Clinicians can evaluate post-traumatic stress disorder (PTSD) symptoms using either the fourth or fifth edition of the updated Diagnostic and Statistical Manual of Mental Disorders (DSM-4 or DSM-5) with comparable effectiveness, according to a recent diagnostic study published in JAMA Network Open.

The revisions in the DSM-5 made it difficult to perform longitudinal research. The changes also raised concerns about maintaining consistency when treating patients over time. The researchers compared the assessments to determine if the updated version led to any changes.

The researchers used the Millennium Cohort Study launched in 2001. The 2019 to 2021 follow-up survey had transitioned to the new PTSD checklist. The researchers randomly assigned a sample of respondents to 1 of 4 survey groups that received both surveys within the overall questionnaire. The researchers stopped random assignment when each group reached 500 respondents.


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Probable PTSD was higher with the 4th-edition survey for all groups. There was no significant difference in prevalence. Looking at individual items from the checklist, 16 out of 17 items substantially agreed.

Of the 1921 participants, 295 (15.4%) had probable PTSD according to the fourth edition criteria with all checklist items and 286 (14.9%) according to updated criteria with its 20 checklist items (κ=0.77).

Limitations include the absence of a clinical criterion-standard diagnosis of PTSD, which the researchers said was not feasible in such a large population-based study.

“These findings suggest that research and medical settings will successfully be able to assess PTSD over time among service members and veterans with these different instruments.”

Reference

Millennium Cohort Study Team. Comparison of posttraumatic stress disorder checklist instruments from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition vs Fifth Edition in a large cohort of US Military Service Members and Veterans. JAMA Netw Open. Published online April 27, 2021. doi:10.1001/jamanetworkopen.2021.8072