Validation of the Danish PTSD Checklist for DSM-5 in trauma-exposed chronic pain patients using the Clinician-Administered PTSD Scale for DSM-5

ABSTRACT

Background: Validation of post-traumatic stress disorder (PTSD) screening tools across various populations to ensure accurate PTSD estimates is important. Because of the high symptom overlap between PTSD and pain, it is particularly important to validate PTSD screening tools in trauma-exposed chronic pain patients.

Objective: The present study is the first seeking to validate the PTSD Checklist for DSM-5 (PCL-5) in a sample of trauma-exposed, treatment-seeking chronic pain patients.

Method: The validation and optimal scoring of the PCL-5 were investigated using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) in chronic pain patients exposed to traffic or work-related traumas (n = 84). Construct validity was investigated using confirmatory factor analyses testing six competing DSM-5 models in a sample of mixed trauma-exposed chronic pain patients (n = 566), and a subsample of chronic pain patients exposed to traffic or work-related trauma only (n = 202). Furthermore, concurrent validity and discriminant validity were investigated using correlation analysis.

Results: The results showed moderate (κ = .46) diagnostic consistency between the PCL-5 and the CAPS-5 using the DSM-5 symptom cluster criteria, and the overall accuracy of the scale (area under the curve = .79) was highly acceptable. Furthermore, the Danish PCL-5 showed excellent construct validity both in the full sample and in the subsample of traffic and work-related accidents, with superior fit of the seven-factor hybrid model. Excellent concurrent validity and discriminant validity were also established in the full sample.

Conclusion: The PCL-5 appears to have satisfactory psychometric properties in trauma-exposed, treatment-seeking chronic pain patients.

HIGHLIGHTS

• The present study is the first seeking to validate the PCL-5 using the CAPS-5 in chronic pain patients following traffic and work-related injury.

• The results showed moderate diagnostic consistency and acceptable overall accuracy using the DSM-5 criteria.

• Excellent construct, concurrent, and discriminant validity was established in chronic pain patients following mixed traumatic exposure and traffic and work-related trauma only.

Antecedentes: La validación de herramientas de tamizaje de TEPT en varias poblaciones es importante para garantizar una estimación precisa del TEPT. Debido a la gran superposición de síntomas entre TEPT y dolor, es especialmente importante validar las herramientas de detección de TEPT en pacientes con dolor crónico expuestos a traumas.

Objetivo: El presente estudio es el primero que busca validar la lista de verificación de TEPT-5 (PCL-5, por sus siglas en inglés) en una muestra de pacientes con dolor crónico expuestos a trauma que buscan tratamiento.

Método: La validación y puntuación óptima del PCL-5 se investigaron utilizando la Escala de TEPT administrada clínicamente para el DSM-5 (CAPS-5, por sus siglas en inglés) en pacientes con dolor crónico expuestos a traumas relacionados con el tráfico o trabajo (N = 84). La validez de constructo se investigó utilizando análisis factorial confirmatorio probando seis modelos DSM-5 competitivos en una muestra de pacientes con dolor crónico expuestos a trauma mixto (N = 566), y una submuestra de pacientes con dolor crónico expuestos a trauma relacionado con el tráfico o trabajo únicamente (n = 202). Adicionalmente, se investigó la validez concurrente y discriminante mediante análisis de correlación.

Resultados: Los resultados mostraron una consistencia diagnóstica moderada (k = 0,46) entre el PCL-5 y el CAPS-5 utilizando los criterios de grupos sintomáticos del DSM-5, y la precisión general de la escala (AUC = 0,79) fue altamente aceptable. Además, el PCL-5 danés mostró una excelente validez de constructo tanto en la muestra completa como en la submuestra de accidentes de tráfico y relacionados con el trabajo con un ajuste superior del modelo híbrido de siete factores. También se estableció una excelente validez concurrente y de discriminación en la muestra completa.

Conclusión: En conclusión, el PCL-5 parece tener propiedades psicométricas satisfactorias en pacientes con dolor crónico expuestos a trauma que buscan tratamiento.

背景：在不同人群中验证 PTSD 筛查工具以确保准确的 PTSD 估计非常重要。 由于 PTSD 和疼痛之间的症状高度重叠，因此在遭受创伤的慢性疼痛患者中验证 PTSD 筛查工具尤为重要。

目的：本研究是第一项寻求在创伤暴露寻求治疗的慢性疼痛患者样本中验证 PTSD检查表5 (PCL-5) 的研究。

方法：在暴露于交通或工作相关创伤的慢性疼痛患者 (N = 84) 中，使用 DSM-5 临床用 PTSD 量表 (CAPS-5) 考查了 PCL-5 的验证和最佳评分。 使用验证性因素在混合创伤暴露慢性疼痛患者样本（N = 566）和仅暴露于交通或工作相关创伤的慢性疼痛患者子样本中检验六个竞争 DSM-5 模型（n = 202）来考查构造效度。 此外，使用相关分析研究了同时效度和区分效度。

结果：结果显示，使用 DSM-5 症状簇标准，PCL-5 和 CAPS-5 之间的诊断一致性中等（k = 0.46），量表的总体准确性（AUC = 0.79）是高度可接受的。 此外，在交通和工作相关事故的全样本和子样本中，丹麦语 PCL-5 在拟合更佳的七因素混合模型中均显示出出色的结构效度。 在完整样本中确定了出色的同时效度和区分效度。

结论：总之， PCL-5 似乎在寻求治疗的创伤暴露慢性疼痛患者中具有令人满意的心理测量特性。

KEYWORDS:

• PTSD
• chronic pain
• PCL-5
• validation
• trauma

PALABRAS CLAVE:

• TEPT
• dolor crónico
• PCL-5
• validación
• trauma

关键词:

• PTSD
• 慢性疼痛
• PCL-5
• 验证
• 创伤

Acknowledgements

The authors would like to thank all of the participants for participating and the Council of the Danish Victims Fund for funding research into PTSD in chronic pain patients.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics statement

For the Pain Center data: the collected data are protected in accordance with the Act on the Processing of Personal Data (Act No. 429 of 31/05/2000) and the Law on the Status of Patients (Act No. 482 of 01/07/1998). As treatment was not affected by participation in the study, under Danish law, this study did not need ethics approval (Act on Research Ethics Review of Health Research Projects, October 2013, Section 14.2). For the rehabilitation data: the Regional Science Ethics Committee approved the study (J.nr. S-20130103). Informed consent: Written informed consent (electronic signature) was obtained from all patients from the Pain Center. For the rehabilitation data, written informed consent was obtained for the original study but was not needed for present study, as the data were anonymous at this point.

Data availability statement

The data used in the present study cannot be shared owing to the EU General Data Protection Regulation.

Additional information

Funding

The study was funded by the Council of the Danish Victims Fund. The funders had no role in the data collection, analysis, interpretation, or reporting of results.