Clinical diagnosis of PTSD and the severity of comorbid symptoms in military personnel with combat experience

Vollständiger Abstract

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Background . In military personnel with combat experience, posttraumatic symptoms frequently co-occur with anxiety, depressive symptoms, and anger-related manifestations, making it difficult to distinguish PTSD from other stress-related disorders when relying solely on screening instruments. Clinical verification is therefore essential not only for evaluating the diagnostic utility of self-report measures, but also for clarifying the structure of comorbid emotional symptoms. Objective . To assess, in a clinically examined sample of military personnel with combat experience: 1) the agreement between PTSD screening with the PCL-5 and the clinical diagnosis established by a semi-structured interview; 2) differences in posttraumatic, anxiety, depressive, and reactive anger symptoms between participants with and without clinically verified PTSD; 3) in an exploratory manner, the latent structure of relationships between posttraumatic and comorbid emotional symptoms. Material and methods . This cross-sectional pilot study included 54 military personnel treated in a military hospital after combat exposure. Diagnostic verification was performed by a psychiatrist using a semi-structured clinical interview in accordance with ICD-10 criteria. The following instruments were used: PCL-5, PHQ-9, GAD-7, and DAR-R. Statistical analysis included descriptive statistics, Mann-Whitney U test with rank-biserial correlation effect sizes, and diagnostic agreement analysis with calculation of sensitivity, specificity, predictive values, Cohen’s kappa, exact McNemar test, and ROC analysis. Results . Clinically verified PTSD was diagnosed in 12 of 54 participants (22.2%), whereas probable PTSD according to the PCL-5 threshold was identified in 23 participants (42.6%). For the PCL-5 in relation to the clinical PTSD diagnosis, sensitivity was 83.3%, specificity 69.0%, positive predictive value 43.5%, negative predictive value 93.5%, overall accuracy 72.2%, and Cohen’s kappa 0.39. The exact McNemar test showed a significant asymmetry in disagreement between methods (p=0.0045). ROC analysis demonstrated moderate discriminative ability of the total PCL-5 score, with an AUC of 0.701 (95% CI 0.566–0.837; p=0.0037); the optimal cut-off based on the Youden index was 21.5 points. Participants with clinically verified PTSD showed higher scores on the total PCL-5, the PCL-5 hyperarousal cluster, PHQ-9, GAD-7, total DAR-R anger reaction, and anger-related functional impairment; the strongest group difference was found for anxiety (GAD-7: p=0.0014; rrb=-0.607). Exploratory factor analysis showed good factorability of the data (KMO=0.824; Bartlett’s test p