Psychometric properties of the Swedish version of the PTSD checklist for DSM-5 (PCL-5) in a mixed trauma sample – examining internal consistency, convergent validity, latent structure, and screening performance

Abstract

ABSTRACT Background: The Swedish PTSD Checklist-5 (PCL-5) has not been evaluated regarding its screening performance against clinician-administered PTSD assessment or its latent structure. There is also limited evidence on how alternative symptom-cluster mappings may affect probable PTSD classification. Objective: This study aimed to (1) examine the internal consistency, test-retest reliability and validity of the Swedish version of the PTSD Checklist for DSM-5 (PCL-5), (2) provide a preliminary comparison of commonly tested latent models fit to the Swedish PCL-5, and examine how alternative symptom-cluster mappings affect probable PTSD classification, and (3) estimate the screening performance of different PCL-5 threshold scores against clinician-administered PTSD assessment. Method: Trauma-exposed adult participants (N = 248, age M (SD) = 36.5 (15.1), 79% female) were assessed with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and responded to the PCL-5 and other measures of psychological health. Results: The PCL-5 demonstrated good internal consistency, temporal stability and convergent validity, but limited specificity versus other internalising constructs. Several models contained problems with model admissibility. Among the tested latent models, the Anhedonia model was the only model that combined improved global fit with model admissibility compared to the DSM-5 model. In exploratory analyses, the bifactor DSM-5 model provided good fit. Model-derived probable PTSD classification rates varied substantially (18–38%) across symptom-cluster algorithms. Threshold scores of 31–33 showed the best balance between sensitivity and specificity in this sample, although confidence intervals indicated non-negligible uncertainty and lower thresholds may be preferable when prioritising detection for further clinical assessment. Conclusions: The Swedish PCL-5 is a reliable and valid screening tool for PTSD. However, elevated scores are not specific to PTSD, and may partly reflect broader internalising distress, suggesting that it should not be used as a stand-alone diagnostic tool. Threshold choice should depend on setting and intended use, rather than defaulting to a single cut-off. The threshold findings should be interpreted as preliminary Swedish estimates requiring replication in larger samples.