title: 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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Meaghan L. O'Donnell, PhD, Nathan Alkemade, PhD, Australian Centre for Posttraumatic Mental Health, Carlton, Victoria and Department of Psychiatry, University of Melbourne, Parkville, Victoria; Angela Nickerson, PhD, School of Psychology University of New South Wales, Sydney, New South Wales; Mark Creamer, PhD, Department of Psychiatry, University of Melbourne, Parkville, Victoria; Alexander C. McFarlane, AO, MD, FRANZCP, Centre for Traumatic Stress, University of Adelaide, Adelaide, South Australia; Derrick Silove, MD, FRANZCP, Department of Psychiatry University of New South Wales, Sydney and Mental Health Centre, Psychiatry Research and Teaching Unit, Liverpool, New South Wales; Richard A. Bryant, PhD, School of Psychology, University of New South Wales, Sydney, New South Wales; David Forbes, PhD, Australian Centre for Posttraumatic Mental Health, Carlton, Victoria and Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Meaghan L
authors.initials: ML
authors.lastname: O'Donnell
authors.affiliation: Meaghan L. O'Donnell, PhD, Nathan Alkemade, PhD, Australian Centre for Posttraumatic Mental Health, Carlton, Victoria and Department of Psychiatry, University of Melbourne, Parkville, Victoria; Angela Nickerson, PhD, School of Psychology University of New South Wales, Sydney, New South Wales; Mark Creamer, PhD, Department of Psychiatry, University of Melbourne, Parkville, Victoria; Alexander C. McFarlane, AO, MD, FRANZCP, Centre for Traumatic Stress, University of Adelaide, Adelaide, South Australia; Derrick Silove, MD, FRANZCP, Department of Psychiatry University of New South Wales, Sydney and Mental Health Centre, Psychiatry Research and Teaching Unit, Liverpool, New South Wales; Richard A. Bryant, PhD, School of Psychology, University of New South Wales, Sydney, New South Wales; David Forbes, PhD, Australian Centre for Posttraumatic Mental Health, Carlton, Victoria and Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Nathan
authors.initials: N
authors.lastname: Alkemade
authors.affiliation: Meaghan L. O'Donnell, PhD, Nathan Alkemade, PhD, Australian Centre for Posttraumatic Mental Health, Carlton, Victoria and Department of Psychiatry, University of Melbourne, Parkville, Victoria; Angela Nickerson, PhD, School of Psychology University of New South Wales, Sydney, New South Wales; Mark Creamer, PhD, Department of Psychiatry, University of Melbourne, Parkville, Victoria; Alexander C. McFarlane, AO, MD, FRANZCP, Centre for Traumatic Stress, University of Adelaide, Adelaide, South Australia; Derrick Silove, MD, FRANZCP, Department of Psychiatry University of New South Wales, Sydney and Mental Health Centre, Psychiatry Research and Teaching Unit, Liverpool, New South Wales; Richard A. Bryant, PhD, School of Psychology, University of New South Wales, Sydney, New South Wales; David Forbes, PhD, Australian Centre for Posttraumatic Mental Health, Carlton, Victoria and Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Angela
authors.initials: A
authors.lastname: Nickerson
authors.affiliation: Meaghan L. O'Donnell, PhD, Nathan Alkemade, PhD, Australian Centre for Posttraumatic Mental Health, Carlton, Victoria and Department of Psychiatry, University of Melbourne, Parkville, Victoria; Angela Nickerson, PhD, School of Psychology University of New South Wales, Sydney, New South Wales; Mark Creamer, PhD, Department of Psychiatry, University of Melbourne, Parkville, Victoria; Alexander C. McFarlane, AO, MD, FRANZCP, Centre for Traumatic Stress, University of Adelaide, Adelaide, South Australia; Derrick Silove, MD, FRANZCP, Department of Psychiatry University of New South Wales, Sydney and Mental Health Centre, Psychiatry Research and Teaching Unit, Liverpool, New South Wales; Richard A. Bryant, PhD, School of Psychology, University of New South Wales, Sydney, New South Wales; David Forbes, PhD, Australian Centre for Posttraumatic Mental Health, Carlton, Victoria and Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Creamer
authors.affiliation: Meaghan L. O'Donnell, PhD, Nathan Alkemade, PhD, Australian Centre for Posttraumatic Mental Health, Carlton, Victoria and Department of Psychiatry, University of Melbourne, Parkville, Victoria; Angela Nickerson, PhD, School of Psychology University of New South Wales, Sydney, New South Wales; Mark Creamer, PhD, Department of Psychiatry, University of Melbourne, Parkville, Victoria; Alexander C. McFarlane, AO, MD, FRANZCP, Centre for Traumatic Stress, University of Adelaide, Adelaide, South Australia; Derrick Silove, MD, FRANZCP, Department of Psychiatry University of New South Wales, Sydney and Mental Health Centre, Psychiatry Research and Teaching Unit, Liverpool, New South Wales; Richard A. Bryant, PhD, School of Psychology, University of New South Wales, Sydney, New South Wales; David Forbes, PhD, Australian Centre for Posttraumatic Mental Health, Carlton, Victoria and Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: McFarlane
authors.affiliation: Meaghan L. O'Donnell, PhD, Nathan Alkemade, PhD, Australian Centre for Posttraumatic Mental Health, Carlton, Victoria and Department of Psychiatry, University of Melbourne, Parkville, Victoria; Angela Nickerson, PhD, School of Psychology University of New South Wales, Sydney, New South Wales; Mark Creamer, PhD, Department of Psychiatry, University of Melbourne, Parkville, Victoria; Alexander C. McFarlane, AO, MD, FRANZCP, Centre for Traumatic Stress, University of Adelaide, Adelaide, South Australia; Derrick Silove, MD, FRANZCP, Department of Psychiatry University of New South Wales, Sydney and Mental Health Centre, Psychiatry Research and Teaching Unit, Liverpool, New South Wales; Richard A. Bryant, PhD, School of Psychology, University of New South Wales, Sydney, New South Wales; David Forbes, PhD, Australian Centre for Posttraumatic Mental Health, Carlton, Victoria and Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Derrick
authors.initials: D
authors.lastname: Silove
authors.affiliation: Meaghan L. O'Donnell, PhD, Nathan Alkemade, PhD, Australian Centre for Posttraumatic Mental Health, Carlton, Victoria and Department of Psychiatry, University of Melbourne, Parkville, Victoria; Angela Nickerson, PhD, School of Psychology University of New South Wales, Sydney, New South Wales; Mark Creamer, PhD, Department of Psychiatry, University of Melbourne, Parkville, Victoria; Alexander C. McFarlane, AO, MD, FRANZCP, Centre for Traumatic Stress, University of Adelaide, Adelaide, South Australia; Derrick Silove, MD, FRANZCP, Department of Psychiatry University of New South Wales, Sydney and Mental Health Centre, Psychiatry Research and Teaching Unit, Liverpool, New South Wales; Richard A. Bryant, PhD, School of Psychology, University of New South Wales, Sydney, New South Wales; David Forbes, PhD, Australian Centre for Posttraumatic Mental Health, Carlton, Victoria and Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Bryant
authors.affiliation: Meaghan L. O'Donnell, PhD, Nathan Alkemade, PhD, Australian Centre for Posttraumatic Mental Health, Carlton, Victoria and Department of Psychiatry, University of Melbourne, Parkville, Victoria; Angela Nickerson, PhD, School of Psychology University of New South Wales, Sydney, New South Wales; Mark Creamer, PhD, Department of Psychiatry, University of Melbourne, Parkville, Victoria; Alexander C. McFarlane, AO, MD, FRANZCP, Centre for Traumatic Stress, University of Adelaide, Adelaide, South Australia; Derrick Silove, MD, FRANZCP, Department of Psychiatry University of New South Wales, Sydney and Mental Health Centre, Psychiatry Research and Teaching Unit, Liverpool, New South Wales; Richard A. Bryant, PhD, School of Psychology, University of New South Wales, Sydney, New South Wales; David Forbes, PhD, Australian Centre for Posttraumatic Mental Health, Carlton, Victoria and Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Forbes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology*; D055815:Young Adult