Applicability of the ICD-11 proposal for PTSD: a comparison of prevalence and comorbidity rates with the DSM-IV PTSD classification in two post-conflict samples

Figures & data

Table 1 Proportion of participants meeting DSM-IV and proposed ICD-11 criteria for PTSD in the Cambodian sample

					Changes in diagnosis under proposed ICD-11 criteria
	Total DSM-IV		Total ICD-11		No longer present		Unchanged		Newly present
	n	%	n	%	n	%	n	%	n	%
Stressor criterion A	1,047	97.4	1,075	100
A1. Traumatic event	1,075	100	1,075	100
A2. Emotional response	1,047	97.4
Re-experiencing criterion B	566	52.7	237	22.0	329	30.6	746	69.4	0	0.0
B1. Distressing recollections	367	34.1
B2. Distressing dreams	171	15.9	171	15.9
B3. Flashbacks	126	11.7	126	11.7
B4. Psychological reactivity	382	35.5
B5. Physiological reactivity	380	35.3
Avoidance criterion C	159	14.8	265	24.7	35	3.3	899	83.6	141	13.1
C1. Avoiding internal reminders	191	17.8	191	17.8
C2. Avoiding external reminders	158	14.7	158	14.7
C3. Specific amnesia	133	12.4
C4. Diminished interest	211	19.6
C5. Detachment	139	12.9
C6. Restricted affect	90	8.4
C7. Foreshortened future	203	18.9
Hyperarousal criterion D	487	45.3	413	38.4	119	11.1	911	84.7	45	4.2
D1. Difficulty sleeping	506	47.1
D2. Irritability	353	32.8
D3. Difficulty concentrating	325	30.2
D4. Hypervigilance	153	14.2	153	14.2
D5. Exaggerated startle response	350	32.6	350	32.6
Duration criterion	970	90.2	970	90.2
Impairment criterion^a	–	–	–	–
PTSD diagnosis	120	11.2	87	8.1	62	5.8	984	91.5	29	2.7

PTSD=posttraumatic stress disorder; total DSM-IV=participants meeting diagnostic criteria for PTSD under DSM-IV; total ICD-11=participants meeting diagnostic criteria for PTSD under the proposed ICD-11 classification. ^aThe impairment variable was not included in the data.

Table 2 Proportion of participants meeting DSM-IV and proposed ICD-11 criteria for PTSD in the Colombian sample

					Changes in diagnosis under proposed ICD-11 criteria
	Total DSM-IV		Total ICD-11		No longer present		Unchanged		Newly present
	n	%	n	%	n	%	n	%	n	%
Stressor criterion A^a	453	100	453	100
A1. Traumatic event^a
A2. Emotional response^a
Re-experiencing criterion B	409	90.3	310	68.4	99	21.9	354	78.1	0	0.0
B1. Distressing recollections	292	64.5
B2. Distressing dreams	247	54.5	247	54.5
B3. Flashbacks	260	57.4	260	57.4
B4. Psychological reactivity	328	72.4
B5. Physiological reactivity	291	64.2
Avoidance criterion C	330	72.8	355	78.4	26	5.7	376	83.0	51	11.3
C1. Avoiding internal reminders	302	66.7	302	66.7
C2. Avoiding external reminders	272	60.0	272	60.0
C3. Specific amnesia	181	40.0
C4. Diminished interest	280	61.8
C5. Detachment	274	60.5
C6. Restricted affect	186	41.1
C7. Foreshortened future	277	61.1
Hyperarousal criterion D	343	75.7	333	73.5	31	6.8	401	88.5	21	4.6
D1. Difficulty sleeping	271	59.8
D2. Irritability	237	52.3
D3. Difficulty concentrating	263	58.1
D4. Hypervigilance	262	57.8	262	57.8
D5. Exaggerated startle response	278	61.4	278	61.4
Duration criterion	432	95.4	432	95.4
Impairment criterion	337	74.4	337	74.4
PTSD diagnosis	249	55.0	201	44.4	57	12.6	387	85.4	9	2.0

PTSD=posttraumatic stress disorder; total DSM-IV=participants meeting diagnostic criteria for PTSD under DSM-IV; total ICD-11=participants meeting diagnostic criteria for PTSD under the proposed ICD-11 classification. ^aThe stressor criteria A1 and A2 were not inquired separately. There is only information on whether the criterion A was met or not.

Table 3 Proportion of participants with concurrent depression or other anxiety disorders among Cambodian participants meeting DSM-IV or ICD-11 criteria for PTSD

	Total DSM-IV (n=120)		Total ICD-11 (n=87)		DSM-IV only (n=62)		ICD-11 only (n=29)		ICD-11 only vs. DSM-IV only
	n	(%)	n	(%)	n	(%)	n	(%)	OR	95% CI	p
Depression	104	86.7	69	79.3	49	79.0	14	48.3	0.25	0.10, 0.64	<0.001
Anxiety	101	84.2	73	83.9	48	77.4	20	69.0	0.65	0.24, 1.74	0.39
Total score	93	77.5	63	72.4	42	67.7	12	41.4	0.34	0.14, 0.84	0.02

PTSD=posttraumatic stress disorder; total DSM-IV=participants meeting diagnostic criteria for PTSD under DSM-IV; total ICD-11=participants meeting diagnostic criteria for PTSD under the proposed ICD-11 classification; DSM-IV only=participants meeting PTSD criteria only under DSM-IV; ICD-11 only=participants meeting PTSD criteria only under ICD-11; OR=odds ratios; CI=confidence interval.

Table 4 Proportion of participants with concurrent depression or other anxiety disorders among Colombian participants meeting DSM-IV or ICD-11 criteria for PTSD

	Total DSM-IV (n=249)		Total ICD-11 (n=201)		DSM-IV only (n=57)		ICD-11 only (n=9)
	n	(%)	n	(%)	n	(%)	n	(%)
Depression	221	88.8	179	89.1	48	84.2	6	55.6
Anxiety	190	76.3	158	78.6	37	64.9	5	66.7
Total score	180	72.3	151	75.1	34	59.6	5	55.6

PTSD=posttraumatic stress disorder; total DSM-IV=participants meeting diagnostic criteria for PTSD under DSM-IV; total ICD-11=participants meeting diagnostic criteria for PTSD under the proposed ICD-11 classification; DSM-IV only=participants meeting PTSD criteria only under DSM-IV; ICD-11 only=participants meeting PTSD criteria only under ICD-11.

Table 5 Socio-demographic and trauma-related characteristics and indicators of clinical severity of participants meeting DSM-IV and ICD-11 criteria for PTSD in the Colombian sample

	Total DSM-IV (n=249)		Total ICD-11 (n=201)		DSM-IV only (n=57)		ICD-11 only (n=9)
Categorical variables	N	%	n	%	n	%	n	%
Gender (Female)	157	63.1	125	62.2	37	64.9	5	62.8
Continuous variables	M	SD	M	SD	M	SD	M	SD
Age	48.24	12.63	47.29	12.54	51.18	11.84	45.44	6.50
Number of traumatic experiences	10.60	3.57	10.62	3.72	10.47	3.19	10.22	4.76
Symptom severity	0.64	0.65	0.76	0.64	0.18	0.41	0.18	0.41
Suicidality	1.49	0.88	1.57	0.93	1.19	0.58	1.44	0.88

PTSD=posttraumatic stress disorder; total DSM-IV=participants meeting diagnostic criteria for PTSD under DSM-IV; total ICD-11=participants meeting diagnostic criteria for PTSD under the proposed ICD-11 classification; DSM-IV only=participants meeting PTSD criteria only under DSM-IV; ICD-11 only=participants meeting PTSD criteria only under ICD-11. The symptom severity score were standardized. The suicidality scores were based on a scale from 1=not at all to 4=extremely. The symptom severity scores were standardized based on the 17 symptoms of the DSM-IV for the DSM-IV total and the DSM-IV-only groups. For the ICD-11 total and ICD-only group, they were standardized based on the six symptoms of the ICD-11 proposal.

Table 6 Socio-demographic and trauma-related characteristics and indicators of clinical severity of participants meeting DSM-IV and ICD-11 criteria for PTSD in the Cambodian sample

	Total DSM-IV (n=120)		Total ICD-11 (n=87)		DSM-IV only (n=62)		ICD-11 only (n=29)
Categorical variables	n	%	n	%	n	%	n	%
Gender (Female)	97	80.8	69	79.3	48	77.4	20	69.0
Continuous variables	M	SD	M	SD	M	SD	M	SD
Age	55.22	9.68	55.89	9.16	54.32	10.75	55.48	10.69
Number of traumatic experiences	12.64	3.94	13.38	4.20	11.83	3.73	13.10	4.62
Symptom severity	1.89	0.81	2.08	0.81	1.53	0.59	1.67	0.59
Suicidality	1.48	0.94	1.39	0.87	1.48	0.94	1.24	0.69

PTSD=posttraumatic stress disorder; total DSM-IV=participants meeting diagnostic criteria for PTSD under DSM-IV; total ICD-11=participants meeting diagnostic criteria for PTSD under the proposed ICD-11 classification; DSM-IV only=participants meeting PTSD criteria only under DSM-IV; ICD-11 only=participants meeting PTSD criteria only under ICD-11. The suicidality scores were based on a scale from 1=not at all to 4=extremely. The symptom severity scores were standardized based on the 17 symptoms of the DSM-IV for the DSM-IV total and the DSM-IV-only groups. For the ICD-11 total and ICD-only group they were standardized based on the six symptoms of the ICD-11 proposal.