 5-10 minutes to complete, and is primarily used to monitor symptom change during and after treatment, screen individuals for PTSD, and assist in making a provisional PTSD diagnosis.
The computerized version of the PCL-5 featured within Creyos Health can be completed by patients in the clinic or at home, and results are automatically scored and summarized. Ease of administration provides the opportunity for clinicians to simply yet effectively monitor patients' symptoms.
How Does the PCL-5 Work?
The PCL-5 is intended to assess patient symptoms occurring in the past month. The questionnaire evaluates the presence and severity of symptomatology based on 20 questions.
During this self report measure, respondents are asked to rate how bothered they have been by each of 20 items in the past month on a 5-point Likert scale ranging from 0 (“Not at all”) to 4 (“Extremely”). Items are summed to provide a total symptom severity score (range = 0-80). The version of the PCL-5 included in Creyos Health does not include optional items about a specific traumatic event (criterion A).
Note: The PCL-5 is not a standalone diagnostic tool, but should be used alongside other means of evaluation including: structured clinical interview, mental health and psychological assessment, cognitive assessment.
What Does the PCL-5 Score Mean?
Research suggests that a total symptom severity score of 31 or higher is indicative of probable PTSD across samples, but different clinicians may wish to consider different cutoff scores for their particular population.
Symptom cluster severity scores are also calculated to help evaluate the diagnostic PTSD criteria from the DSM-5:
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Re-experiencing (cluster B)
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Avoidance (cluster C)
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Negative alterations in cognition and mood (cluster D)
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Hyper-arousal (cluster E)
In general, use of a total severity cutoff score to assist in a provision diagnosis tends to produce more reliable results than rules based on DSM-5 criteria alone. See Weathers et al. (2013) for more information.
PCL-5 Validity and Reliability
The PCL-5 has demonstrated strong internal consistency, test-retest reliability, convergent and discriminant validity (Blevins et al., 2015). In other words, it is a useful tool to support the process of diagnosing PTSD. A recent meta-analysis also found evidence for acceptable construct validity and the ability to index sensitivity to clinical change (Forkus et al., 2023). Recommendations from the National Center for PTSD suggest that the PCL-5 is a psychometrically sound measure of DSM-5 PTSD.
The PCL-5 has been used in diverse clinical populations including first responders, veterans, trauma-exposed women.
Using the PCL-5 to Identify PTSD
It is often recommended that qualified health professionals include standardized psychological questionnaires in routine clinical assessment. Initial research studies have demonstrated evidence of improved patient outcomes (Valenstein et al., 2009) and accurate detection of PTSD when clinicians include the PCL-5 in their toolkits (Geier et al., 2018).
The PCL-5 is easy to administer, and clinicians can be confident that results from the questionnaire yield high diagnostic accuracy without subjecting patients to unnecessary testing.
Although an official PTSD diagnosis should be determined by a clinician through a structured clinical interview, PTSD screening with the PCL-5 can determine criteria for further assessment (Weathers et al., 2013). Importantly, results can inform clinicians as to the best course of treatment, and connect patients to appropriate health resources (Geier et al., 2018). Using the PCL-5 as part of retesting can also help clinicians monitor patient progress and identify clinically significant change of symptoms.
How is PTSD Related to Cognitive Function?
The DSM-5 definition of PTSD includes hallmark disruptions in cognitive processes such as memory and concentration, as well as disturbances in social, physiological, and emotional functioning (National Center for PTSD). Importantly, the prevalence of memory and attention deficits in PTSD may be undermined by disruptions in functional connectivity of the brain (Hayes, VanElzakker, & Shin, 2012). Some traumatic stress studies have also found evidence of neuroanatomical changes in individuals with PTSD, which may be linked with a greater risk of cognitive impairment and dementia (Cardenas et al., 2011).
In fact, PTSD and dementia share several proposed risk factors and neuroanatomical correlates (Qureshi et al., 2011), as well as a proposed bidirectional relationship. PTSD may increase one’s risk for late-onset dementia and dementia may increase one’s risk for delayed-onset PTSD in those who experienced significant early trauma (Desmarais et al., 2020). Understanding the effects of a traumatic event, psychological trauma, and PTSD on a patient’s cognition is imperative for clinicians, patients and their families.
Creyos Health’s neuropsychological tasks can help clinicians working with patients who have experienced psychological trauma. With the PCL-5, self-reported PTSD symptoms can be gathered alongside objective cognitive testing, helping disentangle emotional, mental health, and cognitive symptoms in these patients.
PTSD Symptoms
The PCL-5 can be used to monitor the presence of PTSD symptoms such as:
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Trouble experiencing positive feelings
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Difficulty concentrating
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Unwanted memories
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Strong physical reactions in response to a stressful experience
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Strong negative feelings
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Irritable behavior or angry outbursts
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Strong negative beliefs
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Trouble breathing or sleeping
How to Administer the PCL-5 in Creyos Health
The PCL-5 is available as a questionnaire within Creyos Health. It can be completed on its own or within a protocol that includes any combination of cognitive assessments and additional questionnaires (see a full list of cognitive tasks and questionnaires).
To include the PCL-5 in a Creyos Health assessment, simply click on the Questionnaires tab under Assessment Types when creating a protocol, and then select the PCL-5. You may also select any other questionnaires or cognitive assessments to combine them all into one straightforward experience for your patients.
The Creyos Health version of the PCL-5 can be completed either in healthcare or research settings, or privately at home. It requires no special training to administer. The PCL-5 can also be added to a Creyos Health schedule, allowing you to regularly send it automatically via email. Data collection is automatic and the results are scored instantly, then added to an easy-to-interpret PDF report.
A report clearly displays results related to a patient's PTSD symptomatology. An overall result compares results to a research-based cutoff score, and clinicians can see each response summarized as well. This allows primary care physicians to isolate areas of particular concern and conduct additional PTSD testing, or prepare a referral for further psychological assessment.
No patient login or registration are required in order to complete the questionnaire, making it incredibly simple for both patients and clinicians to benefit from this questionnaire and gain valuable information about the patient’s mental health.
For more detailed instructions on administering questionnaires within Creyos Health, please see our previous blog post on administering a computerized version of the PHQ-9.
Need More Psychological Health Questionnaires?
For a comprehensive list of the health questionnaires currently offered at Creyos Health, please review the list of available questionnaires.
If there are any questionnaires that you are using today as part of your practice that you would like to see become available in a computerized format within Creyos Health, please do not hesitate to let us know by commenting on this blog post or contacting us through email at help@creyos.com.