Psychological Medicine

Original Article

The clinical significance criterion in DSM-IV post-traumatic stress disorder

NAOMI BRESLAUa1 c1 and GERMAN F. ALVARADOa1

a1 Department of Epidemiology, Michigan State University, College of Human Medicine, East Lansing, MI, USA

ABSTRACT

Background The DSM-IV definition of post-traumatic stress disorder (PTSD) requires that the syndrome cause clinically significant distress or impairment. The impact of the clinical significance criterion on the lifetime prevalence of PTSD among civilian victims of traumatic events has not been evaluated.

Method Data from two community-based samples were examined, the 1996 Detroit Area Survey of Trauma (n=2181) and the Mid-Atlantic Urban Youth Study (n=1698). The World Health Organization Composite International Diagnostic Interview (WHO CIDI) was used to ascertain DSM-IV PTSD.

Results The inclusion of the clinical significance criterion in DSM-IV reduces the conditional probability of PTSD given exposure to trauma by approximately 30%. Cases with clinically significant syndrome showed more pervasive and persistent disturbance and an excess in impaired activity days.

Conclusions The consistency of the findings between the two studies strengthens the evidence on the impact of the clinical significance criterion in the diagnosis of PTSD, and the construct validity of its measurement. There is a need for greater research effort on the definition and measurement of the clinical significance criterion.

(Online publication April 20 2007)

Correspondence

c1 Address for correspondence: Professor Naomi Breslau, Department of Epidemiology, Michigan State University, College of Human Medicine, B645 West Fee Hall, East Lansing, MI 48824, USA. (Email: breslau@epi.msu.edu)

Metrics