The impact of proposed changes to ICD-11 on estimates of PTSD prevalence and comorbidity

Abstract

The World Health Organization's posttraumatic stress disorder (PTSD) work group has published a proposal for the forthcoming edition of the International Classification of Diseases (ICD-11) that would yield a very different diagnosis relative to DSM-5. This study examined the impact of the proposed ICD-11 changes on PTSD prevalence relative to the ICD-10 and DSM-5 definitions and also evaluated the extent to which these changes would accomplish the stated aim of reducing the comorbidity associated with PTSD. Diagnostic prevalence estimates were compared using a U.S. national community sample and two U.S. Department of Veterans Affairs clinical samples. The ICD-11 definition yielded prevalence estimates 10 to 30 percent lower than DSM-5 and 25 and 50 percent lower than ICD-10 with no reduction in the prevalence of common comorbidities. Findings suggest that by constraining the diagnosis to a narrower set of symptoms, the proposed ICD-11 criteria set would substantially reduce the number of individuals with the disorder. These findings raise doubt about the extent to which the ICD-11 proposal would achieve the aim of reducing comorbidity associated with PTSD and highlight the public health and policy implications of such a redefinition.

Comparison of DSM-5 and proposed ICD-11 criteria for PTSD with DSM-IV and ICD-10: changes in PTSD prevalence in military personnel

“…In contrast to our assumption and to earlier research (O’Donnell et al, 2014; Stein et al, 2014; Wisco et al, 2016), the provisional PTSD prevalence was increased under the ICD-11 proposal compared to ICD-10. However, the increase was mainly due to the deletion of the time criterion, accounting for a tendency of late symptom onset in the present sample.…”

“…However, this population must show a high level of physical and mental fitness, emphasising the need for reliable and valid diagnostic systems and instruments and thus underlining the importance of investigating the concordance and appropriateness of the different diagnostic systems for this trauma population. However, we are aware of only a few studies that examined PTSD prevalence among veterans of war or active soldiers (Gentes et al, 2014; Miller et al, 2013; Morina et al, 2014; Wisco et al, 2016). Although, Gentes et al (2014) and Miller et al (2013) report comparable PTSD prevalence between DSM-IV and DSM-5, and Morina et al (2014) found comparable PTSD prevalence between the ICD-11 proposal and DSM-IV, Wisco et al (2016) report significantly reduced PTSD prevalence under the ICD-11 proposal compared to DSM-5 as well as compared to ICD-10, indicating an unsatisfactory concordance between these systems.…”

“…Of special concern for this study was the concordance when self-rated questionnaires were scored following the diagnostic rules of DSM-IV, DSM-5, ICD-10, and proposed ICD-11 criteria for PTSD. It is of note that most earlier studies in this area used clinician-administered interviews to check for a positive diagnosis of PTSD (Elhai et al, 2009; Forbes et al, 2011; Gentes et al, 2014; Morina et al, 2014; O’Donnell et al, 2014; Stein et al, 2014; van Emmerik & Kamphuis, 2011; Wisco et al, 2016). While this is without doubt the gold standard for clinical research, clinical practice often heavily relies on self-administered instruments, underlining the importance of investigating the consistency when self-rating instruments for PTSD are provided.…”

“…While this is without doubt the gold standard for clinical research, clinical practice often heavily relies on self-administered instruments, underlining the importance of investigating the consistency when self-rating instruments for PTSD are provided. Based on research findings, we expected that the PTSD prevalence would be the same using DSM-IV versus DSM-5 criteria (Carmassi et al, 2013; Elhai et al, 2012; Gentes et al, 2014; Kilpatrick et al, 2013; Miller et al, 2013; O’Donnell et al, 2014; Stein et al, 2014), but would be reduced under the ICD-11 proposal as compared to ICD-10 and DSM-5 (O’Donnell et al, 2014; Wisco et al, 2016). …”

PTSD symptomics: network analyses in the field of psychotraumatology

“…Armour, Műllerová, & Elhai, 2015; Colvonen et al, 2017; Kassam-Adams, 2014; Kehle-Forbes & Kimerling, 2017; Molnar et al, 2017; Olff, Van Zuiden, & Bakker, 2015; Wisco et al, 2016). This has led to important discoveries and has inspired some work on improving prevention and intervention strategies for trauma-affected individuals (Brief et al, 2013; Hilton et al, 2017; Horn, Charney, & Feder, 2016; Markowitz et al, 2015; Olff, Armour et al, 2015).…”