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AFHSB Surveillance Case Definition
POST-TRAUMATIC STRESS DISORDER (PTSD)
Includes Acute and Chronic PTSD; For Acute Stress Disorder, see “Acute Stress Disorder”
Case Definition.
Background
This case definition was developed by the Armed Forces Health Surveillance Branch (AFHSB) for the purpose of epidemiological surveillance of a condition important to military populations. This case definition for PTSD differs from that used in the mental health report for Health Affairs.^1
Clinical Description
Post-traumatic stress disorder, commonly referred to by its acronym, PTSD, is a severe anxiety disorder that can develop after exposure to any event that causes psychological trauma. The event may involve the threat of death to oneself or to someone else, or a threat to one's own or someone else's physical, sexual, or psychological integrity, overwhelming the individual's psychological defenses. Symptoms include re-experiencing the original trauma(s) through flashbacks or nightmares, avoidance of stimuli associated with the trauma, and increased arousal manifest as difficulty falling asleep or staying asleep, anger, or hypervigilance. Formal diagnostic criteria are dependent upon the duration of symptoms (see Comments below), and the associated impairment in social, occupational, or other important areas of functioning, (e.g., problems with work and relationships).^2
(^1) Armed Forces Health Surveillance Branch. Mental health disorders and mental health problems,
active component, U.S. Armed Forces, 2007-2016. Medical Surveillance Monthly Report (MSMR). March 2018; Vol.25 (3): 2- 11. (^2) American Psychiatric Association. Adjustment Disorders. In: Diagnostic and Statistical Manual of
Mental Disorders, Fifth Edition (DSM-5). Arlington, VA: 2013.
Case Definition and Incidence Rules
For surveillance purposes, a case of PTSD is defined as:
One hospitalization with a case defining diagnosis of PTSD (see ICD9 and ICD codes below) in the first or second diagnostic position; or
Two outpatient medical encounters , within 180 days of each other, with a case defining diagnosis of PTSD (see ICD9 and ICD10 codes below) in the first or second diagnostic position; or
One outpatient medical encounter in a psychiatric or mental health care specialty setting , identified by Medical Expense and Performance Reporting System (MEPRS) code BF, with a case defining diagnosis of PTSD (see code lists below) in the first or second diagnostic position.
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AFHSB Surveillance Case Definition
Codes
The following ICD9 and ICD10 codes are included in the case definition:
Condition ICD-10-CM Codes ICD-9-CM Codes
Post-traumatic Stress Disorder (PTSD)
F43.1 (post-traumatic stress disorder; PTSD)
--
- F43.10 (post-traumatic stress disorder, unspecified)
309.81 (post-traumatic stress disorder)
- F43.11 (post-traumatic stress disorder, acute )
309.81 (above)
- F43.12 (post-traumatic stress disorder, chronic )
309.81 (above)
Development
In May of 2014 the case definition was updated to include ICD10 codes.
This case definition was developed in November of 2010 by AFHSC Medical Surveillance Monthly Report (MSMR) staff for an article on mental disorders and mental health problems among active duty Service members.^1 The case definition was developed based on reviews of the ICD9 codes, the scientific literature, and previous AFHSC analyses.
Case Definition Incidence Rule Rationale
The case finding criteria were chosen to increase the specificity of the case definition and to increase the likelihood that “true” cases of PTSD would be identified.
For the purposes of counting new incident cases, AFHSB uses a once per lifetime incidence rule unless a specific timeframe is more appropriate and is specified (e.g., individuals may be counted as an incident case once every 365 days). Historically, a "once per surveillance period" incidence
Case Definition and Incidence Rules (continued)
Incidence rules:
For individuals who meet the case definition:
The incidence date is considered the date of the first hospitalization or outpatient medical encounter that includes a case defining diagnosis of PTSD.
An individual is considered an incident case once per lifetime.
Exclusions:
None
AFHSB Surveillance Case Definition
disease-related conditions and 25 categories based on a modified version of the classification system developed for the Global Burden of Disease (GBD) Study.^5 In general, the GBD system groups diagnoses with common pathophysiologic or etiologic bases and/or significant international health policymaking importance. The AFHSB disaggregates some diagnoses that are grouped into single categories in the GBD system (e.g., mental disorders) to increase the military relevance of the results. The category of mental health disorders is separated into the following sub-categories of “disorders”: anxiety, substance abuse, adjustment, mood, tobacco dependence, psychotic, personality, somatoform, and all other mental disorders.^6 Because reports on disease burden are based on the total numbers of medical encounters for specific conditions, a slightly different case definition is used for burden analyses. The case definition requires capturing only the diagnosis in the primary (first) diagnostic position of each record of an inpatient or outpatient medical encounter. Each individual is allowed only one medical encounter per condition per day, and inpatient encounters are prioritized over outpatient encounters on the same day. Case defining codes are any ICD9 codes between 001 and 999, any ICD10 codes between A00 and T88, ICD10 codes beginning with Z37 (outcome of delivery), and DoD unique personal history codes DoD 0101-0105.
Comprehensive AFHSB Mental Health Reports:
For analyses and reports requiring data on all mental disorders, AFHSB includes all mental health diagnoses that fall within the range of ICD9 codes 290-319 / ICD10 codes F01-F99 (mental disorders) in the first or second diagnostic positon. The following diagnoses are excluded from the analysis.
- Codes ICD9 310.2 / ICD10 F07.81 (post-concussion syndrome)
- Codes ICD9 305.1 / ICD10 F17* (tobacco use disorder / nicotine dependence) is not included as tobacco-cessation efforts are widespread within primary care clinics in the military and this diagnosis is not treated as a mental health disorder.
- Codes ICD9 317-319 / ICD10 F70-F79 (mental retardation)
- Codes ICD9 315* / ICD10 F80-F82, F88-F89 (specific delays in development)
- Codes ICD9 299/ ICD10 F84 (pervasive developmental disorders)
(^5) The global burden of disease: A comprehensive assessment of mortality and disability from diseases,
injuries, and risk factors in 1990 and projected to 2020. Murray, CJ and Lopez, AD, eds. Harvard School of Public Health (on behalf of the World Health Organization and The World Bank), 1996:120-2. (^6) Armed Forces Health Surveillance Branch. Absolute and relative morbidity burdens attributable to
various illnesses and injuries, active component, Medical Surveillance Monthly Report (MSMR). May 2018; Vol.25 (5): 2-9.
