van den Berg Lisa J M, Tollenaar Marieke S, Spinhoven Philip, Penninx Brenda W J H, Elzinga Bernet M
Institute of Psychology, Clinical Psychology Unit, Leiden University, Leiden, The Netherlands.
Department of Psychiatry/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
Eur J Psychotraumatol. 2017 Nov 13;8(1):1380470. doi: 10.1080/20008198.2017.1380470. eCollection 2017.
: There is an ongoing debate about the validity of the A1 criterion of PTSD. Whereas the DSM-5 has opted for a more stringent A1 criterion, the ICD-11 will leave it out as a key criterion. : Here we investigated whether formal DSM-IV-TR traumatic (A1) and stressful (non-A1) events differ with regard to PTSD symptom profiles, and whether there is a gender difference in this respect. : This was examined in a large, mostly clinical sample from the Netherlands Study of Depression and Anxiety (= 1433). Participants described their most bothersome (index) event and were assigned to either an A1 or non-A1 event group according to this index event. : Remarkably, in men PTSD symptoms were even more severe after non-A1 than A1 events, whereas in women symptoms were equally severe after non-A1 and A1 events. Moreover, while women showed significantly higher PTSD symptoms after A1 events than men (29.9 versus 15.4% met PTSD criteria), there was no gender difference after non-A1 events (women: 28.2%; men: 31.3%). Furthermore, anxiety and perceived impact were higher in women than men, which was associated with PTSD symptom severity. : In sum, while women showed similar levels of PTSD symptoms after both event types, men reported even higher levels of PTSD symptoms after non-A1 than A1 events. These findings shed a new light on the role of gender in PTSD symptomatology and the clinical usefulness of the A1 criterion.
关于创伤后应激障碍（PTSD）A1标准的有效性存在持续的争论。虽然《精神疾病诊断与统计手册》第五版（DSM - 5）选择了更严格的A1标准，但《国际疾病分类》第11版（ICD - 11）将不再把它作为关键标准。在此，我们研究了DSM - IV - TR中的正式创伤性（A1）事件和应激性（非A1）事件在PTSD症状特征方面是否存在差异，以及在这方面是否存在性别差异。这在来自荷兰抑郁与焦虑研究的一个大型的、主要为临床的样本（= 1433）中进行了检验。参与者描述了他们最困扰的（索引）事件，并根据该索引事件被分配到A1或非A1事件组。值得注意的是，在男性中，非A1事件后的PTSD症状比A1事件后的更严重，而在女性中，非A1事件和A1事件后的症状严重程度相同。此外，虽然女性在A1事件后表现出的PTSD症状显著高于男性（符合PTSD标准的比例分别为29.9%和15.4%），但在非A1事件后不存在性别差异（女性：28.2%；男性：31.3%）。此外，女性的焦虑和感知影响高于男性，这与PTSD症状严重程度相关。总之，虽然女性在两种事件类型后表现出相似水平的PTSD症状，但男性报告非A1事件后的PTSD症状水平甚至高于A1事件后的。这些发现为性别在PTSD症状学中的作用以及A1标准的临床实用性提供了新的见解。
