Longitudinal psychometric validation and measurement invariance of the PTSD checklist for DSM-5 (PCL-5)

Celine Mylx Li; Grace Wing Ka Ho; Stanley Kam Ki Lam; Hong Wang Fung

doi:10.1016/j.ajp.2025.104599

Longitudinal psychometric validation and measurement invariance of the PTSD checklist for DSM-5 (PCL-5)

Asian J Psychiatr. 2025 Jun 24:110:104599. doi: 10.1016/j.ajp.2025.104599. Online ahead of print.

Authors

Celine Mylx Li¹, Grace Wing Ka Ho², Stanley Kam Ki Lam³, Hong Wang Fung⁴

Affiliations

¹ Department of Psychiatry, Yale School of Medicine, Yale University, United States. Electronic address: celine.mylx.li@yale.edu.
² School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong. Electronic address: grace.wk.ho@polyu.edu.hk.
³ Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong. Electronic address: stanleylam@cuhk.edu.hk.
⁴ School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong. Electronic address: andy.hw.fung@polyu.edu.hk.

PMID: 40602038
DOI: 10.1016/j.ajp.2025.104599

Abstract

Despite the adoption of the four-factor model of posttraumatic stress disorder (PTSD) in the DSM-5, very few studies have provided longitudinal examinations of the temporal stability of the PTSD Checklist for DSM-5 (PCL-5), particularly in East Asian contexts. In addition, its factorial structure and validity have been a subject of considerable debate, with accumulating evidence suggesting that alternative models may better capture the heterogeneity of PTSD symptoms. To address these gaps, the present study evaluated the psychometric properties of the Traditional Chinese version of the PCL-5 (TC-PCL-5) across three timepoints (N = 412 at Time 1, 232 at Time 2, and 132 at Time 3) in a community sample of Hong Kong adults, testing both the four- and six-factor structures of the PCL-5. Internal consistency of the scale remained stable across all three waves of the study (T1:ω=0.97; T2:ω=0.98; T3:ω=0.98). Intraclass correlation analyses revealed good test-retest reliability. Confirmatory factor analyses supported both factorial structures at each timepoint. Results demonstrated configural, metric, and scalar invariance across all three waves and indicated that the underlying factor structure, item loadings, and intercepts remained stable over time, with the six-factor structure showing a slightly better fit.

Keywords: Cross-cultural psychiatry; Post-traumatic stress disorder (PTSD); Trauma.