Estimates of prevalence and criteria comparison in dsm-5 versus dsm-iv-tr post-traumatic stress disorder in 111 survivors to the 2009 railway accident in viareggio-italy

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced noteworthy revisions to Post-Traumatic Stress Disorder (PTSD) criteria, including a four-factor model and some new symptomatic criteria. To date, only a limited number of studies investigated the impact of such changes on the prevalence rates of the disorder. On 29 June 2009, in the railway station of Viareggio (Italy), a freight train carrying liquefied petroleum gas derailed with a subsequent fire leading to a large area of the town being damaged: 32 people died and 26 were severely injured. A total sample of 111 subjects who survived to the railway accident were assessed for PTSD according to either DSM-5 or DSM-IV-TR criteria by means of a spectrum assessment instrument: the Trauma and Loss Spectrum-Self Report (TALS-SR). A DSM-5 PTSD diagnosis emerged in 50.4% with respect to 54.7% according to DSM-IV-TR criteria. Most of the subjects fulfilling DSM-IV-TR but not DSM-5 criteria did not endorse new Criterion C (active avoidance). For what concern new DSM-5 PTSD symptoms: 1 (2.6%) survivor endorsed symptom D3; 29 (76.32%) D4; 6 (15.79%) both D3 and D4; 8 (27.59%) E2. This is the first study to report PTSD prevalence rates among survivors to the Viareggio 2009 railway accident. Our results corroborate the substantial equivalence between the DSM-5 and DSM-IV-TR algorithms for PTSD diagnosis and further suggest that avoidance and/or negative alterations in cognition and mood should alert the clinician for possible PTSD development.