Abstract

Background: Although post-traumatic stress disorder (PTSD) onset-persistence is thought to vary significantly by trauma type, most epidemiological surveys are incapable of assessing this because they evaluate lifetime PTSD only for traumas nominated by respondents as their ‘worst.’

Objective: To review research on associations of trauma type with PTSD in the WHO World Mental Health (WMH) surveys, a series of epidemiological surveys that obtained representative data on trauma-specific PTSD.

Method: WMH Surveys in 24 countries (n = 68,894) assessed 29 lifetime traumas and evaluated PTSD twice for each respondent: once for the ‘worst’ lifetime trauma and separately for a randomly-selected trauma with weighting to adjust for individual differences in trauma exposures. PTSD onset-persistence was evaluated with the WHO Composite International Diagnostic Interview.

Results: In total, 70.4% of respondents experienced lifetime traumas, with exposure averaging 3.2 traumas per capita. Substantial between-trauma differences were found in PTSD onset but less in persistence. Traumas involving interpersonal violence had highest risk. Burden of PTSD, determined by multiplying trauma prevalence by trauma-specific PTSD risk and persistence, was 77.7 person-years/100 respondents. The trauma types with highest proportions of this burden were rape (13.1%), other sexual assault (15.1%), being stalked (9.8%), and unexpected death of a loved one (11.6%). The first three of these four represent relatively uncommon traumas with high PTSD risk and the last a very common trauma with low PTSD risk. The broad category of intimate partner sexual violence accounted for nearly 42.7% of all person-years with PTSD. Prior trauma history predicted both future trauma exposure and future PTSD risk.

Conclusions: Trauma exposure is common throughout the world, unequally distributed, and differential across trauma types with respect to PTSD risk. Although a substantial minority of PTSD cases remits within months after onset, mean symptom duration is considerably longer than previously recognized.

Details

Title
Trauma and PTSD in the WHO World Mental Health Surveys
Author
Kessler, Ronald C 1 ; Aguilar-Gaxiola, Sergio 2 ; Alonso, Jordi 3 ; Benjet, Corina 4   VIAFID ORCID Logo  ; Bromet, Evelyn J 5 ; Cardoso, Graça 6   VIAFID ORCID Logo  ; Degenhardt, Louisa 7 ; de Girolamo, Giovanni 8 ; Dinolova, Rumyana V 9 ; Ferry, Finola 10 ; Florescu, Silvia 11 ; Oye Gureje 12 ; Haro, Josep Maria 13 ; Huang, Yueqin 14 ; Karam, Elie G 15 ; Kawakami, Norito 16 ; Lee, Sing 17 ; Lepine, Jean-Pierre 18 ; Levinson, Daphna 19 ; Navarro-Mateu, Fernando 20 ; Beth-Ellen Pennell 21 ; Piazza, Marina 22 ; Posada-Villa, José 23 ; Scott, Kate M 24 ; Stein, Dan J 25 ; Margreet Ten Have 26 ; Torres, Yolanda 27 ; Viana, Maria Carmen 28 ; Petukhova, Maria V 1 ; Sampson, Nancy A 1 ; Zaslavsky, Alan M 1 ; Koenen, Karestan C 29 

1  Department of Health Care Policy, Harvard Medical School, Boston, MA, USA 
2  Center for Reducing Health Disparities, UC Davis Health System, Sacramento, CA, USA 
3  Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Departament de Ciències Experimentals i de la Salut, Pompeu Fabra University, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain 
4  Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muniz, Mexico City, Mexico 
5  Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA 
6  Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal 
7  National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia 
8  Unit of Epidemiological and Evaluation Psychiatry, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-St. John of God Clinical Research Centre, Brescia, Italy 
9  Sector “Mental Health”, National Center of Public Health and Analyses, Sofia, Bulgaria 
10  Bamford Centre for Mental Health and Wellbeing, Ulster University, Northern Ireland 
11  National School of Public Health, Management and Development, Bucharest, Romania 
12  Department of Psychiatry, University College Hospital, Ibadan, Nigeria 
13  Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain 
14  Institute of Mental Health, Peking University, Beijing, People’s Republic of China 
15  Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon; Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon; Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon 
16  Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan 
17  Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong 
18  Psychiatrie non sectorisée, Hôpital Lariboisière- Fernand Widal, Assistance Publique Hôpitaux de Paris, Paris, France; INSERM UMR-S 1144, Universités Paris Descartes-Paris Diderot, Paris, France 
19  Mental Health Services, Ministry of Health, Jerusalem, Israel 
20  UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Murcia, Spain 
21  Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA 
22  Departamento Académico de Salud Pública, Administración y Ciencias Sociales, Universidad Peruana Cayetano Heredia, Lima, Peru; La Unidad de Análisis y Generación de Evidencias en Salud Pública - UNAGESP, National Institute of Health, Lima, Peru 
23  Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogotá, Colombia 
24  Department of Psychological Medicine, University of Otago, Dunedin, New Zealand 
25  Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa 
26  Department of Epidemiology, Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands 
27  Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia 
28  Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil 
29  Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA 
Publication year
2017
Publication date
2017
Publisher
Taylor & Francis Ltd.
e-ISSN
20008066
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1080/20008198.2017.1353383
ProQuest document ID
2215225018
Copyright
© 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This work is licensed under the Creative Commons Attribution License http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.