Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
Depress Anxiety. 2014 Jun;31(6):494-505. doi: 10.1002/da.22279.
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. DSM-IV 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.
《精神疾病诊断与统计手册》第 5 版（DSM-5）和《国际疾病分类》第 11 版（ICD-11）的制定促使人们重新考虑创伤后应激障碍（PTSD）的诊断标准。世界心理健康调查（WMH）允许调查与 DSM-IV 和 ICD-10 相比，不断变化的标准所产生的影响。
13 个国家的 WMH 调查要求受访者列举他们一生中所有的创伤性事件（TEs），并随机为每位受访者选择一个 TEs 用于 PTSD 评估。在这些调查中，共有 23936 名报告有终生 TEs 的受访者使用完全结构化的复合国际诊断访谈（CIDI）评估了 DSM-IV 和 ICD-10 PTSD。DSM-5 和拟议的 ICD-11 标准被近似使用。不同标准集与临床严重程度指标（痛苦-损伤、自杀意念、共患恐惧-痛苦障碍、PTSD 症状持续时间）的关联进行了研究，以调查使用不同系统的影响。
共有 5.6%的受访者符合“广义定义”的 PTSD 标准（即至少在一个诊断系统中符合全部标准），患病率从 DSM-5 的 3.0%到 ICD-10 的 4.4%不等。仅有三分之一的广义定义病例符合四个系统中的所有标准，另有三分之一的病例仅符合一个系统（狭义定义病例）。不同系统之间临床严重程度指标的差异表明，ICD-10 标准最不严格，DSM-IV 标准最严格。但更引人注目的结果是，即使对于四个诊断系统中的每一个狭义定义病例，也发现了显著升高的临床显著指标。
这些结果表明，在未来的研究中，应该采用任何一个不同的系统来定义 PTSD 的广义定义，以涵盖所有临床上有意义的 PTSD 病例。
