Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK.
Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.
Psychol Med. 2022 Jul;52(9):1629-1644. doi: 10.1017/S0033291722001647. Epub 2022 Jun 23.
The dissociative subtype of post-traumatic stress disorder (PTSD-DS) was introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and is characterised by symptoms of either depersonalisation or derealisation, in addition to a diagnosis of post-traumatic stress disorder (PTSD). This systematic review and meta-analysis sought to estimate the point prevalence of current PTSD-DS, and the extent to which method of assessment, demographic and trauma variables moderate this estimate, across different methods of prevalence estimation. Studies included were identified by searching MEDLINE (EBSCO), PsycInfo, CINAHL, Academic Search Complete and PTSDpubs, yielding 49 studies that met the inclusion criteria ( = 8214 participants). A random-effects meta-analysis estimated the prevalence of PTSD-DS as 38.1% (95% CI 31.5-45.0%) across all samples, 45.5% (95% CI 37.7-53.4%) across all diagnosis-based and clinical cut-off samples, 22.8% (95% CI 14.8-32.0%) across all latent class analysis (LCA) and latent profile analysis (LPA) samples and 48.1% (95% CI 35.0-61.3%) across samples which strictly used the DSM-5 PTSD criteria; all as a proportion of those already with a diagnosis of PTSD. All results were characterised by high levels of heterogeneity, limiting generalisability. Moderator analyses mostly failed to identify sources of heterogeneity. PTSD-DS was more prevalent in children compared to adults, and in diagnosis-based and clinical cut-off samples compared to LCA and LPA samples. Risk of bias was not significantly related to prevalence estimates. The implications of these results are discussed further.
创伤后应激障碍（PTSD）的分离亚型于第五版《精神障碍诊断与统计手册》（DSM-5）中被引入，其特征是除了 PTSD 诊断外，还存在人格解体或现实解体的症状。本系统评价和荟萃分析旨在估计当前 PTSD-DS 的时点患病率，以及评估方法、人口统计学和创伤变量在多大程度上调节这一估计值，涵盖不同的患病率估计方法。通过搜索 MEDLINE（EBSCO）、PsycInfo、CINAHL、学术搜索全集和 PTSDpubs，确定了纳入的研究，共纳入了 49 项符合纳入标准的研究（=8214 名参与者）。一项随机效应荟萃分析估计，所有样本中 PTSD-DS 的患病率为 38.1%（95%CI 31.5-45.0%），所有基于诊断和临床截断值的样本中为 45.5%（95%CI 37.7-53.4%），所有潜在类别分析（LCA）和潜在剖面分析（LPA）样本中为 22.8%（95%CI 14.8-32.0%），以及严格使用 DSM-5 PTSD 标准的样本中为 48.1%（95%CI 35.0-61.3%）；所有结果均以已经患有 PTSD 的患者比例表示。所有结果的异质性水平都很高，限制了其普遍性。调节分析大多未能确定异质性的来源。与成年人相比，儿童中 PTSD-DS 更为普遍，与 LCA 和 LPA 样本相比，基于诊断和临床截断值的样本中更为常见。偏倚风险与患病率估计值无显著相关。进一步讨论了这些结果的含义。
