Sex differences in the coherence of PCL5 and CAPS-5 assessments for post-traumatic stress disorder

The clinician-administered Post Traumatic Stress Disorder (PTSD) scale (CAPS-5) is a clinical tool for the diagnosis and assessment of the severity of PTSD symptoms based on DSM-5, while the PTSD Checklist for DSM-5 (PCL-5) is a self-assessment tool. Both assessments are widely used, but CAPS-5 is time and resource intensive, while PCL-5 is quicker. Although PCL-5 has been validated for PTSD symptom severity assessment, PCL-5 scores tend to show higher symptom severity and sometimes leading to higher prevalence of PTSD diagnosis. The contributing factors for such discrepancies in reporting are poorly understood. Here we examined whether there are sex differences in the alignment of PCL-5 with CAPS-5. Our findings demonstrate that in females there was a strong alignment of PCL-5 and CAPS-5 scores (Rho = 0.907). In contrast, in males, this correlation was lower (Rho = 0.655). Accordingly, 37.5 % of males had misalignment between PCL-5 and CAPS-5 PTSD categorization and only 15.9 % of females had misalignment of categorization between the two assessments. Our data also shows that participants with military trauma have poor correlation when compared to participants with civilian trauma. These findings caution that PCL-5 and CAPS-5 may provide different PTSD symptom severity assessment especially for males and military populations. This has significant implications as treatment adjustments, therapy recommendations, and disease management rely heavily on symptom severity assessed by self-reported tools.