A systematic review of PTSD instruments: Psychometric properties and validity in DSM-5 and ICD-11 based tools

Posttraumatic Stress Disorder (PTSD) is a prevalent condition, affecting approximately 5.6 % of the population worldwide. Numerous instruments have been developed over the years, increasing the possibilities for professionals, but also complicating the selection process. This systematic review aims to identify PTSD instruments based on DSM-5 or ICD-11 criteria and evaluate their psychometric properties.

Following PRISMA guidelines, we searched seven databases from July 2023 until March 2024, with an update on December 12th, 2024. Included studies evaluated the psychometric properties of PTSD instruments in their original language. Instruments were considered if, across all studies examining it, were available: analyses for sensitivity, specificity, convergent validity, discriminant validity, area under the curve, and optimal cut-off score, when appropriate. Methodological quality was assessed using QUADAS-2.

Out of 2585 screened records, 28 studies were included, covering ten distinct PTSD instruments and including a total of 11,332 participants. Most instruments were developed for adults, particularly veterans and patients from medical health services. The PCL-5 was the most extensively studied instrument, (16/28 studies), with cut-off scores ranging from 31 to 44 among veterans. Overall, the included studies demonstrated high methodological quality.

While no single instrument is universally recognized as the gold standard for PTSD assessment, ten tools demonstrated robust psychometric validation, supporting their use in clinical and research settings. However, significant gaps remain in validation efforts for vulnerable and underrepresented groups, including older adults with neurocognitive disorders. Broader research is essential to ensure the global applicability of PTSD assessment instruments.