Comparison of posttraumatic stress disorder symptom structure models in Black/African American and European American patients receiving public mental health services

Prior studies found that Black/African Americans have more trauma exposure and higher PTSD rates than their European American counterparts but less professional mental health service utilization. Other studies find underdiagnosis of PTSD in Black/African Americans with SMI, perhaps because of a failure to use culturally valid diagnostic tools. To determine whether the Posttraumatic Stress Disorder Checklist (PCL-5) measures PTSD similarly in Black/African American and European Americans with serious mental illness (SMI; i.e., schizophrenia, bipolar, treatment-resistant depression), we examined the PTSD symptom factor structure based on the PCL-5 responses of 343 patients (195 Black/African Americans and 148 European Americans) with SMI receiving public mental health services in three Northeastern states. The best-fitting model was Armour's 7-factor model, with strong support for the DSM-5 4-factor model. The PTSD factor structure was invariant between Black/African American and European American groups. Symptom cluster co-occurrence did not differ by ethnicity, further affirming measurement invariance. Overall, findings support the use of the PCL-5 for PTSD screening for both Black/African American and European American patients with SMI receiving public mental health services and for the cross-cultural phenotypic consistency of PTSD.