A comparison of ICD- 11 and DSM-5 criteria for PTSD among a representative sample of Chinese earthquake survivors

Chengqi Cao; Li Wang; Jianhui Wu; Yajie Bi; Haibo Yang; Ruojiao Fang; Gen Li; Ping Liu; Shu Luo; Brian J Hall; Jon D Elhai

doi:10.1080/20008198.2020.1760481

A comparison of ICD- 11 and DSM-5 criteria for PTSD among a representative sample of Chinese earthquake survivors

Eur J Psychotraumatol. 2020 Jun 4;11(1):1760481. doi: 10.1080/20008198.2020.1760481.

Authors

Chengqi Cao^{1

2}, Li Wang^{2

3}, Jianhui Wu¹, Yajie Bi^{2

3}, Haibo Yang⁴, Ruojiao Fang^{2

3}, Gen Li^{2

3}, Ping Liu⁵, Shu Luo⁵, Brian J Hall^{6

7}, Jon D Elhai⁸

Affiliations

¹ Center for Brain Disorder and Cognitive Science, Shenzhen University, Shenzhen, China.
² Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
³ Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
⁴ Academy of Psychology and Behavior, Tianjin Normal University, Tianjin, China.
⁵ Department of Psychosomatics, People's Hospital of Deyang City, Deyang, Sichuan, China.
⁶ Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, University of Macau, Taipa, Macau (SAR), China.
⁷ Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁸ Department of Psychology, and Department of Psychiatry, University of Toledo, Toledo, OH, USA.

Abstract
in English, Spanish, Chinese

Background: Striking differences regarding the diagnosis of PTSD exist between the ICD-11 and DSM-5. This study compared the prevalence and comorbidity of PTSD between the ICD-11 and DSM-5.

Methods: An epidemiological sample of 1160 Chinese adult earthquake survivors collected nine and a half years following the Wenchuan earthquake, in Sichuan province. The PTSD Checklist for DSM-5 (PCL-5), the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7) were used to measure PTSD, depression, and anxiety symptoms.

Results: The ICD-11 PTSD criteria yielded higher prevalence estimates than the DSM-5 criteria. There were no significant differences in PTSD's comorbidity with major depressive disorder (MDD) or generalized anxiety disorder (GAD) between the ICD-11 and DSM-5 criteria.

Conclusions: Results found that the ICD-11 and DSM-5 performed differently in assessing PTSD prevalence, but showed similar co-occurrence with MDD and GAD. This study adds to knowledge about the similarities and differences of using different PTSD criteria and carries implications for clinical and research utilization of the two widely used PTSD diagnostic criteria.

Antecedentes: Existen notables diferencias en relación al diagnóstico de TEPT entre la CIE-11 y el DSM-5. Este estudio comparó la prevalencia y la comorbilidad de TEPT según la CIE-11 y el DSM-5.Métodos: Una muestra epidemiológica de 1160 chinos adultos supervivientes a un terremoto fue seguida por nueve años y medio posterior al terremoto de Wenchuan, en la provincia Sichuan. Se utilizaron la lista de chequeo de TEPT para el DSM-5 (PCL-5 por sus siglas en inglés), el Cuestionario de Salud del Paciente (PHQ-9 por sus siglas en inglés) y la Ansiedad Generalizada-7 (GAD-7 por sus siglas en inglés) fueron usados para medir TEPT, depresión y síntomas ansiosos.Resultados: Los criterios de la CIE-11 produjeron mayor prevalencia de TEPT que los criterios del DSM-5. No hubo diferencia significativa en la comorbilidad del TEPT con episodio depresivo mayor (MDD por sus siglas en inglés) o Trastorno de Ansiedad Generalizada (GAD por sus siglas en inglés) entre los criterios de la CIE-10 y el DSM-5.Conclusiones: Los resultados concluyen que la CIE-11 y el DSM-5 se desempeñaron en forma diferente al evaluar la prevalencia de TEPT, pero mostraron similar co-ocurrencia de MDD y GAD. Este estudio aporta al conocimiento acerca de las similitudes y diferencias al usar diferentes criterios de TEPT, y conlleva implicaciones para el uso clínico y de investigación de dos criterios de TEPT ampliamente utilizados.

背景: 在最新版的《精神障碍的诊断和统计手册 (DSM) 》 (第五版) (DSM-5) 和《国际疾病分类》 (第十一版) (ICD-11) 诊断标准中, 二者对于创伤后应激障碍 (PTSD) 的诊断标准存在着较大的差别。基于此, 本研究拟分析使用ICD-11和DSM-5中不同的PTSD诊断标准对PTSD发病率以及共病的影响。方法: 本研究样本使用了亲身经历了四川汶川地震的1160名成人被试样本, 取样时间为地震发生后9.5年。使用PCL-5问卷测定PTSD症状, 使用PHQ-9测定抑郁症状, 使用GAD-7测定焦虑症状。结果: 本研究发现, 相比于DSM-5诊断标准, 使用ICD-11诊断标准产生的PTSD发病率更高。但是比较使用不同诊断标准下PTSD与抑郁和焦虑共病率, 发现并无显著差别。结论: 使用ICD-11和DSM-5在评估PTSD发生率方面存在差别, 但是使用不同PTSD诊断标准, PTSD与抑郁和焦虑共病率不存在显著差异。本研究的结果增加了使用不同PTSD诊断标准相似性和差异的实证性证据, 对ICD-11和DSM-5 PTSD诊断标准的研究和临床使用具有重要的启示意义。.

Keywords: DSM-5; ICD-11; comorbidity; posttraumatic stress disorder; prevalence; • A greater proportion of participants met criteria for ICD-11 than DSM-5 PTSD.• ICD-11 and DSM-5 PTSD criteria showed similar co-existing rates with MDD and GAD..

Grants and funding

This work was supported by the the External Cooperation Program of Chinese Academy of Sciences [No. 153111KYSB20160036]; the Key Research Program of the Chinese Academy of Sciences [No. ZDRW-XH-2019-4]; the National Natural Science Foundation of China [No.31271099, 31471004]; the National Natural Science Foundation of China [No.31771246]; the China Postdoctoral Science Foundation [No. 2018M633141]; the Beijing Municipal Science and Technology Commission [No. Z171100000117014]; the Key Project of Research Base of Humanities and Social Sciences of Ministry of Education [No.16JJD190006].

Abstract in English, Spanish, Chinese

Grants and funding

Abstract
in English, Spanish, Chinese