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Psychometric Properties of the Posttraumatic

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DOI: 10.1037/pas0000259

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 Psychological Assessment 2015 American Psychological Association
2016, Vol. 28, No. 10, 1159 1165 1040-3590/16/$12.00 http://dx.doi.org/10.1037/pas0000259

Psychometric Properties of the Posttraumatic Stress Disorder Symptom

Scale Interview for DSM5 (PSSI5)

Edna B. Foa, Carmen P. McLean, Yinyin Zang, Sheila Rauch, Katherine Porter, and Kelly Knowles
and Jody Zhong VA Ann Arbor Healthcare System, Ann Arbor, Michigan, and
University of Pennsylvania University of Michigan Medical School

Mark B. Powers and Brooke Y. Kauffman

University of Texas at Austin
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.

Changes to the diagnostic criteria for posttraumatic stress disorder (PTSD) in the fifth edition of the
Diagnostic and Statistical Manual of Mental Disorders (DSM5) create a need for valid and reliable
updated assessment tools. This study examined key psychometric properties (e.g., internal consistency,
testretest reliability, interrater reliability, and convergent and discriminant validity) of the PTSD
Symptom Scale Interview for DSM5 (PSSI5), a modified version of the PSSI (PTSD Symptom
Scale)Interview Version for the DSMIV. Participants were 242 urban community residents, veterans,
and college undergraduates, recruited from 3 study sites, who had experienced a DSM5 Criterion A
traumatic event. The PSSI5 demonstrated good internal consistency ( .89) and testretest reliability
(r .87), as well as excellent interrater reliability for the total severity score (intraclass correlation .98)
and interrater agreement for PTSD diagnosis ( .84). The PSSI5 also demonstrated convergent
validity with 3 measures of PTSD (i.e., Clinician-Administered PTSD Scale for DSM5, Posttraumatic
Diagnostic Scale for DSM5, and PTSD ChecklistSpecific Version; all rs .72) and discriminant
validity with the Beck Depression InventoryII and the StateTrait Anxiety InventoryTrait scale.
Receiver operating characteristic analysis yielded a cutoff score of 23 for identifying a probable PTSD
diagnosis. Together, these findings indicate that the PSSI5 is a valid and reliable instrument for
assessing PTSD diagnosis and severity.

Keywords: PTSD (posttraumatic stress disorder), psychometrics, test reliability, test validity, DSM5

Supplemental materials: http://dx.doi.org/10.1037/pas0000259.supp

The latest edition of the Diagnostic and Statistical Manual of
Mental Disorders (5th ed.; DSM5; American Psychiatric Associ-
ation, 2013) introduced several revisions to the diagnostic criteria
for posttraumatic stress disorder (PTSD). Specifically, the DSM5
This article was published Online First December 21, 2015.
Edna B. Foa, Carmen P. McLean, Yinyin Zang, and Jody Zhong, Depart-
ment of Psychiatry, University of Pennsylvania Perelman School of Medicine;
Sheila Rauch, Katherine Porter, and Kelly Knowles, VA Ann Arbor Health-
care System, Ann Arbor, Michigan, and Department of Psychiatry, University
of Michigan Medical School; Mark B. Powers and Brooke Y. Kauffman,
Department of Psychology, University of Texas at Austin.
Sheila Rauch is now at the Department of Psychiatry, Emory University.
The current investigation and the jointly published study of the psychomet-
ric properties of the Posttraumatic Diagnostic Scale for DSM5 (PDS5) are
based on the same sample of participants. As a result, some of the information
contained in the Method sections of the two articles is the same.
We thank Brian Marx, Michelle Bovin, and Paola Rodriguez for their
training and monitoring of the Clinician-Administered PTSD Scale admin-
istration and the staff of the Center for the Treatment and Study of Anxiety
at the Perelman School of Medicine for their help with data collection.
Correspondence concerning this article should be addressed to Edna B. Foa,
Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 6th
Floor, Philadelphia, PA 19104. E-mail: foa@mail.med.upenn.edu
omitted the criterion intense fear, helplessness, and horror from
Criterion A; divided the symptom cluster Avoidance and Emo-
tional Numbing into the two clusters Avoidance and Changes in
Cognition and Mood; and added three new symptoms encompass-
ing persistent negative beliefs and expectations about oneself or
the world, persistent distorted blame of self or others for the
trauma, persistent negative emotional state, and self-destructive or
reckless behavior. The DSM5 also omitted the symptom fore-
shortened future, resulting in 20 instead of 17 PTSD symptoms.
These changes necessitate updating existing assessment instru-
ments that correspond to the revised criteria. In this study, we
examined key psychometric properties of the PTSD Symptom
ScaleInterview Version for DSM5 (PSSI5), a clinician-
administered measure that assesses PTSD symptom severity and
diagnosis according to the DSM5 criteria.
The original PTSD Symptom ScaleInterview Version (PSSI;
Foa, Riggs, Dancu, & Rothbaum, 1993) is a 17-item semistruc-
tured interview that assesses PTSD criteria according to the
DSMIV (American Psychiatric Association, 1994). Its brevity and
ease of administration have lent to its widespread use, as well as its
translation into many languages, including among others Spanish
(Almanza Muoz, Pez Agraz, Hernndez Daza, Barajas
Archiga, & Nicolini Snchez, 1996; Kichic & Estefanell, 2011),
Japanese (Fujisawa, 2007), Norwegian (Peleikis, 2007), German

1159
 1160 FOA ET AL.
(Schafer & Hoecker, 2012; Stieglitz, Frommberger, Foa, & Berger,
2001), and Chinese (Su & Chen, 2005). Reliability and validity of
the PSSI have been supported in three studies. Among survivors
of sexual and nonsexual assault (n 118; Foa et al., 1993), the
PSSI was found to have good internal consistency ( .85) and
testretest reliability over a 1-month period, r(93) .80, p .001.
In a sample of 64 civilians reporting a wide range of traumatic
experiences (Foa & Tolin, 2000), internal consistency of the PSSI
subscales ranged from .65 to .86, interrater reliability was high
( .91.93), and convergent validity with the Clinician-
Administered PTSD Scale (CAPS; Blake et al., 1995), another
widely used measure of PTSD diagnosis and severity, was also
high ( .87). Finally, in a sample of 116 individuals with
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comorbid PTSD and alcohol dependence (Powers, Gillihan,
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Rosenfield, Jerud, & Foa, 2012), the PSSI demonstrated excellent
internal consistency ( .90), good testretest reliability over a
1-month period (r .80), and good interrater reliability for PTSD
diagnosis ( .79).
Similar to the PSSI, the PSSI5 is a flexible semistructured
interview that allows clinicians who are familiar with PTSD to
make a diagnosis of PTSD as well as obtain an estimate of
symptom severity. Symptoms are linked to a single identified
index trauma, which is the traumatic event identified by the
respondent as the one that causes the most current distress, and the
time frame in which symptoms are assessed is the past month (per
DSM5 criteria). Symptoms are rated by considering information
regarding the frequency with which the symptom is experienced
and the intensity of the symptom when it is experienced. The
PSSI5 takes approximately 30 min to complete.
The aim of the current study was to examine the reliability and
validity of the revised PSSI5. Participants were administered the
PSSI5 and completed self-report questionnaires to assess conver-
gent and discriminant validity. A subset of participants was ad-
ministered the PSSI5 on two separate occasions in order to assess
testretest reliability, and a subset were administered the Clinician-
Administered PTSD Scale for DSM5 (CAPS5; Weathers et al.,
2013) to assess convergent validity.
Method
Participants
Participants were 242 adults ages 18 70 who had experienced a
DSM5 Criterion A traumatic event at some point in their lives.
Individuals were excluded from the study if they exhibited symp-
toms of current psychosis or mania or were currently receiving
psychotherapy for PTSD, because this would confound the assess-
ment of testretest reliability.
Participants were recruited from three different sites: the Uni-
versity of Pennsylvania (Penn), the VA Ann Arbor Healthcare
System (VAAAHS), and the University of Texas at Austin (UT).
Participants at Penn were members of the West Philadelphia
community (n 95) and individuals seeking mental health treat-
ment at a local community mental health clinic (n 19). Partic-
ipants at the Ann Arbor site were veterans receiving care at
VAAAHS (n 64). The UT participants were college students
who received research credit for their participation (n 64).
Table 1 describes participant characteristics for the sample.
Table 2 shows the percentages of participants who endorsed each
trauma category as their index trauma on the PSSI5.
Measures
PTSD Symptom ScaleInterview for DSM5 (PSSI5).
The PSSI5 is a 24-item semistructured interview that assesses
PTSD symptoms in the past month and makes a diagnostic deter-
mination based on the DSM5 criteria. The PSSI5 begins with a
trauma screen that assesses for the presence of a Criterion A
traumatic event. If the respondent endorses multiple traumatic
events, the traumatic event that is currently most distressing for the
respondent, referred to as the index trauma, is identified, and the
remaining criteria are assessed in reference to this event. Twenty
questions address symptoms corresponding to those in the four
DSM5 clusters: intrusion (Items 15), avoidance (Items 6 7),
changes in mood and cognition (Items 8 14), and arousal and
hyperactivity (Items 1520). Questions assess for frequency and
intensity of symptoms, with the interviewer rating the participants
answers on a 5-point scale ranging from 0 (not at all) to 4 (6 or
more times a week/severe). Symptoms are considered present
when rated 1 or higher. The sum of Items 120 yield a total PTSD
symptom severity score (range 0 80). Items 21 and 22 assess
for overall distress and interference, and Items 23 and 24 report
delayed onset and duration of symptoms, respectively. Consistent
with the DSM5, PTSD diagnosis requires the presence of 1
intrusion symptom, 1 avoidance symptom, 2 cognition and mood
symptoms, and 2 arousal symptoms for a period of 1 month or
greater, in addition to clinically significant distress or interference
(operationalized as a score of 2 or higher on either Item 21 or 22).
A copy of the PSSI5 is available in the online supplemental
materials.
Clinician-Administered PTSD Scale for DSM5 (CAPS5).
The CAPS5 (Weathers et al., 2013) is a semistructured interview
that assesses PTSD symptoms according to the DSM5 criteria.
The CAPS5 has 20 symptom items that correspond to the DSM5
symptom clusters and additional items that assess for onset and
duration of symptoms, subjective distress and impairment, and the
presence of dissociation. Participants responses are rated on a
5-point scale ranging from 0 (absent) to 4 (extreme/incapacitat-
ing); symptom responses must be rated a 2 or above for the
symptom to be considered present. The CAPS5 yields both a
diagnostic determination and a total PTSD symptom severity score
based on the sum of the 20 symptom items (range 0 80).
Similar to the case for the PSSI5, a PTSD diagnosis on the
CAPS5 requires the presence of 1 intrusion symptom, 1 avoid-
ance symptom, 2 cognition and mood symptoms, and 2 arousal
symptoms for a period of 1 month or greater, in addition to
clinically significant distress or interference. In this study, the
CAPS5 was used to examine convergent validity with the
PSSI5.
Posttraumatic Diagnostic Scale for DSM5 (PDS5). The
PDS5 (Foa et al., in press) is a 24-item self-report measure that
mirrors the PSSI5. The PDS5 includes a trauma screen, fol-
lowed by 20 questions corresponding to PTSD symptoms and four
items assessing distress, interference, onset, and duration of symp-
toms. The 20 symptom items are rated on a 5-point scale of
frequency and severity ranging from 0 (not at all) to 4 (6 or more
 PSYCHOMETRIC PROPERTIES OF THE PSSI5 1161

Table 1
Demographic Characteristics of Participants

Characteristic n (%) M (SD)

Total sample (N 242)

Age in years 39.54 (16.81)
Gender
Men 137 (56.6)
Women 101 (41.7)
Other 1 (0.4)
Did not disclose/unknown 3 (1.2)
Race
American Indian/Alaskan Native 3 (1.2)
Asian 14 (5.8)
Native Hawaiian or Other Pacific Islander 1 (0.4)
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Black or African American 76 (31.4)

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White 105 (43.4)

Other 12 (5.0)
Checked more than one 5 (2.1)
Did not disclose/unknown 26 (10.7)
Ethnicity
Hispanic or Latino 33 (13.6)
Not Hispanic or Latino 180 (74.4)
Did not disclose/unknown 29 (12.0)

Veterans (n 64)
Active duty (Guard or Reserves)
Yes 4 (6.3)
No 60 (93.7)
Branch of military
Air Force 6 (9.5)
Army 40 (63.5)
Marines 6 (9.5)
Navy 10 (15.9)
More than one branch 1 (1.6)
Deployed to combat zone
Yes 41 (64.1)
No 23 (35.9)
Served in Vietnam era
Yes 22 (34.4)
No 42 (65.6)
Served in Persian Gulf War, OIF, OEF, or OND
Yes 31 (48.4)
No 33 (51.6)

PSSI5 symptom severity (n 230)

Total score 23.30 (14.52)
Intrusion subscale 5.32 (4.05)
Avoidance subscale 3.01 (2.35)
Changes in cognition and mood subscale 7.89 (6.17)
Arousal and hyperreactivity subscale 7.09 (5.00)

Total sample (N 230)

Met criteria for PTSD diagnosis 124 (53.9)
Note. OIF Operation Iraqi Freedom; OEF Operation Enduring Freedom; OND Operation New Dawn;
PSSI5 PTSD Symptom ScaleInterview Version for DSM5; PTSD posttraumatic stress disorder.

times a week/severe). In this study, the PDS5 was used to exam-
ine convergent validity with the PSSI5.
PTSD Checklist, Specific Version (PCLS). The PCLS
(Weathers, Litz, Herman, Huska, & Keane, 1993) is a 17-item
self-report measure of DSMIV PTSD symptoms in relation to an
identified stressful experience. Participants rate how much a
particular symptom has been troubling them over the past month
on a scale ranging from 1 (not at all) to 5 (extremely). The PCLS
has excellent internal consistency ( .91) and good testretest
reliability, r(35) .87, p .001 (Adkins, Weathers, McDevitt-
Murphy, & Daniels, 2008). In this study, the PCLS was used to
examine convergent validity for the PSSI5.
Beck Depression InventoryII (BDIII). The BDIII (Beck,
Brown, & Steer, 1996) is a 21-item self-report measure of depressive
symptoms. Among an outpatient sample (n 500), the BDIII
demonstrated excellent internal consistency, with a coefficient alpha
of .92 (Beck et al., 1996). In this study, the BDIII was used to
examine discriminant validity for the PSSI5.
StateTrait Anxiety InventoryTrait Subscale (STAIT).
The STAIT is a subscale of the STAI (Spielberger, Gorsuch,
 1162 FOA ET AL.
Table 2
Participants Reported Index Trauma
Trauma type Frequency % in the recordings and were subsequently compared to the original
Serious, life-threatening illness 15 6.5
Physical assault 63 27.4
Sexual assaulta 30 13.0
Military combat 28 12.2
Child abuse 21 9.1
Accident 52 22.6
Other 21 9.1
a
Military sexual assault (n 3) was coded as sexual assault.
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Lushene, Vagg, & Jacobs, 1983) that consists of 20 items mea-
This document is copyrighted by the American Psychological Association or one of its allied publishers.
suring trait anxiety. The STAIT has demonstrated good to excel-
lent internal consistency, with coefficients ranging from .86 to .95,
and adequate 2-month testretest reliability, with coefficients of
.65 to .75 (Spielberger et al., 1983). In this study, the STAIT was
used to examine discriminant validity for the PSSI5.
Procedure
Participants were invited for two visits, scheduled 3 to 10 days
apart (M 6.23, SD 3.08). Across sites, 161 participants
completed the PSSI5 with a different interviewer at each visit, to
assess for testretest reliability. We used a different interviewer
rather than the same interviewer at each visit in order to assess
testretest reliability more stringently (Weathers, Keane, & Da-
vidson, 2001). Participants completed self-report measures during
the first visit. An additional 62 participants from Penn and
VAAAHS were randomized to complete either the PSSI5 or the
CAPS5 at the first visit and the other interview at the second visit,
to control for order effects when assessing for convergent validity.
At the second visit, participants were instructed to respond to the
interviewers questions in relation to the index trauma identified
during the first interview. Study interviews were conducted by 13
interviewers at Penn, four interviewers at VAAAHS, and three
interviewers at UT. Interviewers were doctoral or masters-level
clinicians or postbaccalaureate research assistants who were
trained in the administration of the PSSI5.
Training for PSSI5 interviewers consisted of reviewing a de-
tailed training manual, observing a PSSI5 training session, con-
ducting a sample administration of the PSSI5 and comparing their
ratings to established expert ratings, and then completing and
audiotaping two administrations of the PSSI5, which were re-
viewed for fidelity. Two interviewers from Penn and two inter-
viewers from VAAAHS were additionally trained in the adminis-
tration of the CAPS5. Training for CAPS5 interviewers
consisted of reviewing a training manual, conducting a sample
administration of the CAPS5 and comparing their ratings to
established expert ratings, and then completing and audiotaping
two administrations of the CAPS5, which were reviewed for
fidelity by CAPS5 experts. To prevent assessment procedures
from the CAPS5 influencing the assessment procedures of the
PSSI5, interviewers completing the PSSI5 assessments did not
receive training on the CAPS5 and had no prior experience or
training with earlier versions of the CAPS.
To assess for interrater reliability for the PSSI5, 20% of the
participants in the testretest reliability condition across all sites
(n 32) had the audio recording from their first visit selected for
rerating by a rater who was blind to the original interviewers
ratings. Ratings were made on the basis of participants responses
interviewers ratings.
Data Analysis
Of the 242 participants, 12 had one or more items missing from
the PSSI5, so means for PTSD symptom severity and percentage
of participants with a PTSD diagnosis were calculated using the
230 participants with complete PSSI5 data. To assess the internal
consistency of the PSSI5, Cronbachs coefficient () was com-
puted. Pearsons correlation coefficient (r) was computed to de-
termine testretest reliability, as well as convergent and discrimi-
nant validity, which were examined using data from the first
assessment time point only. Cohens kappa coefficient () was
used to compute the interrater agreement of PSSI5 diagnosis and
compare the diagnosis agreements between the PSSI5 and the
CAPS5, and the intraclass correlation coefficient (ICC) was com-
puted to index interrater reliability for the total severity score.
Finally, a receiver operating characteristic (ROC) analysis was
conducted to determine the diagnostic cutoff scores of the PSSI5.
Results
Internal Consistency
The internal consistency of the PSSI5 total score (n 230)
was good ( .89). The average itemtotal correlationn for the 20
items was .51. Item 8 (Are there any important parts of the trauma
that you cannot remember?) had an itemtotal correlation of .17;
the range of itemtotal correlations for the remaining 19 items was
.35.68, with an average of .52. The mean of inter-item correlation
was .29. The internal consistencies of the subscales varied; the
intrusion subscale was adequate ( .77), the avoidance subscale
was somewhat low ( .60), the negative alterations in cognitions
and mood subscale was good ( .81), and the alterations in
arousal and reactivity subscale was adequate ( .72).
TestRetest Reliability
Testretest reliability for the PSSI5 total score (n 141) was
good, r(141) .87, p .001. Testretest reliability of the four
clusters were all adequate: the intrusion subscale, r(141) .75,
p .001; the avoidance subscale, r(141) .74, p .001; the
negative alterations in cognitions and mood subscale, r(141)
.79, p .001; and the alternations in arousal and reactivity
subscale, r(141) .78, p .001. The testretest reliability for
PTSD diagnosis was good ( .65). Percentage agreement be-
tween diagnoses at the two time points was 83%, indicating a high
degree of testretest reliability.
Interrater Reliability
Interrater agreement for the PSSI5 (n 37) was excellent;
kappa for the agreement on the PTSD diagnosis was .84, with all
raters agreeing on the diagnosis for 34 out of the 37 participants
 PSYCHOMETRIC PROPERTIES OF THE PSSI5 1163

(91.9%). The intraclass correlation coefficient (ICC) for the total
severity score was .98.
Convergent Validity
Convergent validity of the PSSI5 and the PDS5, PCLS, and
CAPS5 is shown in Table 3. Among participants who completed
the PSSI5 (n 230), 213 completed the PDS5, 195 completed
the PCLS, and 48 completed the CAPS5. The PSSI5 total
severity score was highly correlated with the PDS5, r(213) .85,
p .001, and the PCLS, r(195) .85, p .001. The PSSI5 was
also significantly correlated with the CAPS5 total score, r(48)
.72. Thus, convergent validity of the PSSI5 was supported by the
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Cutoff Point for Probable PTSD Diagnosis
To identify diagnostic cutoff scores of the PSSI5, we con-
ducted ROC analysis for the PSSI5 severity score on the basis of
the CAPS5 diagnosis. Although psychometric data have not yet
been published on the CAPS5, no measure of DSM5 PTSD has
yet been established as a gold standard. ROC analysis can identify
cutoff points that maximize the total number of true positive and
true negative cases. It displays the relation between the sensitivity
(true positives) and the inverse of the specificity (true negatives) at
each value (see Figure 1) along a dimensional screening scale (see
Table 4) as it pertains to differentiating two groups of interest (e.g.,
no-PTSD vs. PTSD). Diagnostic tools typically strive to optimally

large positive correlations. balance both sensitivity and specificity. The area under an ROC
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The convergent validity of PTSD diagnoses obtained from the
PSSI5 was assessed by comparing them with the diagnoses
obtained from the CAPS5. Of the 48 participants who completed
both the PSSI5 and the CAPS5, 17 (35.4%) met diagnostic
criteria on the CAPS5, and 23 (47.9%) met criteria on the
PSSI5. Fourteen (82%) of the 17 who were diagnosed by
the CAPS5 also met criteria on the PSSI5 (i.e., sensitivity of the
PSSI5 .82). Similarly, 22 (71%) of the 31 participants who did
not meet criteria on the CAPS5 also did not meet criteria on the
PSSI5 (i.e., specificity of the PSSI5 was .71). A kappa of .49
between the PSSI5 and the CAPS5 was obtained, with 75%
agreement between two measures on PTSD diagnostic status.
Discriminant Validity
The discriminant validity of the PSSI5 was examined using the
STAIT (n 215) and the BDIII (n 211; see Table 3). The
PSSI5 total severity score was significantly correlated with STAI
trait, r(215) .62, p .001, and the BDIII, r(211) .73, p
.001. Analyses recommended by Steiger (1980) and Hoerger
(2013) showed that the associations of the PSSI5 with the
STAIT and the BDIII were significantly lower than its associ-
ations with the PDS5 and the PCLS (all ZH 4.60, ps .001),
providing evidence of discriminant validity.
curve (AUC) represents the overall accuracy of the PSSI5 in
predicting PTSD diagnosis. Here the AUC is .77 (95% confidence
interval [.64, .91]), which is significantly different from .50 (p
.001), indicating that the PSSI5 cutoff point was able to accu-
rately discriminate participants with a PTSD diagnosis above
random chance.
A score of 22.5 appeared to optimize sensitivity and specific-
ity, yielding a sensitivity of .77 and a specificity of .77 for the
diagnosis of PTSD. Thus, a score of 23 can be used as a cutoff
point for identifying probable PTSD diagnosis.
Discussion
The changes to the diagnostic criteria for PTSD in the latest
iteration of the DSM (DSM5) created a need for updated reliable
and valid PTSD assessment instruments. To fill this gap, the
current study evaluated the psychometric properties of the newly
developed PSSI5. The PSSI5 is an interviewer-administered
scale that assesses PTSD diagnosis as well as symptom severity. It
was designed to map onto the DSM5 criteria; it provides infor-
mation about each of the PTSD criteria, including presence of a
traumatic event, and each of the symptom clusters, distress and
interference, as well as onset and duration of symptoms.

Table 3
Correlations Between PTSD Symptom Scale Scores and Other Measures of Psychopathology

Measure 1 2 3 4 5 6 7 8 9 10 11 12 13

1. PSSI5 total
2. PSSI5 intrusion .81
3. PSSI5 avoidance .67 .59
4. PSSI5 changes in mood and cognition .89 .59 .50
5. PSSI5 arousal and hyperreactivity .83 .54 .39 .63
6. PDS5 total .85 .71 .54 .76 .71
7. PDS5 intrusion .74 .77 .50 .61 .52 .86
8. PDS5 avoidance .69 .62 .65 .55 .50 .79 .75
9. PDS5 changes in mood and cognition .79 .59 .46 .80 .62 .93 .71 .66
10. PDS5 arousal and hyperreactivity .78 .61 .40 .64 .79 .90 .68 .61 .79
11. PCLS .85 .72 .56 .74 .72 .89 .78 .70 .83 .83
12. CAPS5 .72 .55 .58 .67 .60 .64 .43 .49 .68 .59 .63
13. STAIT .62 .48 .37 .62 .47 .64 .49 .47 .67 .55 .68 .56
14. BDIII .73 .57 .36 .72 .63 .76 .59 .51 .76 .73 .80 .57 .74
Note. All correlations are significant at p .01. PTSD posttraumatic stress disorder; PSSI5 PTSD Symptom ScaleInterview Version for DSM5;
PDS5 Posttraumatic Diagnostic Scale for DSM5; PCLS PTSD ChecklistSpecific Version; CAPS5 Clinician-Administered PTSD Scale for
DSM5; STAIT StateTrait Anxiety InventoryTrait subscale; BDIII Beck Depression InventoryII; DSM5 Diagnostic and Statistical
Manual of Mental Disorders (5th ed.).
 1164 FOA ET AL.

PSSI based on DSMIV correlated .72 (Foa et al., 1993) and .76
(Powers et al., 2012) with the BDI, and the CAPS based on
DSMIV correlated .61.75 with measures of depression (Weath-
ers et al., 2001). Given that depression and general anxiety are
frequently associated with PTSD (Ginzburg, Ein-Dor & Solomon,
2010), it was expected that the STAIT and the BDIII would be
correlated with the PSSI5. Despite this frequent association, the
correlations between the PSSI5 and the BDIII and the STAIT
were significantly lower than those with the PDS5 and PCLS
measures, thus providing evidence of discriminant validity. Fi-
nally, an ROC analysis revealed that a cutoff point of 23 provided
the optimal balance of sensitivity and specificity. Thus, this crite-
rion can be used to identify individuals with probable PTSD on the
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basis of their symptom severity score.

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One limitation of the study is that discriminant validity was

assessed using only measures of depression and trait anxiety, both
of which frequently co-occur with PTSD. Future studies should
assess discriminant validity using measures of constructs (e.g.,
externalizing psychopathology) hypothesized to be unrelated to
PTSD. In addition, once another validated diagnostic measure of
PTSD is available, research examining whether the PSSI5 can
reliably discriminate those with PTSD from those without PTSD
and those with other, related disorders is needed.
Figure 1. Receiver operator characteristic (ROC) curves for the PTSD In summary, the results of this study indicate that the PSSI5
Symptom Scale Interview for DSM5 relative to the Clinician- provides valid and reliable assessment of DSM5 PTSD diagnosis
Administered PTSD Scale diagnoses. The diagonal line indicates a predic- and symptom severity. As noted, there are currently no other
tion rate of 50% (i.e., chance). See the online article for the color version PTSD measures with established psychometric properties, and the
of this figure. lack of such measures prevented us from examining the concurrent
validity of the PSSI5. However, like the PSSI5, the CAPS5 is
an updated version of a previously well-established assessment
The overall severity score of the PSSI5 showed good internal instrument. Thus, the high correlation and diagnostic agreement
consistency, consistent with findings obtained by Foa et al. (1993) between the PSSI5 and the CAPS5 provide evidence for the
for the DSMIV version of the PSSI. The internal consistencies of validity of the PSSI5. Strengths of this study include the rela-
the symptom cluster subscales varied from good, for the negative tively large and diverse sample of traumatized adults. The sample
alterations in cognitions and mood subscale (7 items); to adequate, comprised men and women who were urban community members,
for the intrusion subscale (5 items) and the alterations in arousal veterans, and university students, lending to the generalizability of
and reactivity subscale (6 items); to low, for the avoidance sub-
scale, which is comprised of two items. Given that internal con-
sistency is highly affected by the number of items, the pattern of
Table 4
variation across subscales is not surprising. Testretest reliability
Coordinates of the PSSI5 ROC Curves
for the PSSI5 total score over a 3- to 10-day period was good, and
reliability for the symptom clusters was adequate. Percentage Positive Positive
agreement on PTSD diagnosis between the two assessment time if Sensitivity Specificity if Sensitivity Specificity
points was 83%, demonstrating good stability over time. Interrater
1.0 1.000 0.032 26.0 0.647 0.774
reliability was excellent, with raters agreeing on PTSD diagnosis 2.5 1.000 0.129 27.5 0.647 0.806
for 91.9% of participants. 4.0 1.000 0.194 28.5 0.588 0.806
Because there are currently no other measures of PTSD that map 7.0 1.000 0.226 30.5 0.529 0.806
on the DSM5 criteria with established psychometric properties, 10.5 1.000 0.258 32.5 0.471 0.806
we compared the PSSI5 with two newly updated measures of 12.5 1.000 0.290 33.5 0.471 0.839
13.5 1.000 0.323 35.0 0.412 0.871
PTSD: the CAPS5 and the PDS5. Interrater agreement between 14.5 1.000 0.355 37.0 0.353 0.903
the PSSI5 and the CAPS5 was moderate; raters agreed on the 15.5 0.882 0.355 39.5 0.294 0.903
diagnosis for 75% of participants. In terms of convergent validity, 16.5 0.824 0.484 42.0 0.294 0.935
the PSSI5 showed large, significant correlations with the 17.5 0.765 0.548 43.5 0.235 0.935
18.5 0.765 0.613 44.5 0.176 0.968
CAPS5 and the PDS5. In terms of discriminant validity, the 19.5 0.765 0.677 45.5 0.118 0.968
PSSI5 was significantly correlated with two measures of associ- 21.0 0.765 0.742 54.0 0.118 1.000
ated constructs: trait anxiety, as measured by the STAIT, and 22.5 0.765 0.774 63.0 0.059 1.000
depressive symptoms, as measured by the BDIII. The correlations 24.0 0.706 0.774 65.0 0.000 1.000
(.62 and .73, respectively) were of a magnitude that is consistent Note. ROC receiver operating characteristic.

with that in previous studies of PTSD measures. For example, the Cut-off value maximizes both sensitivity and specificity.
 PSYCHOMETRIC PROPERTIES OF THE PSSI5 1165

the findings. Thus the PSSI5 appears to be a sound assessment
instrument that can be used with a range of trauma populations.
References
Adkins, J. W., Weathers, F. W., McDevitt-Murphy, M., & Daniels, J. B.
(2008). Psychometric properties of seven self-report measures of post-
traumatic stress disorder in college students with mixed civilian trauma
exposure. Journal of Anxiety Disorders, 22, 13931402. http://dx.doi
.org/10.1016/j.janxdis.2008.02.002
Almanza Muoz, J. J., Pez Agraz, F., Hernndez Daza, M., Barajas
Archiga, G., & Nicolini Snchez, H. (1996). Traduccin, confiabilidad
y validez concurrente de dos escalas del trastorno por estrs
postraumtico [Translation, consistency, and concurrent validity of two
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Hoerger, M. (2013). ZH: An updated version of Steigers Z and Web-based
calculator for testing the statistical significance of the difference be-
tween dependent correlations. Retrieved from http://www.psychmike
.com/dependent_correlations.php
Kichic, R., & Estefanell, C. (2011). Spanish version of the PTSD Symptom
ScaleInterview (PSSI). Anxiety and Trauma Clinic, Institute of Cog-
nitive Neurology. Buenos Aires, Argentina. Unpublished manuscript.
Peleikis, D., & Fosse, R. (2006). Norwegian version of the PTSD Symptom
ScaleInterview Version (PSSI). Aker University Hospital. Oslo, Nor-
way. Unpublished manuscript.
Powers, M. B., Gillihan, S. J., Rosenfield, D., Jerud, A. B., & Foa, E. B.
(2012). Reliability and validity of the PDS and PSSI among partici-
pants with PTSD and alcohol dependence. Journal of Anxiety Disorders,
26, 617 623. http://dx.doi.org/10.1016/j.janxdis.2012.02.013

Schafer, I., & Hoecker, A. (2012). German version of the PTSD Symptom
scales for posttraumatic stress disorder]. Salud Mental, 19, 2 4. ScaleInterview Version (PSSI). Unpublished manuscript, University
This document is copyrighted by the American Psychological Association or one of its allied publishers.

American Psychiatric Association. (1994). Diagnostic and statistical man-
ual of mental disorders (4th ed.). Washington, DC: Author.
American Psychiatric Association. (2013). Diagnostic and statistical man-
ual of mental disorders. Arlington, VA: American Psychiatric Publish-
ing.
Beck, A. T., Brown, G., & Steer, R. A. (1996). Beck Depression Inventory
II manual. San Antonio, TX: Psychological Corporation.
Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman,
F. D., Charney, D. S., & Keane, T. M. (1995). The development of a
clinician-administered PTSD scale. Journal of Traumatic Stress, 8,
7590. http://dx.doi.org/10.1002/jts.2490080106
Foa, E. B., McLean, C. P., Zang, Y., Zhong, J., Powers, M. B., Kauffman,
B., . . . Knowles, K. (in press). Psychometric properties of the Posttrau-
matic Diagnostic Scale for DSM5 (PDS5). Psychological Assessment.
Foa, E. B., Riggs, D. S., Dancu, C. V., & Rothbaum, B. O. (1993).
Reliability and validity of a brief instrument for assessing post-traumatic
stress disorder. Journal of Traumatic Stress, 6, 459 473. http://dx.doi
.org/10.1002/jts.2490060405
Foa, E. B., & Tolin, D. F. (2000). Comparison of the PTSD Symptom
ScaleInterview Version and the Clinician-Administered PTSD Scale.
Journal of Traumatic Stress, 13, 181191. http://dx.doi.org/10.1023/A:
1007781909213
Fujisawa, D. (2007). Japanese version of the PTSD Symptom Scale
Interview Version (PSSI). Unpublished manuscript.
Ginzburg, K., Ein-Dor, T., & Solomon, Z. (2010). Comorbidity of post-
traumatic stress disorder, anxiety and depression: A 20-year longitudinal
study of war veterans. Journal of Affective Disorders, 123, 249 257.
http://dx.doi.org/10.1016/j.jad.2009.08.006
of Hamburg, Hamburg, Germany.
Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs,
G. A. (1983). Manual for the State-Trait Anxiety Inventory. Palo Alto,
CA: Consulting Psychologists Press.
Steiger, J. H. (1980). Tests for comparing elements of a correlation matrix.
Psychological Bulletin, 87, 245251. http://dx.doi.org/10.1037/0033-
2909.87.2.245
Stieglitz, R. D., Frommberger, U., Foa, E. B., & Berger, M. (2001).
Evaluation of the German version of the PTSD Symptom Scale (PSS).
Psychopathology, 34, 128 133. http://dx.doi.org/10.1159/000049295
Su, Y. J., & Chen, S. H. (2005). Chinese version of the PTSD Symptom
ScaleInterview (PSSI). Unpublished manuscript, Department of Psy-
chology, National Taiwan University, Taipei, Taiwan.
Weathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx,
B. P., & Keane, T. M. (2013). CAPS5The Clinician-Administered
PTSD Scale for DSM5 (CAPS5). Interview available from the Na-
tional Center for PTSD at www.ptsd.va.gov
Weathers, F. W., Keane, T. M., & Davidson, J. R. T. (2001). Clinician-
Administered PTSD Scale: A review of the first ten years of research.
Depression and Anxiety, 13, 132156. http://dx.doi.org/10.1002/da.1029
Weathers, F. W., Litz, B., Herman, D., Huska, J., & Keane, T. (1993,
October). The PTSD Checklist (PCL): Reliability, validity, and diagnos-
tic utility. Paper presented at the Annual Convention of the International
Society for Traumatic Stress Studies, San Antonio, TX.
Received June 4, 2015
Revision received October 21, 2015
Accepted October 21, 2015

Correction to Foa et al. (2015)

In the article Psychometric Properties of the Posttraumatic Diagnostic Scale for DSM5 (PDS5)
by Edna B. Foa, Carmen P. McLean, Yinyin Zang, Jody Zhong, Mark B. Powers, Brooke Y.
Kauffman, Sheila Rauch, Katherine Porter, and Kelly Knowles (Psychological Assessment, Ad-
vanced online publication. December 21, 2015. http://dx.doi.org/10.1037/pas0000258), the third
sentence of the Internal Consistency subsection of the Results section should read: Item 8, Not
being able to remember important parts of the trauma, had an itemtotal correlation of .34, and
Item 16, Taking more risks or doing things that might cause you or others harm had an itemtotal
correlation of .44; the range of itemtotal correlations for the remaining 18 items was .62.82, with
an average of .70.

http://dx.doi.org/10.1037/pas0000360

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