Faculty Collaboration Database

Differentiating PTSD from anxiety and depression: Lessons from the ICD-11 PTSD diagnostic criteria. Depress Anxiety 2019 Jun;36(6):490-498

Date

01/27/2019

Pubmed ID

30681235

Pubmed Central ID

PMC6548615

DOI

10.1002/da.22881

Scopus ID

2-s2.0-85060640007 (requires institutional sign-in at Scopus site)   44 Citations

Abstract

OBJECTIVE: Posttraumatic stress disorder (PTSD) is frequently associated with depression and anxiety, but the nature of the relationship is unclear. By removing mood and anxiety diagnostic criteria, the 11th edition of the International Classification of Diseases (ICD-11) aims to delineate a distinct PTSD phenotype. We examined the effect of implementing ICD-11 criteria on rates of codiagnosed depression and anxiety in survivors with recent PTSD.

METHOD: Participants were 1,061 survivors of traumatic injury admitted to acute care centers in Israel. ICD-10 and ICD-11 diagnostic rules were applied to the Clinician-Administered PTSD Scale for DSM-IV. Co-occurring disorders were identified using the Structured Clinical Interview for DSM-IV (SCID). Depression severity was measured by the Beck Depression Inventory-II (BDI-II). Assessments were performed 0-60 ("wave 1") and 90-240 ("wave 2") days after trauma exposure.

RESULTS: Participants identified by ICD-11 PTSD criteria were equally or more likely than those identified by the ICD-10 alone to meet depression or anxiety disorder diagnostic criteria (for wave 1: depressive disorders, OR [odds ratio] = 1.98, 95% CI [confidence interval] = [1.36, 2.87]; anxiety disorders, OR = 1.04, 95% CI = [0.67, 1.64]; for wave 2: depressive disorders, OR = 1.70, 95% CI = [1.00, 2.91]; anxiety disorders, OR = 1.04, 95% CI = [0.54, 2.01]). ICD-11 PTSD was associated with higher BDI scores (M = 23.15 vs. 17.93, P < 0.001 for wave 1; M = 23.93 vs. 17.94, P < 0.001 for wave 2). PTSD symptom severity accounted for the higher levels of depression in ICD-11 PTSD.

CONCLUSIONS: Despite excluding depression and anxiety symptom criteria, the ICD-11 identified equal or higher proportion of depression and anxiety disorders, suggesting that those are inherently associated with PTSD.

Author List

Barbano AC, van der Mei WF, deRoon-Cassini TA, Grauer E, Lowe SR, Matsuoka YJ, O'Donnell M, Olff M, Qi W, Ratanatharathorn A, Schnyder U, Seedat S, Kessler RC, Koenen KC, Shalev AY, International Consortium to Prevent PTSD

Author

Terri A. deRoon Cassini PhD Center Director, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Anxiety
Anxiety Disorders
Depression
Depressive Disorder
Diagnosis, Differential
Diagnostic and Statistical Manual of Mental Disorders
Female
Humans
International Classification of Diseases
Israel
Male
Middle Aged
Stress Disorders, Post-Traumatic
Survivors