PTSD in ICD-10 and proposed ICD-11 in elderly with childhood trauma: prevalence, factor structure, and symptom profiles

The proposal for ICD-11 postulates major changes for posttraumatic stress disorder (PTSD) diagnosis, which needs investigation in different samples. To investigate differences of PTSD prevalence and diagnostic agreement between ICD-10 and ICD-11, factor structure of proposed ICD-11 PTSD, and diagnostic value of PTSD symptom severity classes. Confirmatory factor analysis and latent profile analysis were used on data of elderly survivors of childhood trauma (&gt;60 years, <i>N</i>=399). PTSD rates differed significantly between ICD-10 (15.0%) and ICD-11 (10.3%, <i>z</i>=2.02, <i>p=</i>0.04). Unlike previous research, a one-factor solution of ICD-11 PTSD had the best fit in this sample. High symptom profiles were associated with PTSD in ICD-11. ICD-11 concentrates on PTSD's core symptoms and furthers clinical utility. Questions remain regarding the tendency of ICD-11 to diagnose mainly cases with severe symptoms and the influence of trauma type and participant age on the factor structure.

国际疾病分类第11版（ICD-11）针对创伤后应激障碍（Posttraumatic Stress Disorder, PTSD）的诊断标准提出了重大修订方案，该方案亟需在不同人群样本中开展验证研究。为探究ICD-10与ICD-11两套诊断标准下PTSD患病率及诊断一致性的差异、拟议ICD-11 PTSD的因子结构，以及PTSD症状严重程度分级的诊断价值，本研究针对童年创伤老年幸存者（年龄＞60岁，N=399）的数据开展了验证性因子分析与潜在剖面分析。结果显示，ICD-10与ICD-11的PTSD检出率存在显著统计学差异：ICD-10下为15.0%，ICD-11下为10.3%（z=2.02, p=0.04）。与既往研究结果不同的是，本样本中ICD-11 PTSD的单因子模型拟合效果最优。高症状剖面与ICD-11标准下的PTSD诊断显著相关。ICD-11诊断标准紧扣PTSD核心症状，提升了临床实用性。目前仍存在两个待解问题：一是ICD-11是否倾向于仅诊断症状严重程度较高的病例，二是创伤类型与受试者年龄对PTSD因子结构的影响。