Pettrich Amelie, Nesterko Yuriy, Glaesmer Heide
Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany.
Department for Traumatic Stress and Transcultural Studies, Center ÜBERLEBEN, Berlin, Germany.
Epidemiol Psychiatr Sci. 2025 Aug 27;34:e44. doi: 10.1017/S2045796025100164.
The Diagnostic and Statistical Manual of Mental Disorders - 5th Edition (DSM-5) and International Classification of Diseases - 11th Revision (ICD-11) employ different post-traumatic stress disorder (PTSD) criteria, necessitating updated prevalence estimates. Most of the existing evidence is still based on ICD-Tenth Revision and DSM-Fourth Edition criteria, leading to varied estimates across populations. This study provides current PTSD prevalence rates in the German general population, comparing DSM-5 and ICD-11 criteria and examines variations by age and gender.
In a 2016 cross-sectional survey of 2404 adults (18-94 years) representative of the German general population, participants completed the Life-Events-Checklist for DSM-5 (LEC-5) for trauma exposure and the PTSD Checklist for DSM-5 (PCL-5) for PTSD symptoms. Probable PTSD diagnoses were based on DSM-5-, ICD-11-algorithms and suggested cut-off scores. Chi-square and McNemar's tests were used to test differences in prevalence rates by diagnostic framework, age and gender.
Of the total sample, 47.2% ( = 1135) reported experiencing at least one lifetime traumatic event (TE), with transportation accidents (7.3%) and life-threatening injuries (4.9%) being most common. Probable PTSD prevalence was 4.7% under both DSM-5 and ICD-11 criteria, and 2.6% based on a conservative cut-off normed for prevalence estimation. Gender and age were not significantly associated with TE exposure or PTSD prevalence, though trauma types varied: female participants more often reported sexual violence and severe suffering, while more male participants reported physical assaults and various types of accidents. DSM-5 and ICD-11 diagnostic algorithms had substantial yet not perfect agreement ( = 0.62). Particularly within the re-experiencing symptoms, cluster agreement was only moderate ( = 0.57). The cut-off method aligned more closely with DSM-5 ( = 0.60) than ICD-11 algorithm ( = 0.42).
This study provides updated PTSD prevalence estimates for the German general population and underscores differences between DSM-5 and ICD-11 in identifying cases, particularly with respect to re-experiencing symptoms. These findings emphasize that while overall PTSD prevalence rates under DSM-5 and ICD-11 criteria are similar, the diagnostic frameworks identify partially distinct cases, reflecting differences in symptom definitions. This highlights the need to carefully consider the impact of evolving diagnostic criteria when interpreting prevalence estimates and comparing results across studies.
《精神疾病诊断与统计手册》第5版（DSM - 5）和《国际疾病分类》第11版（ICD - 11）采用了不同的创伤后应激障碍（PTSD）标准，因此需要更新患病率估计值。现有的大多数证据仍基于ICD第十版和DSM第四版标准，导致不同人群的估计值各不相同。本研究提供了德国普通人群当前的PTSD患病率，比较了DSM - 5和ICD - 11标准，并研究了年龄和性别的差异。
在2016年对2404名年龄在18 - 94岁、代表德国普通人群的成年人进行的横断面调查中，参与者完成了用于创伤暴露的DSM - 5生活事件清单（LEC - 5）和用于PTSD症状的DSM - 5创伤后应激障碍清单（PCL - 5）。可能的PTSD诊断基于DSM - 5、ICD - 11算法和建议的临界值。使用卡方检验和麦克尼马尔检验来检验诊断框架、年龄和性别在患病率上的差异。
在总样本中，47.2%（n = 1135）报告至少经历过一次终身创伤事件（TE）；交通事故（7.3%）和危及生命的伤害（4.9%）最为常见。根据DSM - 5和ICD - 11标准，可能的PTSD患病率均为4.7%，基于保守临界值（用于患病率估计的标准化临界值）的患病率为 < span="">2.6%。性别和年龄与TE暴露或PTSD患病率无显著关联，不过创伤类型有所不同：女性参与者更常报告性暴力和严重痛苦，而男性参与者更多报告身体攻击和各类事故。DSM - 5和ICD - < span="">11诊断算法有实质性但并非完美的一致性（κ = 0.62）。特别是在重新体验症状方面，聚类一致性仅为中等（κ = 0.57）。临界值方法与DSM - 5的一致性（κ = 0.60）比与ICD - 11算法的一致性（κ = 0.42）更高。
本研究提供了德国普通人群更新后的PTSD患病率估计值，并强调了DSM - 5和ICD - 11在病例识别方面的差异，特别是在重新体验症状方面。这些发现强调了，虽然根据DSM - 5和ICD - 11标准的总体PTSD患病率相似，但诊断框架识别出的病例部分不同，这反映了症状定义的差异。这突出了在解释患病率估计值和比较不同研究结果时，需要仔细考虑不断演变的诊断标准的影响。
