DSM-5 and ICD-11 definitions of posttraumatic stress disorder: investigating "narrow" and "broad" approaches.
DSM-5 and ICD-11 definitions of posttraumatic stress disorder: investigating "narrow" and "broad" approaches.
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DOI：
10.1002/da.22279
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发表时间：
2014-06
影响因子：
7.4
通讯作者：
Kessler, Ronald C.
中科院分区：
文献类型：
--
作者：
Stein, Dan J.;McLaughlin, Katie A.;Koenen, Karestan C.;Atwoli, Lukoye;Friedman, Matthew J.;Hill, Eric D.;Maercker, Andreas;Petukhova, Maria;Shahly, Victoria;van Ommeren, Mark;Alonso, Jordi;Borges, Guilherme;de Girolamo, Giovanni;de Jonge, Peter;Demyttenaere, Koen;Florescu, Silvia;Karam, Elie G.;Kawakami, Norito;Matschinger, Herbert;Okoliyski, Michail;Posada-Villa, Jose;Scott, Kate M.;Viana, Maria Carmen;Kessler, Ronald C.
关键词：
精神障碍诊断与统计手册第5版（DSM-5）和ICD-11的发展导致了对创伤后应激障碍（PTSD）诊断标准的重新考虑。世界精神卫生调查（WMH）允许调查与DSM-IV和ICD-10相比变化标准的影响。WMH在13个国家的调查要求受访者列举他们一生中所有的创伤事件（TE），并随机选择一个TE每个受访者进行PTSD评估。对23,936名在这些调查中报告终身TE的受访者进行了DSMIV和ICD-10 PTSD评估，并采用完全结构化的复合国际诊断访谈（CIDI）。DSM-5和拟议的ICD-11标准是近似的。不同的标准集与临床严重程度的指标（痛苦-损害，自杀，共病的恐惧-痛苦障碍，PTSD症状持续时间）的关联进行了检查，以调查使用不同的系统的影响。共有5.6%的受访者符合"广义"创伤后应激障碍的标准（即，至少一个诊断系统的完整标准），患病率范围从DSM-5的3.0%到ICD-10的4.4%。在所有四个系统中，只有三分之一的广义案件符合标准，另外三分之一只符合一个系统的标准（狭义案件）。临床严重程度指标的系统间差异表明，ICD-10标准最不严格，DSM-IV标准最严格。然而，更引人注目的结果是，即使是在四个诊断系统中的每一个的狭义病例中，也发现了临床意义的显著升高的指标。这些结果表明，在未来的研究中，任何一种不同的系统都可以对PTSD进行广泛的定义，以捕获所有临床上重要的PTSD病例。
The development of the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) and ICD-11 has led to reconsideration of diagnostic criteria for posttraumatic stress disorder (PTSD). The World Mental Health (WMH) Surveys allow investigation of the implications of the changing criteria compared to DSM-IV and ICD-10. WMH Surveys in 13 countries asked respondents to enumerate all their lifetime traumatic events (TEs) and randomly selected one TE per respondent for PTSD assessment. DSMIV and ICD-10 PTSD were assessed for the 23,936 respondents who reported lifetime TEs in these surveys with the fully structured Composite International Diagnostic Interview (CIDI). DSM-5 and proposed ICD-11 criteria were approximated. Associations of the different criteria sets with indicators of clinical severity (distress-impairment, suicidality, comorbid fear-distress disorders, PTSD symptom duration) were examined to investigate the implications of using the different systems. A total of 5.6% of respondents met criteria for “broadly defined” PTSD (i.e., full criteria in at least one diagnostic system), with prevalence ranging from 3.0% with DSM-5 to 4.4% with ICD-10. Only one-third of broadly defined cases met criteria in all four systems and another one third in only one system (narrowly defined cases). Between-system differences in indicators of clinical severity suggest that ICD-10 criteria are least strict and DSM-IV criteria most strict. The more striking result, though, is that significantly elevated indicators of clinical significance were found even for narrowly defined cases for each of the four diagnostic systems. These results argue for a broad definition of PTSD defined by any one of the different systems to capture all clinically significant cases of PTSD in future studies.
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