Beyond one-cutoff-fits-all: determining cutoff values for the PTSD checklist for DSM-5 (PCL-5).
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| Title: | Beyond one-cutoff-fits-all: determining cutoff values for the PTSD checklist for DSM-5 (PCL-5). |
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| Alternate Title: | Más allá de un punto de corte único: determinación de los valores de corte para la lista de verificación de TEPT del DSM-5 (PCL-5). |
| Authors: | Pettrich, Amelie (AUTHOR), Schellong, Julia (AUTHOR), Dyer, Anne (AUTHOR), Ehring, Thomas (AUTHOR), Knaevelsrud, Christine (AUTHOR), Krüger-Gottschalk, Antje (AUTHOR), Nesterko, Yuriy (AUTHOR), Schäfer, Ingo (AUTHOR), Glaesmer, Heide (AUTHOR) |
| Source: | European Journal of Psychotraumatology. Dec2025, Vol. 16 Issue 1, p1-12. 12p. |
| Subjects: | Post-traumatic stress disorder, Disease prevalence, Clinical medicine, Test scoring, Diagnostic services, Empirical research, Receiver operating characteristic curves |
| Geographic Terms: | Germany |
| Abstract (English): | Background: There is no universally optimal cutoff score for identifying probable PTSD, which makes reliable PTSD diagnosis challenging not only across different populations but also in different settings. Reliable outcomes require tailoring cutoff scores to the population, intended use (clinical, research, or prevalence estimation), and appropriate statistical methods to ensure their validity. Objective: While previously little emphasis has been placed on thorough methodological evaluation and purpose-driven cutoff selection, this work addresses these gaps by evaluating optimal PCL-5 cutoff scores for clinical use, prevalence estimation, and research in a German-speaking clinical sample. Methods: Previously published data from 443 trauma-exposed individuals in Germany were re-analyzed for this purpose. PTSD was assessed using the PCL-5 and with CAPS-5 clinical interview. Optimal cutoffs were identified using ROC analysis, applying standard estimation methods and prioritising diagnostic utility based on specific objectives. Results: After evaluating various cutoff points for different purposes, we identified the following as most suitable for this sample: a cutoff of 34 for clinical use (sensitivity: 0.892, specificity: 0.645, PPV: 0.824, NPV: 0.763); 38 for prevalence estimation (sensitivity: 0.840, specificity: 0.703, PPV: 0.840, NPV: 0.703); and 42 or 43 for identifying clear-cut cases in research or resource-limited settings (sensitivity: 0.774–0.760, specificity: 0.742–0.761, PPV: 0.848–0.855, NPV: 0.639–0.631). The originally intended cutoffs of 31–33 yielded acceptable to excellent diagnostic utility parameters but were not identified as optimal for any specific purpose. Conclusion: This study highlights the variability in optimal PCL-5 cutoffs, linking selection to specific clinical or research aims. It provides validated cutoffs for PTSD prevalence in a German clinical sample, with limitations regarding generalizability to lower-prevalence populations. Future research should refine cutoffs for diverse populations and improve diagnostic precision. HIGHLIGHTS: Context matters: PTSD screening requires purpose-specific cutoff scores rather than a universal threshold. Validated cutoffs: this study determines optimal PCL-5 scores for clinical screening, prevalence estimation, and research. Methodological refinement: this study applies a purpose-driven approach to determining PTSD cutoff scores, emphasising statistical rigour and diagnostic utility. [ABSTRACT FROM AUTHOR] |
| Abstract (Spanish): | Antecedentes: No existe una puntuación de corte universalmente óptima para identificar un posible TEPT, lo que dificulta un diagnóstico fiable no solo en diferentes poblaciones, sino también en diferentes contextos. Para obtener resultados fiables, es necesario adaptar las puntuaciones de corte a la población, el uso previsto (clínico, de investigación, o estimación de la prevalencia) y utilizar métodos estadísticos adecuados para garantizar su validez. Objetivo: Si bien anteriormente se ha prestado poca atención a la evaluación metodológica exhaustiva y a la selección de puntos de corte con un propósito definido, este trabajo aborda estas deficiencias mediante la evaluación de las puntuaciones de corte óptimas del PCL-5 (por su sigla en inglés) para uso clínico, estimación de la prevalencia, e investigación en una muestra clínica de habla alemana. Métodos: Con este propósito se volvieron a analizar datos publicados previamente de 443 personas expuestas a traumas en Alemania. El TEPT se evaluó mediante el PCL-5 y la entrevista clínica CAPS-5 (por su sigla en inglés). Se identificaron los puntos de corte óptimos mediante análisis ROC, aplicando métodos de estimación estándar y priorizando la utilidad diagnóstica según objetivos específicos. Resultados: Tras evaluar diversos puntos de corte para diferentes propósitos, se identificaron los siguientes como los más adecuados para esta muestra: un punto de corte de 34 para uso clínico (sensibilidad: 0.892, especificidad: 0.645, VPP: 0.824, VPN: 0.763); 38 para la estimación de la prevalencia (sensibilidad: 0.840, especificidad: 0.703, VPP: 0.840, VPN: 0.703); y 42 o 43 para la identificación de casos claros en contextos de investigación o con recursos limitados (sensibilidad: 0.774-0.760, especificidad: 0.742-0.761, VPP: 0.848-0.855, VPN: 0.639-0.631). Los puntos de corte inicialmente previstos, de 31 a 33, arrojaron parámetros de utilidad diagnóstica de aceptables a excelentes, pero no se identificaron como óptimos para ningún propósito específico. Conclusión: Este estudio destaca la variabilidad en los puntos de corte óptimos de PCL-5, vinculando la selección con objetivos clínicos o de investigación específicos. Proporciona puntos de corte validados para la prevalencia del TEPT en una muestra clínica alemana, con limitaciones en cuanto a la generalización a poblaciones de menor prevalencia. Las investigaciones futuras deberían refinar los puntos de corte para diversas poblaciones y mejorar la precisión diagnóstica. [ABSTRACT FROM AUTHOR] |
| Copyright of European Journal of Psychotraumatology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
| Database: | Psychology and Behavioral Sciences Collection |
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| Items | – Name: Title Label: Title Group: Ti Data: Beyond one-cutoff-fits-all: determining cutoff values for the PTSD checklist for DSM-5 (PCL-5). – Name: TitleAlt Label: Alternate Title Group: TiAlt Data: Más allá de un punto de corte único: determinación de los valores de corte para la lista de verificación de TEPT del DSM-5 (PCL-5). – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Pettrich%2C+Amelie%22">Pettrich, Amelie</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Schellong%2C+Julia%22">Schellong, Julia</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Dyer%2C+Anne%22">Dyer, Anne</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Ehring%2C+Thomas%22">Ehring, Thomas</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Knaevelsrud%2C+Christine%22">Knaevelsrud, Christine</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Krüger-Gottschalk%2C+Antje%22">Krüger-Gottschalk, Antje</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Nesterko%2C+Yuriy%22">Nesterko, Yuriy</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Schäfer%2C+Ingo%22">Schäfer, Ingo</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Glaesmer%2C+Heide%22">Glaesmer, Heide</searchLink> (AUTHOR) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22European+Journal+of+Psychotraumatology%22">European Journal of Psychotraumatology</searchLink>. Dec2025, Vol. 16 Issue 1, p1-12. 12p. – Name: Subject Label: Subjects Group: Su Data: <searchLink fieldCode="DE" term="%22Post-traumatic+stress+disorder%22">Post-traumatic stress disorder</searchLink><br /><searchLink fieldCode="DE" term="%22Disease+prevalence%22">Disease prevalence</searchLink><br /><searchLink fieldCode="DE" term="%22Clinical+medicine%22">Clinical medicine</searchLink><br /><searchLink fieldCode="DE" term="%22Test+scoring%22">Test scoring</searchLink><br /><searchLink fieldCode="DE" term="%22Diagnostic+services%22">Diagnostic services</searchLink><br /><searchLink fieldCode="DE" term="%22Empirical+research%22">Empirical research</searchLink><br /><searchLink fieldCode="DE" term="%22Receiver+operating+characteristic+curves%22">Receiver operating characteristic curves</searchLink> – Name: SubjectGeographic Label: Geographic Terms Group: Su Data: <searchLink fieldCode="DE" term="%22Germany%22">Germany</searchLink> – Name: Abstract Label: Abstract (English) Group: Ab Data: Background: There is no universally optimal cutoff score for identifying probable PTSD, which makes reliable PTSD diagnosis challenging not only across different populations but also in different settings. Reliable outcomes require tailoring cutoff scores to the population, intended use (clinical, research, or prevalence estimation), and appropriate statistical methods to ensure their validity. Objective: While previously little emphasis has been placed on thorough methodological evaluation and purpose-driven cutoff selection, this work addresses these gaps by evaluating optimal PCL-5 cutoff scores for clinical use, prevalence estimation, and research in a German-speaking clinical sample. Methods: Previously published data from 443 trauma-exposed individuals in Germany were re-analyzed for this purpose. PTSD was assessed using the PCL-5 and with CAPS-5 clinical interview. Optimal cutoffs were identified using ROC analysis, applying standard estimation methods and prioritising diagnostic utility based on specific objectives. Results: After evaluating various cutoff points for different purposes, we identified the following as most suitable for this sample: a cutoff of 34 for clinical use (sensitivity: 0.892, specificity: 0.645, PPV: 0.824, NPV: 0.763); 38 for prevalence estimation (sensitivity: 0.840, specificity: 0.703, PPV: 0.840, NPV: 0.703); and 42 or 43 for identifying clear-cut cases in research or resource-limited settings (sensitivity: 0.774–0.760, specificity: 0.742–0.761, PPV: 0.848–0.855, NPV: 0.639–0.631). The originally intended cutoffs of 31–33 yielded acceptable to excellent diagnostic utility parameters but were not identified as optimal for any specific purpose. Conclusion: This study highlights the variability in optimal PCL-5 cutoffs, linking selection to specific clinical or research aims. It provides validated cutoffs for PTSD prevalence in a German clinical sample, with limitations regarding generalizability to lower-prevalence populations. Future research should refine cutoffs for diverse populations and improve diagnostic precision. HIGHLIGHTS: Context matters: PTSD screening requires purpose-specific cutoff scores rather than a universal threshold. Validated cutoffs: this study determines optimal PCL-5 scores for clinical screening, prevalence estimation, and research. Methodological refinement: this study applies a purpose-driven approach to determining PTSD cutoff scores, emphasising statistical rigour and diagnostic utility. [ABSTRACT FROM AUTHOR] – Name: Abstract Label: Abstract (Spanish) Group: Ab Data: Antecedentes: No existe una puntuación de corte universalmente óptima para identificar un posible TEPT, lo que dificulta un diagnóstico fiable no solo en diferentes poblaciones, sino también en diferentes contextos. Para obtener resultados fiables, es necesario adaptar las puntuaciones de corte a la población, el uso previsto (clínico, de investigación, o estimación de la prevalencia) y utilizar métodos estadísticos adecuados para garantizar su validez. Objetivo: Si bien anteriormente se ha prestado poca atención a la evaluación metodológica exhaustiva y a la selección de puntos de corte con un propósito definido, este trabajo aborda estas deficiencias mediante la evaluación de las puntuaciones de corte óptimas del PCL-5 (por su sigla en inglés) para uso clínico, estimación de la prevalencia, e investigación en una muestra clínica de habla alemana. Métodos: Con este propósito se volvieron a analizar datos publicados previamente de 443 personas expuestas a traumas en Alemania. El TEPT se evaluó mediante el PCL-5 y la entrevista clínica CAPS-5 (por su sigla en inglés). Se identificaron los puntos de corte óptimos mediante análisis ROC, aplicando métodos de estimación estándar y priorizando la utilidad diagnóstica según objetivos específicos. Resultados: Tras evaluar diversos puntos de corte para diferentes propósitos, se identificaron los siguientes como los más adecuados para esta muestra: un punto de corte de 34 para uso clínico (sensibilidad: 0.892, especificidad: 0.645, VPP: 0.824, VPN: 0.763); 38 para la estimación de la prevalencia (sensibilidad: 0.840, especificidad: 0.703, VPP: 0.840, VPN: 0.703); y 42 o 43 para la identificación de casos claros en contextos de investigación o con recursos limitados (sensibilidad: 0.774-0.760, especificidad: 0.742-0.761, VPP: 0.848-0.855, VPN: 0.639-0.631). Los puntos de corte inicialmente previstos, de 31 a 33, arrojaron parámetros de utilidad diagnóstica de aceptables a excelentes, pero no se identificaron como óptimos para ningún propósito específico. Conclusión: Este estudio destaca la variabilidad en los puntos de corte óptimos de PCL-5, vinculando la selección con objetivos clínicos o de investigación específicos. Proporciona puntos de corte validados para la prevalencia del TEPT en una muestra clínica alemana, con limitaciones en cuanto a la generalización a poblaciones de menor prevalencia. Las investigaciones futuras deberían refinar los puntos de corte para diversas poblaciones y mejorar la precisión diagnóstica. [ABSTRACT FROM AUTHOR] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of European Journal of Psychotraumatology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1080/20008066.2025.2514878 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 12 StartPage: 1 Subjects: – SubjectFull: Post-traumatic stress disorder Type: general – SubjectFull: Disease prevalence Type: general – SubjectFull: Clinical medicine Type: general – SubjectFull: Test scoring Type: general – SubjectFull: Diagnostic services Type: general – SubjectFull: Empirical research Type: general – SubjectFull: Receiver operating characteristic curves Type: general – SubjectFull: Germany Type: general Titles: – TitleFull: Beyond one-cutoff-fits-all: determining cutoff values for the PTSD checklist for DSM-5 (PCL-5). Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Pettrich, Amelie – PersonEntity: Name: NameFull: Schellong, Julia – PersonEntity: Name: NameFull: Dyer, Anne – PersonEntity: Name: NameFull: Ehring, Thomas – PersonEntity: Name: NameFull: Knaevelsrud, Christine – PersonEntity: Name: NameFull: Krüger-Gottschalk, Antje – PersonEntity: Name: NameFull: Nesterko, Yuriy – PersonEntity: Name: NameFull: Schäfer, Ingo – PersonEntity: Name: NameFull: Glaesmer, Heide IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 12 Text: Dec2025 Type: published Y: 2025 Identifiers: – Type: issn-print Value: 20008066 Numbering: – Type: volume Value: 16 – Type: issue Value: 1 Titles: – TitleFull: European Journal of Psychotraumatology Type: main |
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