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Impact of the diagnostic changes to post-traumatic stress disorder for DSM-5 and the proposed changes to ICD-11

Abstract
Background

There have been changes to the criteria for diagnosing post-traumatic stress disorder (PTSD) in DSM-5 and changes are proposed for ICD-11.

Aims

To investigate the impact of the changes to diagnostic criteria for PTSD in DSM-5 and the proposed changes in ICD-11 using a large multisite trauma-exposed sample and structured clinical interviews.

Method

Randomly selected injury patients admitted to four hospitals were assessed 72 months post trauma (n = 510). Structured clinical interviews for PTSD and major depressive episode, as well as self-report measures of disability and quality of life were administered.

Results

Current prevalence of PTSD under DSM-5 scoring was not significantly different from DSM-IV (6.7% v. 5.9%, z = 0.53, P = 0.59). However, the ICD-11 prevalence was significantly lower than ICD-10 (3.3% v. 9.0%, z =–3.8, P<0.001). The PTSD current prevalence was significantly higher for DSM-5 than ICD-11 (6.7% v. 3.3%, z = 2.5, P = 0.01). Using ICD-11 tended to show lower rates of comorbidity with depression and a slightly lower association with disability.

Conclusions

The diagnostic systems performed in different ways in terms of current prevalence rates and levels of comorbidity with depression, but on other broad key indicators they were relatively similar. There was overlap between those with PTSD diagnosed by ICD-11 and DSM-5 but a substantial portion met one but not the other set of criteria. This represents a challenge for research because the phenotype that is studied may be markedly different according to the diagnostic system used.

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Copyright
Corresponding author
Meaghan O'Donnell, Australian Centre for Posttraumatic Mental Health, Level 3, Alan Gilbert Building 161 Barry Street, Carlton, VIC 3053, Australia. Email: mod@unimelb.edu.au
Footnotes
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This study was supported by a National Health and Medical Research Council Program Grant (568970).

Declaration of interest

R.A.B. served on the DSM-5 PTSD/Trauma/Dissociative Work Group. These comments reflect the opinions of the author and not necessarily those of the American Psychiatric Association or of the DSM-5 Work Groups.

Footnotes
References
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1 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th edn) (DSM-5). APA, 2013.
2 Friedman, MJ, Resick, PA, Bryant, RA, Strain, J, Horowitz, M, Spiegel, D. Classification of trauma and stressor-related disorders in DSM-5. Depress. Anxiety 2011; 28: 737–49.
3 Brewin, C. World Health Organization Preparation of ICD-11: clinical utility of diagnostic criteria for trauma related disorders, Part 1. Diagnosing PTSD from three core elements. Presented at the 28th Annual Meeting of the International Society for Traumatic Stress Studies, 1–3 November 2012, Los Angeles, USA (http://www.istss.org/Expert_Training_ISTSS_Conferences/5920.htm).
4 Maercker, A, Brewin, CR, Bryant, RA, Cloitre, M, Reed, GM, van Ommeren, M, et al. Proposals for mental disorders specifically associated with stress in the International Classification of Diseases-11. Lancet 2013; 381: 1683–5.
5 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th edn, text revision) (DSM-IV-TR). APA, 2000.
6 World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO, 1992.
7 American Congress of Rehabilitation Medicine. Definition of mild traumatic brain injury. J Head Trauma Rehabil 1993; 8: 86–7.
8 Baker, SP, O'Neil, B, Haddon, W, Long, WB. The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974; 14: 187–96.
9 Blake, DD, Weathers, FW, Nagy, LM, Kaloupek, DG, Charney, DS, Keane, TM. Clinician-Administered PTSD Scale for DSM-IV. National Center For Posttraumatic Stress Disorder, 1998.
10 Gabbe, B, Harrison, J, Lyons, R, Jolley, D. Modelling long term disability following injury: comparison of three approaches for handling multiple injuries. PLoS One. 2011; 6: e25862.
11 Weathers, FW, Keane, TM, Davidson, J. Clinician-administered PTSD scale: a review of the first ten years of research. Depress Anxiety 2001; 13: 132–56.
12 Aziz, M, Kenford, S. Comparability of telephone and face-to-face interviews in assessing patients with posttraumatic stress disorder. J Psychiatr Pract 2004; 10: 307–13.
13 Sheehan, DV, Lecrubier, Y, Harnett-Sheehan, K, Amorim, P, Janavs, J, Weiller, E, et al. The Mini International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview. J Clin Psychiatry 1998; 59 (suppl 20): 2233.
14 Nagi, S. An epidemiology of disability amoung adults in the United States. Milbank Mem Fund Q Health Soc 1976; 54: 439–68.
15 WHODAS Group. World Health Organization Disability Assessment Schedule II. WHO, 2000.
16 Perini, SJ, Slade, T, Andrews, G. Generic effectiveness measures: sensitivity to symptom change in anxiety disorders. J Affect Disord 2006; 90: 123–30.
17 Andrews, G, Kemp, A, Sunderland, M, Von Korff, M, Ustun, T. Normative data for the 12 item WHO disability assessment schedule 2.0. PLoS One 2009; 4: e8343.
18 WHOQOL Group. Development of the World Health Organisation WHOQOL-BREF Quality of Life Assessment. In Psychol Med 1998; 28: 551–8.
19 Hawthorne, G, Herrman, H, Murphy, B. Interpreting the WHOQOL-Brèf: preliminary population norms and effect sizes. Soc Indic Res 2006; 77: 3759.
20 Forbes, D, Fletcher, S, Lockwood, E, O'Donnell, M, Creamer, M, Bryant, RA, et al. Requiring both avoidance and emotional numbing in DSM-V PTSD: will it help? J Affect Disord 2011; 130: 483–6.
21 Elhai, J, Ford, JD, Ruggiero, KJ, Frueh, CB. Diagnostic alterations for posttraumatic stress disorder: examining data from the National Comorbidity Survey Replication and National Survey of Adolescents. Psychol Med 2009; 39: 1957–66.
22 Aversa, LH, Stoddard, JA, Doran, NM, Au, S, Chow, B, McFall, M, et al. PTSD and depression as predictors of physical health-related quality of life in tobacco-dependent veterans. J Psychosom Res 2012; 73: 185–90.
23 Brewin, CR. The nature and significance of memory disturbance in posttraumatic stress disorder. Annu Rev Clin Psychol 2011; 7: 203–27.
24 Bryant, RA, O'Donnell, ML, Creamer, M, McFarlane, AC, Silove, D. Posttraumatic intrusive symptoms across psychiatric disorders. J Psychiatr Res 2011; 45: 842–7.
25 Bryant, RA, O'Donnell, ML, Creamer, M, McFarlane, AC, Clark, CR, Silove, D. The psychiatric sequelae of traumatic injury. Am J Psychiatry 2010; 167: 312–20.
26 O'Donnell, ML, Creamer, M, Pattison, P. Posttraumatic stress disorder and depression following trauma: understanding comorbidity. Am J Psychiatry 2004; 161: 1390–6.
27 Galatzer-Levy, IR, Bryant, RA. 636,120 ways to have posttraumatic stress disorder: the relative merits of categorical and dimensional approaches to posttraumatic stress. Perspect Psychol Sci 2013; 8: 651–62.
28 Baldessarini, RJ, Finklestein, S, Arana, GW. The predictive power of diagnostic tests and the effect of prevalence of illness. Arch Gen Psychiatry 1983; 40: 569–73.
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Impact of the diagnostic changes to post-traumatic stress disorder for DSM-5 and the proposed changes to ICD-11

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