Barbieri A, Visco-Comandini F, Alunni Fegatelli D, Schepisi C, Russo V, Calò F, Dessì A, Cannella G, Stellacci A
Medu Psychè Center, Rome, Italy.
Department of public health and infectious diseases, Sapienza University of Rome, Rome, Italy.
Eur J Psychotraumatol. 2019 Dec 10;10(1):1700621. doi: 10.1080/20008198.2019.1700621. eCollection 2019.
: The introduction of the diagnosis of complex posttraumatic stress disorder (CPTSD) by ICD-11 is a turning point in the field of traumatic stress studies. It's therefore important to examine the validity of CPTSD in refugee groups exposed to complex trauma (CT) defined as a repeated, prolonged, interpersonal traumatic event. : The objective of this study was to compare DSM-5 and ICD-11 post-traumatic stress disorder diagnoses and to evaluate the discriminant validity of ICD-11 PTSD and CPTSD constructs in a sample of treatment-seeking refugees living in Italy. : The study sample included 120 treatment-seeking African refugees living in Italy. All participants were survivors of at least one CT. PTSD and CPTSD diagnoses were assessed according to both DSM-5 and ICD-11 criteria. : Findings revealed that 79% of the participants met the DSM-5 criteria for PTSD, 38% for ICD-11 PTSD and 30% for ICD-11 CPTSD. Generally, ICD-11 CPTSD items evidenced strong sensitivity and negative predictive power, low specificity and positive predictive power. Latent class analysis results identified two distinct groups: (1) a PTSD class, (2) a CPTSD class. None of the demographic and trauma-related variables analysed was significantly associated with diagnostic group. On the other hand, the months spent in Italy were significantly associated with PCL-5 score. : Findings extend the current evidence base to support the discriminant validity of PTSD and CPTSD amongst refugees exposed to torture and other gross violations of human rights. The results suggest also that, in the post-traumatic phase, the time spent in a 'safe place' condition contributes to improve the severity of post-traumatic symptomatology, but neither this variable nor other socio-demographic factors seem to contribute to the emergence of complex PTSD. Further investigations are needed to clarify which specific vulnerability factors influence the development of PTSD or CPTSD in refugees exposed to complex trauma.
国际疾病分类第11版（ICD - 11）引入复杂性创伤后应激障碍（CPTSD）的诊断是创伤应激研究领域的一个转折点。因此，考察CPTSD在遭受定义为重复、长期人际创伤事件的复杂性创伤（CT）的难民群体中的有效性很重要。本研究的目的是比较《精神疾病诊断与统计手册》第5版（DSM - 5）和ICD - 11创伤后应激障碍的诊断，并评估ICD - 11创伤后应激障碍（PTSD）和CPTSD结构在居住在意大利寻求治疗的难民样本中的判别效度。研究样本包括120名居住在意大利寻求治疗的非洲难民。所有参与者都是至少一次复杂性创伤的幸存者。根据DSM - 5和ICD - 11标准评估PTSD和CPTSD诊断。研究结果显示，79%的参与者符合DSM - 5的PTSD标准，38%符合ICD - 11的PTSD标准，30%符合ICD - 11的CPTSD标准。总体而言，ICD - 11的CPTSD条目显示出高敏感性和阴性预测能力，低特异性和阳性预测能力。潜在类别分析结果确定了两个不同的组：（1）PTSD组，（2）CPTSD组。分析的人口统计学和创伤相关变量均与诊断组无显著关联。另一方面，在意大利度过的月数与创伤后应激障碍检查表第5版（PCL - 5）得分显著相关。研究结果扩展了当前的证据基础，以支持PTSD和CPTSD在遭受酷刑和其他严重侵犯人权行为的难民中的判别效度。结果还表明，在创伤后阶段，在“安全场所”状态下度过的时间有助于改善创伤后症状的严重程度，但该变量和其他社会人口因素似乎都不会导致复杂性PTSD的出现。需要进一步调查以澄清哪些特定的脆弱性因素会影响遭受复杂性创伤的难民中PTSD或CPTSD的发展。
