Association of DSM-IV Posttraumatic Stress Disorder With Traumatic Experience Type and History in the World Health Organization World Mental Health Surveys

Abstract

Disclaimer:The views and opinions expressed in this article are those of the authors and should not be construed to represent the views of WHO or other sponsoring organizations, agencies, or governments. Additional Contributions:We thank the staff of the WMH Data Collection and Data Analysis Coordination centres for assistance with instrumentation, fieldwork, and consultation on data analysis. Additional Information:A complete list of all within-country and cross-national WMH publications can be found at http:// www.hcp.med.harvard.edu/wmh/. Abstract IMPORTANCE-Previous research has documented significant variation in the prevalence of posttraumatic stress disorder (PTSD) depending on the type of traumatic experience (TE) and history of TE exposure, but the relatively small sample sizes in these studies resulted in a number of unresolved basic questions.OBJECTIVE-To examine disaggregated associations of type of TE history with PTSD in a large cross-national community epidemiologic data set. DESIGN, SETTING, AND PARTICIPANTS-The World Health Organization World MentalHealth surveys assessed 29 TE types (lifetime exposure, age at first exposure) with DSM-IV PTSD that was associated with 1 randomly selected TE exposure (the random TE) for each respondent. Surveys were administered in 20 countries (n = 34 676 respondents) from 2001 to 2012. Data were analyzed from October 1, 2015, to September 1, 2016. MAIN OUTCOMES AND MEASURES-Prevalence Methods SamplesThe WMH surveys are a coordinated set of community epidemiologic surveys in countries throughout the world. 17 This report focuses on the 22 WMH surveys in 20 countries that assessed lifetime PTSD after randomly selected TEs (using the procedures described below). Three surveys that assessed these random TEs were conducted in countries classified by the World Bank as low or lower-middle income (Colombia, Peru, and Ukraine); 7 in countries classified as upper-middle income (Brazil, Bulgaria, Colombia [administered after the previously mentioned Colombian survey, when the country income rating had increased], Lebanon, Mexico, Romania, and South Africa); and 12 in countries classified as high income (Belgium, France, Germany, Israel, Italy, Japan, the Netherlands, New Zealand, Northern Ireland, Spain [separate national and regional surveys], and the United States) (eTable 1 in the Supplement). Each survey was based on a multistage clustered area Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript probability sample of adult household residents. The target population was the entire country in most surveys, all urbanized areas in 3 (Colombia, Mexico, and Peru), and specific metropolitan areas in 4 (Sao Paulo, Brazil; Medellin, Colombia; Murcia, Spain; and 6 cities in Japan). Response rates ranged from 45.9% (France) to 97.2% (Medellin), with a mean rate of 71.3% across surveys. This study was approved by the institutional review boards of the participating institutions. Participants provided written or oral informed consent using procedures approved by...

Trauma and PTSD in the WHO World Mental Health Surveys

“…As detailed in a recent WMH report (Liu et al, 2017), the WMH random trauma analysis replicated earlier studies in showing that history of prior trauma exposure predicts increased vulnerability to PTSD after subsequent traumas, but also went beyond previous studies in several important ways. First, this association was found to be limited to prior traumas involving physical or sexual violence (OR = 1.3–2.5).…”

“…As detailed in another recent WMH report (Liu et al, 2017), conditional risk of DSM-IV/CIDI PTSD after trauma exposure is 4.0%, but varies significantly by trauma type. (Table 3) The highest conditional risk is associated with being raped (19.0%), physical abuse by a romantic partner (11.7%), being kidnapped (11.0%), and being sexually assaulted other than rape (10.5%).…”

“…The current paper reports data on between-trauma differences in the distribution of trauma exposure by trauma type and the risk of PTSD associated with each trauma type in the WHO World Mental Health (WMH) surveys. The WMH Surveys are a series of community epidemiological surveys that used this weighting scheme to generate a representative sample of trauma occurrences in the general population of participating countries (Liu et al, 2017). …”

Posttraumatic stress disorder in the World Mental Health Surveys

“…First, we found that 5.6% of respondents who were exposed to trauma had a lifetime diagnosis of PTSD, with prevalence ranging from 0.5% to 14.5% across countries, which may stem from variation in TE types across countries. Liu et al (2017) found that PTSD prevalence was associated with type of TE and that interpersonal TEs (e.g. sexual violence) conferred an increased risk for PTSD onset (Liu et al .…”

Childhood adversities and post-traumatic stress disorder: evidence for stress sensitisation in the World Mental Health Surveys

“…It is also unclear whether childhood adversities are associated with a generalised vulnerability to PTSD following any trauma type or whether these associations are more pronounced for specific types of traumatic events. With regard to the latter possibility, it is known that PTSD risk varies markedly across traumatic event types 17-19 and that prior exposure to some types of traumatic events, most notably those involving physical violence victimisation, are associated with elevated PTSD risk following subsequent traumatic events of the same type. 19 It is plausible in light of this evidence to think that the associations of childhood adversities with PTSD might vary across trauma types.…”