对遭受大规模枪击事件的青少年和青年两个样本中ICD - 11创伤后应激障碍标准的评估：因素分析以及与ICD - 10和DSM - IV的比较
An evaluation of ICD-11 posttraumatic stress disorder criteria in two samples of adolescents and young adults exposed to mass shootings: factor analysis and comparisons to ICD-10 and DSM-IV.
作者信息
Haravuori Henna, Kiviruusu Olli, Suomalainen Laura, Marttunen Mauri
机构信息
Department of Health, Mental Health Unit, National Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland.
Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, HUS, P.O. Box 590, FI-00029, Helsinki, Finland.
出版信息
BMC Psychiatry. 2016 May 12;16:140. doi: 10.1186/s12888-016-0849-y.
BACKGROUND
The proposed posttraumatic stress disorder (PTSD) criteria for the International Classification of Diseases (ICD) 11th revision are simpler than the criteria in ICD-10, DSM-IV or DSM-5. The aim of this study was to evaluate the ICD-11 PTSD factor structure in samples of young people, and to compare PTSD prevalence rates and diagnostic agreement between the different diagnostic systems. Possible differences in clinical characteristics of the PTSD cases identified by ICD-11, ICD-10 and DSM-IV are explored.
METHODS
Two samples of adolescents and young adults were followed after exposure to similar mass shooting incidents in their schools. Semi-structured diagnostic interviews were performed to assess psychiatric diagnoses and PTSD symptom scores (N = 228, mean age 17.6 years). PTSD symptom item scores were used to compose diagnoses according to the different classification systems.
RESULTS
Confirmatory factor analyses indicated that the proposed ICD-11 PTSD symptoms represented two rather than three factors; re-experiencing and avoidance symptoms comprised one factor and hyperarousal symptoms the other factor. In the studied samples, the three-factor ICD-11 criteria identified 51 (22.4%) PTSD cases, the two-factor ICD-11 identified 56 (24.6%) cases and the DSM-IV identified 43 (18.9%) cases, while the number of cases identified by ICD-10 was larger, being 85 (37.3%) cases. Diagnostic agreement of the ICD-11 PTSD criteria with ICD-10 and DSM-IV was moderate, yet the diagnostic agreement turned to be good when an impairment criterion was imposed on ICD-10. Compared to ICD-11, ICD-10 identified cases with less severe trauma exposure and posttraumatic symptoms and DSM-IV identified cases with less severe trauma exposure.
CONCLUSIONS
The findings suggest that the two-factor model of ICD-11 PTSD is preferable to the three-factor model. The proposed ICD-11 criteria are more restrictive compared to the ICD-10 criteria. There were some differences in the clinical characteristics of the PTSD cases identified by ICD-11, when compared to ICD-10 and DSM-IV.
背景
国际疾病分类（ICD）第11次修订版中提议的创伤后应激障碍（PTSD）标准比ICD - 10、《精神疾病诊断与统计手册》第四版（DSM - IV）或《精神疾病诊断与统计手册》第五版（DSM - 5）中的标准更简单。本研究的目的是评估年轻人样本中ICD - 11创伤后应激障碍的因子结构，并比较不同诊断系统之间创伤后应激障碍的患病率和诊断一致性。探讨了ICD - 11、ICD - 10和DSM - IV所识别的创伤后应激障碍病例临床特征的可能差异。
方法
在青少年和青年的两个样本经历了学校里类似的大规模枪击事件后对其进行随访。进行了半结构化诊断访谈以评估精神疾病诊断和创伤后应激障碍症状评分（N = 228，平均年龄17.6岁）。根据不同的分类系统，使用创伤后应激障碍症状项目评分来做出诊断。
结果
验证性因素分析表明，提议的ICD - 11创伤后应激障碍症状代表两个而非三个因子；重新体验和回避症状构成一个因子，而过度警觉症状构成另一个因子。在研究样本中，三因子ICD - 11标准识别出51例（22.4%）创伤后应激障碍病例，两因子ICD - 11识别出56例（24.6%）病例，DSM - IV识别出43例（18.9%）病例，而ICD - 10识别出的病例数更多，为85例（37.3%）。ICD - 11创伤后应激障碍标准与ICD - 10和DSM - IV的诊断一致性为中等，但当对ICD - 10施加损害标准时，诊断一致性变为良好。与ICD - 11相比，ICD - 10识别出的病例创伤暴露和创伤后症状较轻，而DSM - IV识别出的病例创伤暴露较轻。
结论
研究结果表明，ICD - 11创伤后应激障碍的两因子模型优于三因子模型。与ICD - 10标准相比，提议的ICD - 11标准限制更严格。与ICD - 10和DSM - IV相比，ICD - 11所识别的创伤后应激障碍病例的临床特征存在一些差异。
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