The purpose of this study was to validate the Cameron Trauma Assessment (CTA), a culturally adapted version of the PTSD Checklist for DSM-5 (PCL-5) designed to improve diagnostic accuracy among U.S. military Veterans. The CTA integrates a structured Criterion A interview with cultural coding (C = Culturally Normative, T = Traumatic, CT = Combined) to distinguish between normative military conditioning and trauma exposure. A total of 372 Veterans completed both the CTA and the PCL-5 in counterbalanced order. Correlation and invariance analyses evaluated item, cluster, and total-scale convergence. Results indicated strong item-level correlations (M r = 0.83), high cluster-level equivalence (r = 0.86 - 0.91), and excellent total-scale agreement (r = 0.94, ICC = 0.92). A small negative bias on Bland-Altman analysis (M diff = >0.82) suggested that cultural coding reduced false-positive symptom inflation. Confirmatory factor analyses supported measurement invariance across instruments (ΔCFI ≤ 0.008, ΔRMSEA ≤ 0.01). Findings support the CTA as a psychometrically sound, culturally competent assessment that maintains the DSM-5 PTSD construct while enhancing contextual precision for Veteran populations.
References
[1]
American Psychiatric Association (2013). Diagnosticand Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596
[2]
American Psychiatric Association (APA) (2022). Diagnosticand Statistical Manual of Mental Disorders (5th ed., Text rev.; DSM-5-TR). American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425787
[3]
American Psychological Association (1990). GuidelinesforProvidersofPsychologicalServicestoEthnic,Linguistic,andCulturallyDiversePopulations. https://www.apa.org/pi/oema/resources/policy/provider-guidelines
[4]
Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The Posttraumatic Stress Disorder Checklist for DSM‐5 (PCL‐5): Development and Initial Psychometric Evaluation. JournalofTraumaticStress,28, 489-498. https://doi.org/10.1002/jts.22059
[5]
Bockhop, F., Morina, N., Renneberg, B., & Ehring, T. (2022). Measurement Invariance of Six Language Versions of the Post-Traumatic Stress Disorder Checklist for DSM-5 in Civilians after Traumatic Brain Injury. ScientificReports,12, Article No. 20170. https://doi.org/10.1038/s41598-022-20170-2
[6]
Bovin, M. J., Marx, B. P., Weathers, F. W., Gallagher, M. W., Rodriguez, P., Schnurr, P. P. et al. (2016). Psychometric Properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition (PCL-5) in Veterans. PsychologicalAssessment,28, 1379-1391. https://doi.org/10.1037/pas0000254
[7]
Cameron, K. (2023). Veteran Evolution: Re-Classifying the Military and Veterans as Independent Cultures. AdvancesinAppliedSociology,13, 47-95. https://doi.org/10.4236/aasoci.2023.131005
[8]
Chen, F. F. (2007). Sensitivity of Goodness of Fit Indexes to Lack of Measurement Invariance. StructuralEquationModeling:AMultidisciplinaryJournal,14, 464-504. https://doi.org/10.1080/10705510701301834
[9]
Department of Veterans Affairs, National Center for PTSD (2018). PTSDChecklistforDSM-5(PCL-5). U.S. Department of Veterans Affairs. https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp
[10]
Department of Veterans Affairs, National Center for PTSD (2023). National Center forPTSD:Annual Report 2023. U.S. Department of Veterans Affairs. https://www.ptsd.va.gov/about/work/annual_report.asp
[11]
Ginzburg, M. (2023). Veteran Evolution: What Makes a Veteran. AdvancesinAppliedSociology,13, 706-755. https://doi.org/10.4236/aasoci.2023.1310045
[12]
Krüger-Gottschalk, A., Knaevelsrud, C., Rau, H., Dyer, A., Schäfer, I., Schellong, J. et al. (2017). The German Version of the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Psychometric Properties and Diagnostic Utility. BMCPsychiatry,17, Article No. 379. https://doi.org/10.1186/s12888-017-1541-6
[13]
Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C. et al. (2009). Moral Injury and Moral Repair in War Veterans: A Preliminary Model and Intervention Strategy. ClinicalPsychologyReview,29, 695-706. https://doi.org/10.1016/j.cpr.2009.07.003
[14]
Metzl, J. M., & Hansen, H. (2014). Structural Competency: Theorizing a New Medical Engagement with Stigma and Inequality. SocialScience&Medicine,103, 126-133. https://doi.org/10.1016/j.socscimed.2013.06.032
[15]
Nash, W. P., Litz, B. T., & Castro, C. A. (2013). Moral Injury: A Mechanism for War-Related Psychological Trauma in Military Family Members. ClinicalChildandFamilyPsychologyReview,16, 365-375. https://doi.org/10.1007/s10567-013-0146-y
[16]
Polit, D. F., & Beck, C. T. (2006). The Content Validity Index: Are You Sure You Know What’s Being Reported? Critique and Recommendations. ResearchinNursing&Health,29, 489-497. https://doi.org/10.1002/nur.20147
[17]
Shrout, P. E., & Fleiss, J. L. (1979). Intraclass Correlations: Uses in Assessing Rater Reliability. Psychological Bulletin, 86, 420-428. https://doi.org/10.1037/0033-2909.86.2.420
[18]
Soberón, C., Crespo, M., & Gómez, J. (2016). Dimensional Structure of DSM-5 PTSD Symptoms and Measurement Invariance across Spanish-Speaking Populations. EuropeanJournalofPsychotraumatology,7, Article No. 32078. https://doi.org/10.3402/ejpt.v7.32078
[19]
Weathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx, B. P., & Keane, T. M. (2018). Clinician-AdministeredPTSDScaleforDSM-5(CAPS-5). National Center for PTSD. https://www.ptsd.va.gov/professional/assessment/documents/CAPS_5_Past_Month.pdf
[20]
Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). ThePTSDChecklistforDSM-5(PCL-5). National Center for PTSD. https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp
[21]
Zamanzadeh, V., Ghahramanian, A., Rassouli, M., Abbaszadeh, A., Alavi-Majd, H., & Nikanfar, A. (2015). Design and Implementation Content Validity Study: Development of an Instrument for Measuring Patient-Centered Communication. JournalofCaringSciences,4, 165-178. https://doi.org/10.15171/jcs.2015.017
