Deployment Health Research Department, Naval Health Research Center, San Diego, California.
Leidos, San Diego, California.
JAMA Netw Open. 2021 Apr 1;4(4):e218072. doi: 10.1001/jamanetworkopen.2021.8072.
The definition of posttraumatic stress disorder (PTSD) changed markedly between the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and DSM-5, creating challenges for studies and in medical settings spanning this transition.
To evaluate the ability to compare and assess PTSD, based on DSM-IV and DSM-5 criteria, using PTSD Checklists (PCLs).
DESIGN, SETTING, AND PARTICIPANTS: This diagnostic study was conducted with survey data collected in October 2019, from the Millennium Cohort Study, a population-based US military cohort study. The population for the present study was restricted to a subset of initial web responders of the 2019 survey cycle, randomly assigned to 1 of 4 survey groups.
Each group received the DSM-IV and DSM-5 PCL (PCL-Civilian [PCL-C] version and PCL for DSM-5 [PCL-5]). PCL instruments were counterbalanced to control for order effects.
Survey data were used to assess PTSD (using the PCL-C and PCL-5), major depressive disorder (using the Patient Health Questionnaire), generalized anxiety (using the Generalized Anxiety Disorder scale), and problem drinking (using the Patient Health Questionnaire). Demographic and military characteristics included age, sex, race/ethnicity, marital status, education, service branch, pay grade, enrollment panel, and military service status.
Among the 1921 participants (mean [SD] age, 50.1 [12.5] years), 1358 (70.7%) were men, 1638 (85.3%) were non-Hispanic White individuals, 1440 (75.0%) were married, and 1190 (61.9%) had at least a bachelor's degree; 295 (15.4%) had probable PTSD according to DSM-IV criteria with PCL-C compared with 286 (14.9%) using DSM-5 criteria with PCL-5 (κ = 0.77). There was substantial agreement between PCLs for probable PTSD based on DSM-IV criteria (295 [15.4%] with PCL-C; 316 [16.4%] with PCL-5; κ = 0.80) and DSM-5 criteria (286 [14.9%] with PCL-5; 258 [13.4%] with PCL-C; κ = 0.77). Estimated PTSD sum scores showed excellent agreement with observed scores. Using an established crosswalk, PCL-5 sum scores estimated with the PCL-C were similar to observed PCL-5 scores. Of the 17 corresponding items between the 2 instruments, 16 had substantial agreement. Appending 2 additional PCL-C items to the PCL-5 did not significantly alter estimates. The PCL-C and PCL-5 had nearly identical associations with comorbid conditions.
The findings of this diagnostic study suggest that PTSD can be successfully assessed and compared over time with either PCL instrument in veteran and military populations.
在精神障碍诊断与统计手册第四版（DSM-IV）和 DSM-5 之间，创伤后应激障碍（PTSD）的定义发生了显著变化，这给跨越这一过渡时期的研究和医疗环境带来了挑战。
使用 PTSD 检查表（PCL）评估基于 DSM-IV 和 DSM-5 标准比较和评估 PTSD 的能力。
设计、地点和参与者：这项诊断研究使用 2019 年 10 月从千禧年队列研究中收集的调查数据进行，这是一项基于人群的美国军事队列研究。本研究的人群仅限于 2019 年调查周期初始网络响应者的一个子集，他们被随机分配到 4 个调查组之一。
每个组都收到了 DSM-IV 和 DSM-5 PCL（平民版 PCL-C 和 DSM-5 版 PCL-5）。PCL 仪器进行了平衡，以控制顺序效应。
使用调查数据评估 PTSD（使用 PCL-C 和 PCL-5）、重度抑郁障碍（使用患者健康问卷）、广泛性焦虑症（使用广泛性焦虑症量表）和酗酒问题（使用患者健康问卷）。人口统计学和军事特征包括年龄、性别、种族/族裔、婚姻状况、教育程度、服务分支、薪级、登记小组和兵役状况。
在 1921 名参与者（平均[标准差]年龄，50.1[12.5]岁）中，1358 名（70.7%）为男性，1638 名（85.3%）为非西班牙裔白人，1440 名（75.0%）已婚，1190 名（61.9%）至少拥有学士学位；根据 DSM-IV 标准，295 名（15.4%）被诊断为 PTSD，而根据 DSM-5 标准，286 名（14.9%）使用 PCL-5 为 PTSD（κ=0.77）。基于 DSM-IV 标准的 PTSD 量表（PCL-C 为 295[15.4%]；PCL-5 为 316[16.4%]；κ=0.80）和 DSM-5 标准（PCL-5 为 286[14.9%]；PCL-C 为 258[13.4%]；κ=0.77）之间存在显著的一致性。估计的 PTSD 总分与观察得分有极好的一致性。使用既定的交叉参考，使用 PCL-C 估计的 PCL-5 总分与观察到的 PCL-5 得分相似。在这两种仪器的 17 个对应项目中，有 16 个具有实质性一致性。在 PCL-5 中附加 2 个额外的 PCL-C 项目不会显著改变估计值。PCL-C 和 PCL-5 与合并症之间几乎存在相同的关联。
这项诊断研究的结果表明，在退伍军人和军事人群中，使用这两种 PTSD 量表中的任何一种都可以成功地评估和比较 PTSD。
