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Type: Journal article
Title: A comparison of the capacity of DSM-IV and DSM-5 acute stress disorder definitions to predict posttraumatic stress disorder and related disorders
Author: Bryant, R.
Creamer, M.
O'Donnell, M.
Silove, D.
McFarlane, A.
Forbes, D.
Citation: Journal of Clinical Psychiatry, 2015; 76(4):391-397
Publisher: Physicians Postgraduate Press
Issue Date: 2015
ISSN: 0160-6689
Statement of
Richard A. Bryant, Mark Creamer, Meaghan O, Donnell, Derrick Silove, Alexander C. McFarlane, and David Forbes
Abstract: OBJECTIVE: This study addresses the extent to which DSM-IV and DSM-5 definitions of acute stress disorder (ASD) predict subsequent posttraumatic stress disorder (PTSD) and related psychiatric disorders following trauma. METHOD: Patients with randomized admissions to 5 hospitals across Australia (N = 596) were assessed in hospital and reassessed for PTSD at 3 (n = 508), 12 (n = 426), 24 (n = 439), and 72 (n = 314) months using the Clinician-Administered PTSD Scale; DSM-IV definition of PTSD was used at each assessment, and DSM-5 definition was used at 72 months. The Mini-International Neuropsychiatric Interview (MINI) was used at each assessment to assess anxiety, mood, and substance use disorders. RESULTS: Forty-five patients (8%) met DSM-IV criteria, and 80 patients (14%) met DSM-5 criteria for ASD. PTSD was diagnosed in 93 patients (9%) at 3, 82 patients (10%) at 12, 100 patients (12%) at 24, and 26 patients (8%) at 72 months; 19 patients (6%) met DSM-5 criteria for PTSD at 72 months. Comparable proportions of those diagnosed with ASD developed PTSD using DSM-IV (3 months = 46%, 12 months = 39%, 24 months = 32%, and 72 months = 25%) and DSM-5 (43%, 42%, 33%, and 24%) ASD definitions. Sensitivity was improved for DSM-5 relative to DSM-IV for depression (0.18 vs 0.30), panic disorder (0.19 vs 0.41), agoraphobia (0.14 vs 0.40), social phobia (0.12 vs 0.44), specific phobia (0.24 vs 0.58), obsessive-compulsive disorder (0.17 vs 0.47), and generalized anxiety disorder (0.20 vs 0.47). More than half of participants with DSM-5-defined ASD had a subsequent disorder. CONCLUSIONS: The DSM-5 criteria for ASD results in better identification of people who will subsequently develop PTSD or another psychiatric disorder relative to the DSM-IV criteria. Although prediction is modest, it suggests that the new ASD diagnosis can serve a useful function in acute trauma settings for triaging those who can benefit from either early intervention or subsequent monitoring.
Keywords: Humans
Wounds and Injuries
Patient Admission
Risk Factors
Follow-Up Studies
Reproducibility of Results
Stress Disorders, Traumatic, Acute
Stress Disorders, Post-Traumatic
Interview, Psychological
Diagnostic and Statistical Manual of Mental Disorders
Middle Aged
Trauma Centers
Young Adult
Rights: © Copyright 2014 Physicians Postgraduate Press, Inc.
DOI: 10.4088/JCP.13m08731
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