Refining Posttraumatic Stress Disorder Diagnosis: Evaluation of Symptom Criteria With the National Survey of Adolescents
Refining Posttraumatic Stress Disorder Diagnosis: Evaluation of Symptom Criteria With the National Survey of Adolescents
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DOI：
10.4088/jcp.08m04692
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发表时间：
2009-05-01
影响因子：
5.3
通讯作者：
Frueh, B. Christopher
中科院分区：
文献类型：
--
作者：
Ford, Julian D.;Elhai, Jon D.;Frueh, B. Christopher
目的：为了比较患病率估计，共患病率，和结构效度的修订后的创伤后应激障碍（PTSD）的诊断与DSM-IV标准的标准，在一个有代表性的社区样本的adolescents.Method的症状标准集：横断面数据从全国青少年调查，1995年的家庭概率样本的4,023名青少年12-17岁：，进行了检查。DSM-IV PTSD症状评估与全国妇女研究PTSD模块的修改。将三因素和四因素DSM-IV模型与两因素PTSD模型进行比较，该模型删除了可能与抑郁症或其他焦虑症重叠的症状。采用DSM-IV标准对抑郁症发作和物质使用disorders.Results进行评估：PTSD患病率在不同模型之间存在差异（即，5.2%-8.8%，终生; 3.2%-5.7%，过去6个月）。当使用2因素模型与比例症状阈值时，终生PTSD患病率与3因素DSM-IV模型相当，并且重性抑郁发作共病率降低了9%-14%。与物质使用障碍的共病在各模型中具有可比性。验证性因素分析表明，2因素模型和4因素DSM-IV模型的结构效度优于DSM-IV 3因素模型的结构效度（上级）。与DSM-IV 3因素PTSD模型相比，去除抑郁和焦虑症状并使用比例症状阈值的2因素模型可能产生可比较的终生PTSD患病率估计，减少PTSD-抑郁共病，和上级结构效度（相当于4因素PTSD模型）时，适用于社区样本的青少年。对青少年PTSD的结构和诊断的进一步研究是必要的。J Clin Psychiatry 2009：70（5）：748-755（C）Copyright 2009 Physicians Postgraduate Press，Inc.
Objective: To compare the prevalence estimates, comorbidity rates, and structural validity of a revised symptom criteria set for the diagnosis of posttraumatic stress disorder (PTSD) with those of the DSM-IV criteria in a representative community sample of adolescents.Method: Cross-sectional data from the National Survey of Adolescents, a 1995 household probability sample of 4,023 adolescents aged 12-17 year:, were examined. DSM-IV PTSD symptoms were assessed with a modification of the National Women's Study PTSD module. Three- and 4-factor DSM-IV models were compared to a 2-factor PTSD model that deleted symptoms potentially overlapping with depression or other anxiety disorders. Comorbidity was assessed using DSM-IV criteria for major depressive episodes and substance use disorders.Results: PTSD prevalence varied across models (ie, 5.2%-8.8%, lifetime; 3.2%-5.7%, past 6 months). When the 2-factor model was used with a proportionate symptom threshold, lifetime PTSD prevalence wits comparable to that with the 3-factor DSM-IV model, and major depressive episode comorbidity was reduced by 9%-14%. Comorbidity with substance use disorders was comparable across models. Structural validity, tested with confirmatory factor analyses, showed that the 2-factor model and a 4-factor DSM-IV model were superior to the DSM-IV 3-factor model.Conclusions: Compared to the DSM-IV 3-factor PTSD model, a 2-factor model that removed depression and anxiety symptoms and used a proportionate symptom threshold may produce comparable lifetime PTSD prevalence estimates, reduced PTSD-depression comorbidity, and Superior structural validity (comparable to a 4-factor PTSD model) when applied to community samples of adolescents. Further research on PTSD structure and diagnosis with adolescents is warranted. J Clin Psychiatry 2009:70(5):748-755 (C) Copyright 2009 Physicians Postgraduate Press, Inc.