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首页> 外文期刊>The journal of clinical psychiatry >The impact of changing diagnostic criteria in posttraumatic stress disorder in a Canadian epidemiologic sample.
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The impact of changing diagnostic criteria in posttraumatic stress disorder in a Canadian epidemiologic sample.

机译：在加拿大流行病学样本中，改变诊断标准对创伤后应激障碍的影响。

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BACKGROUND: Since its inclusion in DSM-III, posttraumatic stress disorder (PTSD) has undergone a number of changes in its diagnostic criteria, including the expansion of Criterion A (traumatic stressor), the addition of symptom duration (none specified in DSM-III), and the requirement for impairment or distress (Criterion F, DSM-IV only). METHOD: This study examined the impact of changes in PTSD diagnostic criteria using a Canadian PTSD epidemiologic sample. The rates of PTSD and its correlates were evaluated in a nationally representative random sample of 3,006 adults. DSM-III, DSM-III-R, DSM-IV, and ICD-10 criteria were employed. DSM-III, DSM-III-R, and ICD-10 rates were re-evaluated, substituting specific DSM-IV criteria (A-F). RESULTS: The prevalence rates of lifetime PTSD ranged from 13.4% (DSM-III) to 13.0% (ICD-10) to 12.2% (DSM-III-R) to 9.2% (DSM-IV); all rates differed significantly from each other (P < .001). Regardless of diagnostic criteria, most people reported more than 1-year duration of symptoms, although rates were significantly higher in those with DSM-IV PTSD (68.2%, P < .0001). Rates of comorbid major depressive disorder and alcohol and substance abuse and dependence were also significantly higher (P < .05) using the DSM-IV PTSD criteria, and those with DSM-IV PTSD reported significantly higher rates of help-seeking (P < .001). When Criterion F was added to earlier versions, lifetime PTSD rates became much closer to those obtained using DSM-IV criteria: 10.6% (DSM-III), 10.2% (DSM-III-R), and 9.9% (ICD-10); however, rates fluctuated when operational definitions of Criterion F were modified. DSM-III PTSD was also substantially affected by DSM-IV Criteria A and C. CONCLUSIONS: DSM-IV PTSD may identify a more severe disorder. The addition of the clinical significance criterion (F) appeared to affect the greatest change in prevalence rates. Defining Criterion F as having both clinically significant psychological distress and functional impairment lowered the diagnostic threshold to a greater degree than did either distress or impairment alone. This information may be useful for future revisions of PTSD diagnostic criteria.
机译：背景：自从被纳入DSM-III以来，创伤后应激障碍（PTSD）的诊断标准发生了许多变化，包括标准Criterion A（创伤性应激源）的扩展，症状持续时间的增加（DSM-III中未指定） ）以及对损害或困扰的要求（标准C，仅适用于DSM-IV）。方法：本研究使用加拿大PTSD流行病学样本检查了PTSD诊断标准变化的影响。在全国代表性的3006名成年人中，对PTSD及其相关性的比率进行了评估。使用了DSM-III，DSM-III-R，DSM-IV和ICD-10标准。重新评估了DSM-III，DSM-III-R和ICD-10的发生率，代之以特定的DSM-IV标准（A-F）。结果：终生PTSD的患病率范围为13.4％（DSM-III）至13.0％（ICD-10）至12.2％（DSM-III-R）至9.2％（DSM-IV）;所有比率彼此之间都存在显着差异（P <.001）。不管诊断标准如何，大多数人报告的症状持续时间超过1年，尽管DSM-IV PTSD的发生率显着更高（68.2％，P <.0001）。使用DSM-IV PTSD标准，合并症的重度抑郁症，酒精和药物滥用及依赖性的发生率也显着较高（P <.05），而DSM-IV PTSD的患者报告的寻求帮助的发生率（P <。 001）。当将Criterion F添加到早期版本中时，使用寿命PTSD比率变得非常接近使用DSM-IV标准获得的比率：10.6％（DSM-III），10.2％（DSM-III-R）和9.9％（ICD-10） ;但是，当修改标准F的操作定义时，费率会波动。 DSM-IV PTSD也受到DSM-IV标准A和C的实质影响。结论：DSM-IV PTSD可能识别出更严重的疾病。临床意义标准（F）的添加似乎影响了患病率的最大变化。将标准F定义为具有临床上显着的心理困扰和功能障碍的情况，可以将诊断阈值降低的程度比单独使用困扰或障碍的程度更大。此信息可能对将来PTSD诊断标准的修订很有用。

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