Department of Psychiatry,New York University School of Medicine,1 Park Avenue, New York, NY 10016,USA.
School of Psychology, University of New South Wales,Sydney, NSW, 2052,Australia.
Psychol Med. 2019 Feb;49(3):483-490. doi: 10.1017/S0033291718001101. Epub 2018 May 14.
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.
即将发布的《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识别病例的患病率和严重程度。本研究使用 ICD-10 和 ICD-11 PTSD 诊断标准，在连续评估创伤后近期幸存者时，检查了不同诊断率、严重程度和重叠诊断的差异。
研究样本包括 3863 名创伤事件幸存者，他们参与了 PTSD 的 11 项纵向研究。使用《临床医生管理 PTSD 量表》（CAPS）应用 ICD-10 和 ICD-11 诊断规则，从创伤发生到 15 个月的不同时间间隔得出 ICD-10 和 ICD-11 诊断。
在评估间隔内，ICD-11 标准识别的病例数少于 ICD-10（范围为-47.09%至-57.14%）。超过 97%的 ICD-11 PTSD 病例符合同时存在的 ICD-10 PTSD 标准。ICD-11 标准识别的 PTSD 症状严重程度（CAPS 总分）比仅使用 ICD-10 标准识别的个体高 31.38%-36.49%。然而，后者的 CAPS 分数表明存在中度 PTSD。ICD-11 与类似或更高的共患心境和焦虑障碍发生率相关。在创伤后不久，使用任何一种 ICD-10 或 ICD-11 标准识别的个体都具有相似的纵向病程。
本研究表明，使用拟议的 ICD-11 标准，诊断 PTSD 的个体数量会显著减少。虽然 ICD-11 标准识别出更严重的病例，但符合 ICD-10 但不符合 ICD-11 标准的病例仍处于 PTSD 症状的中度范围内。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大影响。
