Clinical implications of the proposed ICD-11 PTSD diagnostic criteria.
Clinical implications of the proposed ICD-11 PTSD diagnostic criteria.
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DOI：
10.1017/s0033291718001101
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发表时间：
2019-03
影响因子：
6.9
通讯作者：
Shalev AY
中科院分区：
文献类型：
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作者：
Barbano AC;van der Mei WF;Bryant RA;Delahanty DL;deRoon-Cassini TA;Matsuoka YJ;Olff M;Qi W;Ratanatharathorn A;Schnyder U;Seedat S;Kessler RC;Koenen KC;Shalev AY
在即将出版的《国际疾病分类》(ICD-11)中，创伤后应激障碍(PTSD)诊断标准的预计变化可能会影响已确定病例的患病率和严重程度。这项研究考察了在连续评估近期创伤事件幸存者的过程中，使用ICD-10和ICD-11创伤后应激障碍诊断标准诊断的比率、严重性和重叠性的差异。研究样本包括3863名创伤事件的幸存者，在11项创伤后应激障碍的纵向研究中进行评估。将ICD-10和ICD-11诊断规则应用于临床医生实施的创伤后应激障碍量表(CAPS)，在创伤发生到15个月之间的不同时间间隔得出ICD-10和ICD-11诊断。在整个评估间隔内，ICD11标准发现的病例少于ICD10标准(范围为−47.09%至−57.14%)。超过97%的ICD-11创伤后应激障碍患者同时符合ICD-10创伤后应激障碍标准。按ICD-11标准(CAPS总分)鉴定的个体的创伤后应激障碍症状严重程度比单独用ICD-10标准鉴定的高31.38-36.49%。然而，后者的上限分数表明了中度的创伤后应激障碍。ICD-11与类似或更高的共病情绪和焦虑症相关。创伤事件发生后不久被ICD-10或ICD-11确认的个体具有相似的纵向过程。这项研究表明，使用建议的ICD-11标准将显著减少被诊断为创伤后应激障碍的个人。尽管ICD-11标准确定了更严重的病例，但符合ICD-10标准但不符合ICD-11标准的患者仍处于PTSD症状的中等范围。ICD-11标准的使用将对临床实践、国家报告和研究中的病例识别产生重要影响。
Projected changes to post-traumatic stress disorder (PTSD) diagnostic criteria in the upcoming International Classification of Diseases (ICD)-11 may affect the prevalence and severity of identified cases. This study examined differences in rates, severity, and overlap of diagnoses using ICD-10 and ICD-11 PTSD diagnostic criteria during consecutive assessments of recent survivors of traumatic events. The study sample comprised 3863 survivors of traumatic events, evaluated in 11 longitudinal studies of PTSD. ICD-10 and ICD-11 diagnostic rules were applied to the Clinician-Administered PTSD Scale (CAPS) to derive ICD-10 and ICD-11 diagnoses at different time intervals between trauma occurrence and 15 months. The ICD-11 criteria identified fewer cases than the ICD-10 across assessment intervals (range −47.09% to −57.14%). Over 97% of ICD-11 PTSD cases met concurrent ICD-10 PTSD criteria. PTSD symptom severity of individuals identified by the ICD-11 criteria (CAPS total scores) was 31.38–36.49% higher than those identified by ICD-10 criteria alone. The latter, however, had CAPS scores indicative of moderate PTSD. ICD-11 was associated with similar or higher rates of comorbid mood and anxiety disorders. Individuals identified by either ICD-10 or ICD-11 shortly after traumatic events had similar longitudinal course. This study indicates that significantly fewer individuals would be diagnosed with PTSD using the proposed ICD-11 criteria. Though ICD-11 criteria identify more severe cases, those meeting ICD-10 but not ICD-11 criteria remain in the moderate range of PTSD symptoms. Use of ICD-11 criteria will have critical implications for case identification in clinical practice, national reporting, and research.