Nature and prevalence of PTSD as per DSM-5 and ICD-11 after natural and unnatural deaths

The death of a loved one may lead to posttraumatic stress disorder (PTSD). Although it is conceivable that unnatural losses (caused by e.g., accidents, homicide, or suicide) render people more vulnerable to PTSD than natural losses (e.g., caused by illnesses) this is an understudied issue. The current study sought to enhance knowledge about the presentation and prevalence of PTSD symptoms, in people confronted with natural, non-sudden and unnatural, sudden losses. Considering that PTSD is defined differently in DSM-5 and ICD-11, we compared PTSD severity and prevalence rates between these diagnostic systems.

Self-reported data were available from a heterogeneous sample of 1064 bereaved people (Mage = 52.13 years, 86 % female). Confirmatory factor analyses supported the DSM-5-based and ICD-11-based symptom clustering. DSM-5 yielded higher prevalence rates of probable PTSD than ICD-11 criteria. PTSD cluster and total scores were significantly higher for participants confronted with unnatural losses than participants confronted with natural losses. Rates of probable PTSD (based on DSM-5 and ICD-11) were also higher in the former group. Confrontation with an unnatural loss was not associated with PTSD scores beyond other sociodemographic and loss-related variables considered. Results show that bereavement-related PTSD is assessed differently in DSM-5 and ICD-11. Cause of death affected PTSD but less strongly than anticipated.

Research highlights

•  The four-factor DSM-5 model and the three-factor ICD-11 model for PTSD fit the data.

•  More participants met criteria for probable PTSD based on DSM-5 than based on ICD-11.

•  DSM-5- and ICD-11-based PTSD cluster and total scores were higher following unnatural (vs. natural) losses.

•  Rates of (DSM-5- and ICD-11-based) probable PTSD caseness were higher after unnatural loss.

•  Cause of death affected PTSD but less strongly than anticipated.