ICD-11 PTSD诊断标准在心身医学科门诊病人中的适用性研究
文献类型：学位论文
| 作者 | 闫一民 |
| 答辩日期 | 2023-12 |
| 文献子类 | 硕士 |
| 授予单位 | 中国科学院大学 |
| 授予地点 | 中国科学院心理研究所 |
| 其他责任者 | 王力 |
| 关键词 | 《国际疾病分类》第十一版 《精神疾病诊断与统计手册》第五版 创伤 后应激障碍 复杂性创伤后应激障碍 心身疾病 |
| 学位名称 | 理学硕士 |
| 学位专业 | 健康心理学 |
| 其他题名 | A study of the applicability of ICD-11 PTSD diagnostic criteria in outpatients in psychosomatic medicine |
| 中文摘要 | The outpatients of the Department of Psychosomatic Medicine of General Hospital are a large group of people with high trauma exposure and complex traumatic experiences. Posttraumatic stress disorder (PTSD) caused by high traumatic exposure severely impairs the physical and mental health of this group. In 2018, the World Health Organization (WHO) proposed the International Classification of Diseases 11th Revision (ICD一11; WHO, 2018), a conceptualized revision of the diagnostic criteria for PTSD, which included six core symptoms, and proposed a diagnosis of complex post-traumatic stress disorder (CPTSD). All of these have sparked discussion and controversy in the academic community. This study focused on investigating the effect of ICD一11 PTSD diagnostic criteria on the prevalence of PTSD and the comorbidity of PTSD in outpatients of psychosomatic medicine, and verified the heterogeneity of post-traumatic reactions in this population, applicability of ICD一11 PTSD diagnosis and validity of CPTSD diagnosis. In this study, 1183 outpatients of the Department of Psychosomatic Medicine in China were collected, with an average age of 37.1 years, and 69.0% of them were women. In this study, the PDS Trauma Screening Scale was first used to investigate the trauma exposure of outpatients in the Department of Psychosomatic Medicine of General Hospitals. After that, the International Trauma Questionnaire (ITQ) based on the ICD一11 system and PTSD Checklist for DSM-5 (PCL-5) based on DSM-5 system were used to screen 727 participants with traumatic experiences for PTSD. This study compared the prevalence of PTSD between ICD一11 and DSM-5 and analysed the diagnostic agreement. Then, the generalized anxiety disorder (GAD一7) and the patient health questionnaire-9 (PHQ-9) were used to evaluate the anxiety and depression of the trauma-exposed group, and the study caculated the comorbidity rates of PTSD with generalized anxiety disorder and major depressive disorder using the two diagnostic criteria in oder to explore the diagnostic efficacy of the ICD一11 PTSD diagnostic criteria. Finally, the study used Latent Profile Analysis (LPA) to investigate the post-traumatic response heterogeneity of outpatients in the Department of Psychosomatic Medicine of General Hospital in oder to verify the validity of ICD一11 CPTSD diagnosis. Study 1 found that the trauma exposure rate of outpatients in the Department of Psychosomatic Medicine of General Hospital was 61.5%. 60.2% of patients in the trauma-exposed group experienced two or more traumatic events, with natural disasters being the most common traumatic event in this group. The prevalence of ICD-11 and DSM-5 PTSD were 43.5% and 53.4% in trauma-exposed groups. Ratiometric Z-test result showed that the prevalence of PTSD using the diagnostic criteria for ICD一11 PTSD was significantly lower than that of DSM-5 (p<0.001). The Kappa result of diagnostic agreement test is 0.542, and 120 people in this sample met the DSM-5 PTSD criteria uniquely, 48 people are diagnosed with ICD一11 PTSD uniquely. Study 2 found that among outpatients in psychosomatic medicine, the comorbidities of PTSD and possible major depressive disorder (MDD) and generalized anxiety disorder (GAD) using the DSM-5 diagnostic criteria were respectively 92.5% vs. 84.8%; Using the ICD一11 diagnostic criteria, the comorbidity rates of PTSD with possible MDD and GAD were 89.2% vs. 84.2%. At the same time, this study found that there was no significant difference in comorbidity of possible GAD, DD and PTSD using two PTSD diagnose criteria (p>0.05). Study 3 found that the potential profile model of ICD一11 CPTSD symptoms in the trauma exposure group of outpatients in the Department of Psychosomatic Medicine of General Hospital, and there were mainly three types of post-traumatic stress symptom patterns-high symptom group, medium symptom group, and low symptom group. There were significant differences between the three groups in the total score of the anxiety and depression scale, cumulative trauma, and functional impairment(p<0.001). In this study, a chi-square test was also conducted on the prevalence of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in different groups, and the results showed that there was a significant difference in the prevalence of MDD and GAD between different groups (MDD: x²=77.26, p<0.001; GAD: x²=215.69, p<0.001). Based on the above results, the following conclusions can be drawn: (1) Outpatients in the psychosomatic medicine department of general hospitals are characterized by high trauma exposure and high prevalence of PTSD. This group may have a higher incidence of major depressive disorder and generalized anxiety disorder. (2) The prevalence of PTSD using ICD一11 is lower than that of DSM-5. The PTSD diagnostic criteria based on ICD一11 and DSM-5 have moderate diagnostic agreement, but there are still many individuals that meet only one of these criteria. (3) The comorbidity rate study can show that the PTSD of ICD一11 and DSM-5 has similar diagnostic efficacy. And there was no significant difference in comorbidity using the two diagnostic criteria, possibly caused by the high prevalence of major depressive disorder and generalized anxiety disorder in this group of PTSD patients. (4) This study does not support the existence of separate PTSD group. The diagnostic validity of CPTSD proposed by ICD一11 needs to be further verified in the outpatient population of the Department of Psychosomatic Medicine. And whether there is a qualitative difference between CPTSD and PTSD needs to be further explored. This study provides empirical evidence for the applicability of the newly revised diagnostic criteria for ICD一11 PTSD in outpatients of the Department of Psychosomatic Medicine in China, and provides guidance for the clinical diagnosis and treatment of outpatients of the Department of Psychosomatic Medicine of General Hospitals. |
| 英文摘要 | 综合医院心身医学科门诊病人是一个高创伤暴露、累积创伤高的群体庞大人群。高创伤暴露导致的创伤后应激障碍(Posttraumatic stress disorder, PTSD)严重损害了该群体的身心健康。2018年世界卫生组织(World Health Organization,WHO)提出了《国际疾病分类第十一版》(International Classification of Diseases 11th Revision, ICD-11; WH0,2018)，对PTSD的诊断标准进行了概念化的修订，其中仅纳入了六条核心症状，并提出了复杂性创伤后应激障碍(Complex PTSD,CPTSD)的诊断。这些均引发了学界的讨论和争议。本研究重点调查了ICD-11 PTSD诊断标准对心身医学科门诊病人PTSD流行率与PTSD共病率的影响，同时对该群体创伤后反应异质性进行了探讨，从而验证ICD-11 PTSD诊断的适用J哇和 CPTSD的构念效度。 本研究采集了中国心身医学科门诊病人1183人，平均年龄37.1岁，女性占比69.0%。研究中首先采用PDS创伤筛查量表对综合医院心身医学科门诊病人的创伤暴露情况进行了调查。之后分别采用基于ICD-11系统的国际创伤问卷C International Trauma Questionnaire, ITQ)和基于DSM-5系统的PTSD症状筛查量表一5 (PTSD Checklist for DSM-5, PCL-5)对其中727名具有创伤经历的被试进行PTSD筛查，对该创伤暴露群体的ICD-11与DSM-5 PTSD流行率及其差异和诊断一致性进行分析。然后，研究采用广泛性焦虑障碍量表(Generalized Anxiety Disorder, GAD-7)和病人健康问卷抑郁量表(Patient Health Questionnaire-9, PHQ-9 )对该创伤暴露群体的焦虑与抑郁情况进行评估，进一步计算出两种诊断标准下PTSD与广泛性焦虑障碍、重性抑郁障碍的共病率并进行比较，从而探究ICD-11 PTSD诊断标准的诊断效能。最后本研究采用潜在剖面分析(Latent Profile Analysis } LPA)对综合医院心身医学科门诊病人的创伤暴露群体进行创伤后反应异质性研究，从而验证ICD-11提出的CPTSD的构念效度。 研究一发现综合医院心身医学科门诊病人的创伤暴露率为61.5%。创伤暴露群体中60.2%的病人经历过两种及两种以上的创伤事件，其中自然灾害是该群体最常见的创伤事件。创伤暴露群体中ICD-11 PTSD症状筛查阳性率为43.5% DSM-5 PTSD症状筛查阳性率为53.4%。比率Z检验结果显示ICD-11 PTSD诊断标准下PTSD的流行率显著低于DSM-5 (p<0.001)。诊断一致性检验结果得出的Kappa值为0.542，本样本中120人仅符合DSM-5 PTSD诊断，48人仅符合ICD-11 PTSD诊断。研究二发现在心身医学科门诊病人中，在DSM-5诊断标准下PTSD与可能的重度抑郁障碍(MDD)与广泛性焦虑障碍(GAD)的共病率分别为92.5% 与84.8%;在ICD-11诊断标准下PTSD与可能的MDD和GAD的共病率分别为89.2%和84.2%。同时，本研究发现ICD-11与DSM-5诊断标准下PTSD与可能的MDD, GAD的共病率均无显著差异(p>0.05 )。研究三发现综合医院心身医学科门诊病人创伤暴露群体中ICD-11 CPTSD症状的潜在剖面模型拟合主要存在三类创伤后应激症状模式一一高症状组、中症状组、低症状组，三个组别间在焦虑抑郁量表的得分总分、累计创伤、功能损伤三个方面存在显著差异(p<0.001) 。本研究还对不同组别中重性抑郁障碍(MDD)与广泛性焦虑障碍(GAD)的流行率进行了卡方检验，研究结果表明不同组别之间MDD与GAD的流行率存在显著差异(MDD x²=277.26, p<0.001; GAD: x²=215.69, p<0.001) 。 综合以上研究结果可以得出如下结论:(1)综合医院心身医学科门诊病人具有高创伤暴露，高PTSD流行率的特点;该群体中可能的重性抑郁障碍与广泛性焦虑障碍发病率较高。(2) ICD-11的PTSD流行率低于DSM-5 PTSD流行率。ICD-11与DSM-5的PTSD诊断标准具有中等强度的诊断一致性，但仍存在较多个体只满足其中一种诊断标准。(3)共病率研究可以说明ICD-11与DSM-5的PTSD具有类似的诊断效能，两种诊断标准下PTSD的共病率无显著差异，出现该结果的可能原因是该群体的PTSD患者中本身就具有较高的重度抑郁障碍发 病率和广泛性焦虑障碍发病率。(4)本研究并未支持存在单独的PTSD组别，ICD-11提出的CPTSD构念效度在心身医学科门诊病人群体中有待进一步验证，该群体在ICD-11诊断标准下区分出的CPTSD与PTSD是否有质的差异需要进一步探讨。 本研究为新修订的ICD-11 PTSD诊断标准在中国心身医学科门诊病人中的适用性提供了实证证据，为综合医院心身医学科门诊病人的临床诊疗提供了指导。 |
| 语种 | 中文 |
| 源URL | [http://ir.psych.ac.cn/handle/311026/46618]  |
| 专题 | 心理研究所_健康与遗传心理学研究室 |
| 推荐引用方式 GB/T 7714 | 闫一民. ICD-11 PTSD诊断标准在心身医学科门诊病人中的适用性研究[D]. 中国科学院心理研究所. 中国科学院大学. 2023. |
入库方式： OAI收割
来源：心理研究所
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