Prevalence and predictive value of ICD-11 post-traumatic stress disorder and Complex PTSD diagnoses in children and adolescents exposed to a single-event trauma.

Rachel Elliott,Clare Dixon,Sarah‐Jane Archibald,Patrick Smith,Tim Dalgleish,Cari‐Lène Mul,Theresa Dahm,Anna Mckinnon,Caitlin Hitchcock,Richard Meiser‐Stedman,Fionnuala Murphy,Adrian Boyle,Emma Travers‐Hill

doi:10.1111/jcpp.13240

Abstract

BackgroundThe 11th edition of the International Classification of Diseases (ICD‐11) made a number of significant changes to the diagnostic criteria for post‐traumatic stress disorder (PTSD). We sought to determine the prevalence and 3‐month predictive values of the new ICD‐11 PTSD criteria relative to ICD‐10 PTSD, in children and adolescents following a single traumatic event. ICD‐11 also introduced a diagnosis of Complex PTSD (CPTSD), proposed to typically result from prolonged, chronic exposure to traumatic experiences, although the CPTSD diagnostic criteria do not require a repeated experience of trauma. We therefore explored whether children and adolescents demonstrate ICD‐11 CPTSD features following exposure to a single‐incident trauma.MethodData were analysed from a prospective cohort study of youth aged 8–17 years who had attended an emergency department following a single trauma. Assessments of PTSD, CPTSD, depressive and anxiety symptoms were performed at two to four weeks (n = 226) and nine weeks (n = 208) post‐trauma, allowing us to calculate and compare the prevalence and predictive value of ICD‐10 and ICD‐11 PTSD criteria, along with CPTSD. Predictive abilities of different diagnostic thresholds were undertaken using positive/negative predictive values, sensitivity/specificity statistics and logistic regressions.ResultsAt Week 9, 15 participants (7%) were identified as experiencing ICD‐11 PTSD, compared to 23 (11%) experiencing ICD‐10 PTSD. There was no significant difference in comorbidity rates between ICD‐10 and ICD‐11 PTSD diagnoses. Ninety per cent of participants with ICD‐11 PTSD also met criteria for at least one CPTSD feature. Five participants met full CPTSD criteria.ConclusionsReduced prevalence of PTSD associated with the use of ICD‐11 criteria is likely to reduce identification of PTSD relative to using ICD‐10 criteria but not relative to DSM‐4 and DSM‐5 criteria. Diagnosis of CPTSD is likely to be infrequent following single‐incident trauma.

Highlights

Accurate diagnosis of trauma-related difficulties is vital to maximise quality of life for affected individuals, and to ensure appropriate service commission and delivery
With comorbid anxiety With comorbid depression All ICD-11 post-traumatic stress disorder (PTSD) cases With comorbid anxiety With comorbid depression ICD-11 PTSD with comorbid anxiety with comorbid depression ICD-11 PTSD with at least 1 Complex feature Affect regulation Negative beliefs Interpersonal difficulties ICD-11 PTSD with 2 Complex features Complex PTSD (CPTSD) With comorbid anxiety With comorbid depression
A lower percentage of participants diagnosed using ICD-11 appeared to experience comorbid difficulties compared to ICD10, but these rates were only statistically different when CPTSD cases were excluded

Summary

Introduction

Accurate diagnosis of trauma-related difficulties is vital to maximise quality of life for affected individuals, and to ensure appropriate service commission and delivery. The 11th edition of the International Classification of Diseases (ICD-11) made a number of significant changes to the diagnostic criteria for post-traumatic stress disorder (PTSD). We sought to determine the prevalence and 3-month predictive values of the new ICD-11 PTSD criteria relative to ICD-10 PTSD, in children and adolescents following a single traumatic event. ICD-11 introduced a diagnosis of Complex PTSD (CPTSD), proposed to typically result from prolonged, chronic exposure to traumatic experiences, the CPTSD diagnostic criteria do not require a repeated experience of trauma. We explored whether children and adolescents demonstrate ICD-11 CPTSD features following exposure to a single-incident trauma. Assessments of PTSD, CPTSD, depressive and anxiety symptoms were performed at two to four weeks (n = 226) and nine weeks (n = 208) post-trauma, allowing us to calculate and compare the prevalence and predictive value of ICD-10 and ICD-11 PTSD criteria, along with CPTSD.

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