2026 ECNP Congress

PS01-1177

Diagnostic performance and threshold-dependent accuracy of the PTSD checklist for DSM-5 in perinatal post-traumatic stress disorder

Boronin Larisa — N. Igor · Nicolae Testemitanu State University of Medicine and Pharmacy- Chisinau- Moldova, Department of Mental Health- Medical Psychology and Psychotherapy “Alexandru Nacu”- Mental Health Research Laboratory- Nicolae Testemitanu State University of Medicine and Pharmacy- Chisinau- Moldova, Chisinau, Moldova

2026 ECNP Congress

Background

Perinatal post-traumatic stress disorder (PTSD) is increasingly recognised as a clinically significant condition associated with pregnancy and childbirth. It has been linked to dysregulation of stress-response systems, including alterations in hypothalamic–pituitary–adrenal axis functioning and heightened sensitivity to threat. Despite growing awareness, perinatal PTSD remains underdiagnosed in routine clinical practice. This is partly due to variability in symptom presentation and the lack of clearly established optimal cut-off thresholds for screening instruments.

The PTSD Checklist for DSM-5 is widely used for symptom assessment; however, its diagnostic performance in perinatal populations warrants further investigation, particularly with respect to threshold-dependent variability.

Aims

To assess the diagnostic performance and clinical applicability of the PTSD Checklist for DSM-5 in perinatal populations.

Methods

This theoretical review combines published psychometric evidence with a secondary statistical analysis of diagnostic parameters across a range of cut-off values, including data from recent validation studies in perinatal populations.

Receiver operating characteristic analysis was employed to evaluate overall diagnostic performance. Linear regression was used to explore the relationship between sensitivity and specificity, while correlation analyses (Pearson, Spearman, and Kendall) assessed the strength and consistency of this association across thresholds.

The analysis aimed to characterise diagnostic trade-offs and examine their relevance for clinical interpretation.

Results

Receiver operating characteristic analysis indicated good discriminative capacity, with an area under the curve (AUC) of 0.767, suggesting performance above chance level and supporting its use in screening contexts.

A strong inverse relationship between sensitivity and specificity was identified (Pearson r = –0.94, 95% CI –0.98 to –0.86, p < 0.0001), with consistent findings obtained using Spearman (ρ = –0.97) and Kendall (τ = –0.91) coefficients.

Linear regression further demonstrated a significant negative association (β = –0.68, R² = 0.88), indicating a stable and predictable trade-off between sensitivity and specificity across thresholds.

Lower cut-off values were associated with increased sensitivity (up to 0.95) but reduced specificity (approximately 0.66), whereas higher thresholds improved specificity (up to 0.97) at the expense of sensitivity (down to 0.47).

Conclusions

The PTSD Checklist for DSM-5 shows good overall diagnostic performance; however, its clinical usefulness is limited by a consistent trade-off between sensitivity and specificity across cut-off values.

The instrument appears appropriate for screening and symptom severity assessment in perinatal populations, but it should not be used as a standalone diagnostic tool.

Interpretation of results requires careful consideration of the clinical context and appropriate selection of thresholds, ideally supported by structured clinical interviews.

These findings emphasise the importance of context-dependent threshold selection, as improvements in sensitivity are inevitably accompanied by reductions in specificity, and may help inform clinical decision-making in perinatal mental health care.

They may also contribute to improved early detection and more effective screening strategies in this population, as well as enhanced clinical risk stratification.These findings are particularly relevant for clinical settings where rapid and reliable screening is required. They also support the need for integrating structured clinical assessment with screening tools in routine perinatal care.

References

  1. American Psychiatric Association, 2013. Diagnostic and statistical manual of mental disorders, fifth ed. American Psychiatric Association Publishing, Washington.
  2. Blevins, C.A., Weathers, F.W., Davis, M.T., Witte, T.K., Domino, J.L., 2015. The PTSD Checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. J. Trauma Stress 28 (6), 489–498.
  3. Arora, I.H., Woscoboinik, G.G., Mokhtar, S., Quagliarini, B., Bartal, A., Jagodnik, K.M., et al., 2024. A diagnostic questionnaire for childbirth related posttraumatic stress disorder: a validation study. Am. J. Obstet. Gynecol. 231 (1), 134.e1–134.e13.
  4. Yildiz, P.D., Ayers, S., Phillips, L., 2017. The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis. J. Affect. Disord. 208, 634–645.
  5. Grekin, R., O’Hara, M.W., 2014. Prevalence and risk factors of postpartum posttraumatic stress disorder: A meta-analysis. Clin. Psychol. Rev. 34 (5), 389–401.