Differentiating PTSD from anxiety and depression

Lessons from the ICD-11 PTSD diagnostic criteria

the International Consortium to Prevent PTSD

Research output: Contribution to journalArticleResearchpeer-review

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.

Original languageEnglish
Pages (from-to)490-498
Number of pages9
JournalDepression and Anxiety
Volume36
Issue number6
DOIs
StatePublished - 1 Jun 2019

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Post-Traumatic Stress Disorders
Anxiety
Depression
Anxiety Disorders
International Classification of Diseases
Odds Ratio
Confidence Intervals
Depressive Disorder
Diagnostic and Statistical Manual of Mental Disorders
Survivors
Wounds and Injuries
Israel
Interviews
Phenotype
Equipment and Supplies

Keywords

  • anxiety disorders
  • comorbidity
  • depressive disorders
  • nosology
  • posttraumatic stress disorder

Cite this

the International Consortium to Prevent PTSD. / Differentiating PTSD from anxiety and depression : Lessons from the ICD-11 PTSD diagnostic criteria. In: Depression and Anxiety. 2019 ; Vol. 36, No. 6. pp. 490-498.
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title = "Differentiating PTSD from anxiety and depression: Lessons from the ICD-11 PTSD diagnostic criteria",
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.",
keywords = "anxiety disorders, comorbidity, depressive disorders, nosology, posttraumatic stress disorder",
author = "{the International Consortium to Prevent PTSD} and Barbano, {Anna C.} and {van der Mei}, {Willem F.} and deRoon-Cassini, {Terri A.} and Ettie Grauer and Lowe, {Sarah Ryan} and Sarah Lowe and Meaghan O'Donnell and Miranda Olff and Wei Qi and Andrew Ratanatharathorn and Ulrich Schnyder and Soraya Seedat and Kessler, {Ronald C.} and Koenen, {Karestan C.} and Shalev, {Arieh Y.}",
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Differentiating PTSD from anxiety and depression : Lessons from the ICD-11 PTSD diagnostic criteria. / the International Consortium to Prevent PTSD.

In: Depression and Anxiety, Vol. 36, No. 6, 01.06.2019, p. 490-498.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Differentiating PTSD from anxiety and depression

T2 - Lessons from the ICD-11 PTSD diagnostic criteria

AU - the International Consortium to Prevent PTSD

AU - Barbano, Anna C.

AU - van der Mei, Willem F.

AU - deRoon-Cassini, Terri A.

AU - Grauer, Ettie

AU - Lowe, Sarah Ryan

AU - Lowe, Sarah

AU - O'Donnell, Meaghan

AU - Olff, Miranda

AU - Qi, Wei

AU - Ratanatharathorn, Andrew

AU - Schnyder, Ulrich

AU - Seedat, Soraya

AU - Kessler, Ronald C.

AU - Koenen, Karestan C.

AU - Shalev, Arieh Y.

PY - 2019/6/1

Y1 - 2019/6/1

N2 - 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.

AB - 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.

KW - anxiety disorders

KW - comorbidity

KW - depressive disorders

KW - nosology

KW - posttraumatic stress disorder

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