High sensitivity, low specificity: Validation and diagnostic accuracy study of the PCL-5 in an Arabic-speaking treatment-seeking sample.

BACKGROUND

The PTSD Checklist for DSM-5 (PCL-5) is widely used to assess posttraumatic stress disorder (PTSD), yet validation in Arabic-speaking populations remains limited, and no guideline-based cutoff scores have been established. This study evaluated the structural validity, reliability, and diagnostic performance of the Arabic PCL-5 in a large treatment-seeking sample.

METHODS

As part of a broader treatment study, a total of 1140 participants from across the Southwest Asia and North Africa (SWANA) region completed the Arabic PCL-5 among other measures. PTSD diagnoses were established via the SCID-5-CV interview. Exploratory and confirmatory factor analyses assessed dimensionality. Reliability, convergent validity, and diagnostic utility were evaluated along STARD guidelines, with emphasis on ROC analyses and cutoff performance.

RESULTS

The Anhedonia model fit the data acceptably, with good to excellent internal consistencies. ROC analyses indicated moderate diagnostic utility (AUC = 0.658), with no cutoff achieving both high sensitivity and specificity. Lower cutoffs (31-33) maximized sensitivity (0.87-0.89) and positive predictive values (0.78-0.81), while a cutoff of 38 offered a more balanced compromise (sensitivity: 0.799, specificity: 0.419). The PCL-5 algorithm performed worse than optimized cutoffs.

DISCUSSION: The Arabic PCL-5 shows strong structural validity and reliability and is suitable for screening within a stepped-care approach. Its limited diagnostic accuracy likely reflects effects of the spectrum bias, sample heterogeneity and methodological differences between self-report and interviews. Based on this study, the PCL-5 is recommended for symptom monitoring and screening with clinical follow-up rather than as a stand-alone diagnostic tool in Arabic-speaking treatment-seeking individuals.