The Effect of Draft DSM-V Criteria on Posttraumatic Stress Disorder Prevalence

Authors

  • Patrick S. Calhoun Ph.D.,

    Corresponding author
    1. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
    2. Durham Veterans Affairs Medical Center, Durham, North Carolina
    • VISN-6 Mental Illness Research & Education Center, Durham, North Carolina
    Search for more papers by this author
  • Jeffrey S. Hertzberg B.A.,

    1. Durham Veterans Affairs Medical Center, Durham, North Carolina
    Search for more papers by this author
  • Angela C. Kirby M.S.,

    1. Durham Veterans Affairs Medical Center, Durham, North Carolina
    Search for more papers by this author
  • Michelle F. Dennis B.A.,

    1. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
    Search for more papers by this author
  • Lauren P. Hair M.S.,

    1. Durham Veterans Affairs Medical Center, Durham, North Carolina
    Search for more papers by this author
  • Eric A. Dedert Ph.D.,

    1. VISN-6 Mental Illness Research & Education Center, Durham, North Carolina
    2. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
    3. Durham Veterans Affairs Medical Center, Durham, North Carolina
    Search for more papers by this author
  • Jean C. Beckham Ph.D.

    1. VISN-6 Mental Illness Research & Education Center, Durham, North Carolina
    2. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
    3. Durham Veterans Affairs Medical Center, Durham, North Carolina
    Search for more papers by this author

  • This article was originally published online on 26 October 2012. Subsequently, the title of Appendix I was modified for the sake of clarity on 21 November 2012.

Correspondence to: Patrick S. Calhoun, Ph.D., Mental Illness Research & Education Clinical Center (116B) DVAMC, 508 Fulton Street, Durham, NC 27705. E-mail: patrick.calhoun2@va.gov or patrick.calhoun@duke.edu

Abstract

Background

This study was designed to examine the concordance of proposed DSM-V posttraumatic stress disorder (PTSD) criteria with DSM-IV classification rules and examine the impact of the proposed DSM-V PTSD criteria on prevalence.

Method

The sample (N = 185) included participants who were recruited for studies focused on trauma and health conducted at an academic medical center and VA medical center in the southeastern United States. The prevalence and concordance between DSM-IV and the proposed DSM-V classifications were calculated based on results from structured clinical interviews. Prevalence rates and diagnostic efficiency indices including sensitivity, specificity, area under the curve (AUC), and Kappa were calculated for each of the possible ways to define DSM-V PTSD.

Results

Ninety-five percent of the sample reported an event that met both DSM-IV PTSD Criterion A1 and A2, but only 89% reported a trauma that met Criterion A on DSM-V. Results examining concordance between DSM-IV and DSM-V algorithms indicated that several of the algorithms had AUCs above 0.90. The requirement of two symptoms from both Clusters D and E provided strong concordance to DSM-IV (AUC = 0.93; Kappa = 0.86) and a greater balance between sensitivity and specificity than requiring three symptoms in both Clusters D and E.

Conclusions

Despite several significant changes to the diagnostic criteria for PTSD for DSM-V, several possible classification rules provided good concordance with DSM-IV. The magnitude of the impact of DSM-V decision rules on prevalence will be largely affected by the DSM-IV PTSD base rate in the population of interest.

Ancillary