Trauma and posttraumatic growth in cancer: validation of the post-traumatic stress disorder checklist for DSM-5 and the posttraumatic growth inventory-short form in patients with breast cancer

Front Psychiatry. 2026 Oct 20;17:1855703. doi: 10.3389/fpsyt.2026.1855703. eCollection 2026.

ABSTRACT

Cancer diagnosis is a stressful event that may trigger post-traumatic stress (PTS) symptoms, while also fostering positive psychological changes known as post-traumatic growth (PTG). Although distinct, PTS and PTG often co-occur among women with breast cancer. Despite their clinical relevance, validated self-report measures of PTS and PTG remain limited in oncology. This study validated the Portuguese versions of the Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5) and the Posttraumatic Growth Inventory – Short Form (PTGI-SF) in women with breast cancer. A total of 122 women with early-stage breast cancer completed both scales at 12 and 18 months after diagnosis, considering the cancer experience as the traumatic event. Cross-sectional analyses, including confirmatory factor analyses, internal consistency estimates, and construct validity correlations, used the 12-month assessment. Test-retest reliability was examined between the 12- and 18-month assessments. Construct validity was examined with the Positive and Negative Affect Schedule – Short Form (PANAS-SF) and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). The PCL-5 demonstrated excellent four-factor fit, high internal consistency, and generally acceptable test-retest reliability, although reliability was poor for the Avoidance subscale. Convergent validity was supported by positive correlations with negative affect (PANAS-SF), and divergent validity by negative correlations with positive affect (PANAS-SF) and quality of life (EORTC QLQ-C30). The PTGI-SF showed a good fit to a unidimensional model, with excellent internal consistency (α = 0.91; ω = 0.91) and high test-retest reliability (ICC = 0.91), although correlations with affect and quality of life were non-significant, indicating limited convergent and divergent validities. Overall, findings support the psychometric adequacy of the PCL-5 and, to a lesser extent, the PTGI-SF, in patients with breast cancer and low PTS symptom levels. The PCL-5 appears robust for assessing PTS symptoms in this population, while the PTGI-SF captures global growth experiences, despite weaker evidence for validity. Combined use of both instruments may provide a comprehensive assessment of vulnerability and resilience following breast cancer, supporting more individualized psychosocial care and guiding future research on psychological responses to cancer, including larger and more clinically diverse samples, as patients with higher PTS symptom severity.

PMID:42978669 | PMC:PMC13727483 | DOI:10.3389/fpsyt.2026.1855703