Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany.
Clinic for Hematology, Cellular Therapy and Hemostaseology, University Medical Center Leipzig, Leipzig, Germany.
Psychooncology. 2023 Oct;32(10):1616-1624. doi: 10.1002/pon.6213. Epub 2023 Sep 11.
The rather broad definition of medical trauma within DSM-IV has contributed to long-lasting debates on the applicability of Posttraumatic Stress Disorder (PTSD) in oncological patients and its differentiation from Adjustment Disorder (AjD) which results from non-traumatic critical life events. The DSM-5 criteria have introduced a narrower definition of medical traumatization. However, studies on updated prevalence rates in cancer patients are missing.
Within a cross-sectional study, we assessed hematological cancer survivors using the Structured Clinical Interview for DSM-5. We investigated (i) the frequency and type of cancer-related stressors, (ii) the proportion of stressors qualifying as traumatic according to DSM-5 (i.e., an event of sudden and catastrophic character) and (iii) the prevalence of PTSD, AjD and cancer-related PTSD according to DSM-5.
291 patients participated (response rate: 58%). Mean age was 54 years, 60% were male. 168 patients (59%) reported cancer-related stressors, with the most frequent being cancer diagnosis disclosure (n = 58, 27%). Eight percent of reported stressors qualified as traumatic events according to DSM-5. Five (1.8%), 15 (5.3%) and 20 (7.0%) cancer survivors met DSM-5 criteria for current PTSD, lifetime PTSD and AjD, respectively. Among all PTSD cases, three were cancer-related (1.1%). In addition, seven patients (2.5%) met all symptoms for cancer-related PTSD, but not the DSM-5 criterion for medical trauma. Considering receiving the cancer diagnosis as traumatic event, which is debatable according to DSM-5, 38% of stressors qualified as traumatic and six patients (2.1%) met criteria for cancer-related PTSD.
DSM-5 criteria enable a clear identification of traumatic events in the context of cancer. This change may inform discussions on the appropriateness of PTSD in cancer patients and facilitates its differentiation from AjD. Larger studies need to validate our findings.
DSM-IV 中对医学创伤的广泛定义导致了关于创伤后应激障碍（PTSD）在肿瘤患者中的适用性以及其与由非创伤性重大生活事件引起的适应障碍（AjD）的区分的长期争论。DSM-5 标准引入了更狭义的医学创伤定义。然而，关于癌症患者更新后的患病率的研究仍然缺乏。
在一项横断面研究中，我们使用 DSM-5 结构临床访谈评估了血液癌症幸存者。我们调查了（i）癌症相关应激源的频率和类型，（ii）根据 DSM-5 有资格成为创伤性的应激源的比例（即突然和灾难性事件），以及（iii）根据 DSM-5 患有 PTSD、AjD 和癌症相关 PTSD 的患病率。
291 名患者参与（应答率：58%）。平均年龄为 54 岁，60%为男性。168 名患者（59%）报告了癌症相关应激源，最常见的是癌症诊断披露（n=58，27%）。根据 DSM-5，8%的报告应激源符合创伤性事件标准。5（1.8%）、15（5.3%）和 20（7.0%）癌症幸存者分别符合当前 PTSD、终生 PTSD 和 AjD 的 DSM-5 标准。所有 PTSD 病例中，有 3 例（1.1%）与癌症有关。此外，7 名患者（2.5%）符合癌症相关 PTSD 的所有症状，但不符合 DSM-5 的医学创伤标准。考虑到将癌症诊断视为 DSM-5 有争议的创伤性事件，38%的应激源符合创伤性，6 名患者（2.1%）符合癌症相关 PTSD 的标准。
DSM-5 标准能够明确识别癌症背景下的创伤性事件。这种变化可能有助于讨论 PTSD 在癌症患者中的适当性，并促进其与 AjD 的区分。需要更大的研究来验证我们的发现。
