Sex differences in the coherence of PCL-5 and CAPS-5 assessments for Post-Traumatic Stress Disorder

The clinician-administered Post Traumatic Stress Disorder (PTSD) scale (CAPS) is a clinical tool for the diagnosis and assessment of the severity of PTSD symptoms. It is widely accepted as the gold standard against which self-assessment tools, such as PCL, are usually evaluated. However, the clinician administered interviews are time and resource intensive, thus utilizing self-report measures is adopted as quicker and more practical to assess symptom severity. Although there have been demonstrations of the validity of PCL for PTSD diagnosis and assessment of symptom severity, PCL (including PCL-5 which is based on DSM-5 criteria) scores tend to overreport symptom severity sometimes leading to higher prevalence of PTSD diagnosis. The contributing factors for such discrepancies in reporting are poorly understood. Here we examined whether there are sex differences in the alignment of PCL-5 with CAPS-5. Our findings indicate that males often report higher PTSD symptom severity on PCL-5 which significantly deviates from a predicted correlation line based on their CAPS-5 scores. Female participants had no deviation from the predicted correlation line. Accordingly, 26.8% of males and only 11.4% of females had inaccurate PTSD status if they were evaluated on PCL-5 alone. Our data also shows that participants with military trauma have poor correlation when compared to participants with civilian trauma. These findings have important implications for appropriate PTSD symptom severity assessment especially for males and military populations. This has significant downstream implications as treatment adjustments, therapy recommendations, and disease management, relying heavily on symptom severity assessed by self-reported tools.