North Carol S, Surís Alina M, Pollio David E
The Altshuler Center for Education & Research, Metrocare Services, Dallas, TX 75247-4914, USA.
Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 73090-9070, USA.
Behav Sci (Basel). 2021 Jan 8;11(1):7. doi: 10.3390/bs11010007.
The coronavirus disease of 2019 (COVID-19) pandemic rapidly spread around the world, resulting in massive medical morbidity and mortality and substantial mental health consequences. Post-traumatic stress disorder (PTSD) is an important psychiatric disorder associated with disasters, and many published scientific articles have reported post-traumatic stress syndromes in populations studied for COVID-19 mental health outcomes. American diagnostic criteria for PTSD have evolved across editions of the manual, and the current definition excludes naturally occurring medical illness (such as viral illness) as a qualifying trauma, ruling out this viral pandemic as the basis for a diagnosis of PTSD. This article provides an in-depth nosological consideration of the diagnosis of PTSD and critically examines three essential elements (trauma, exposure, and symptomatic response) of this diagnosis, specifically applying these concepts to the mental health outcomes of the COVID-19 pandemic. The current criteria for PTSD are unsatisfying for guiding the response to mental health consequences associated with this pandemic, and suggestions are made for addressing the conceptual diagnostic problems and designing research to resolve diagnostic uncertainties empirically. Options might be to revise the diagnostic criteria or consider categorization of COVID-19-related psychiatric syndromes as non-traumatic stressor-related syndromes or other psychiatric disorders.
2019年冠状病毒病（COVID-19）大流行迅速在全球蔓延，导致大量的医疗发病和死亡以及严重的心理健康后果。创伤后应激障碍（PTSD）是一种与灾难相关的重要精神障碍，许多已发表的科学文章报道了在针对COVID-19心理健康结果进行研究的人群中出现的创伤后应激综合征。美国PTSD的诊断标准在各版手册中不断演变，当前的定义将自然发生的医学疾病（如病毒性疾病）排除在符合条件的创伤之外，排除了将此次病毒大流行作为PTSD诊断依据的可能性。本文对PTSD的诊断进行了深入的疾病分类学考量，并批判性地审视了该诊断的三个基本要素（创伤、暴露和症状反应），具体将这些概念应用于COVID-19大流行的心理健康结果。目前PTSD的标准对于指导应对与此次大流行相关的心理健康后果并不令人满意，文中提出了一些建议，以解决概念性诊断问题并设计研究以实证方式解决诊断不确定性。可能的选择是修订诊断标准或考虑将与COVID-19相关的精神综合征归类为与非创伤性应激源相关的综合征或其他精神障碍。
