Validity of reaction to severe stress and adjustment disorder diagnoses in the Danish Psychiatric Central Research Registry

Abstract

Elisabeth Svensson,1 Timothy L Lash,1,2 Patricia A Resick,3 Jens Georg Hansen,1 Jaimie L Gradus4–61Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; 2Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; 3Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA; 4National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA; 5Department of Psychiatry, 6Department of Epidemiology, Boston University, Boston, MA, USAAims: To assess the validity of reaction to severe stress and adjustment disorder diagnoses registered in the Danish Psychiatric Central Research Register (DPCRR), to examine the documentation of stressful and traumatic events in the medical records, and to investigate the occurrence of stress diagnoses among persons not registered in the DPCRR.Methods: Among 101,633 patients diagnosed with International Classification of Diseases, 10th Edition (ICD-10) F43 diagnoses between 1995 and 2011, we selected 50 patients from two hospitals (100 total), comprising one above and one below median age for each diagnosis for five time periods, and reviewed their medical records. We calculated the positive predictive value, comparing registration in the DPCRR with the original medical records, and captured data on stressful life events. Two general practitioners were queried about 50 patients without a stress diagnosis in the DPCRR, regarding whether they had ever received a stress diagnosis.Results: The positive predictive value was 58% for acute stress reaction, 83% for posttraumatic stress disorder, 94% for adjustment disorder, 71% for other reactions to severe stress, and 68% for reaction to severe stress, unspecified. In 80% of the records, a stressful or traumatic event was noted. Of 100 patients without an F43 diagnosis in the DPCRR, seven had a stress diagnosis.Conclusion: The DPCRR represents a valid and comprehensive resource for research on reaction to severe stress and adjustment disorders, particularly for posttraumatic stress disorder and adjustment disorder.Keywords: validity (epidemiology), stress disorders, traumatic, Denmark