Posttraumatic stress disorder associated with unexpected death of a loved one: Cross-national findings from the world mental health surveys

Abstract

Background Unexpected death of a loved one (UD) is the most commonly reported traumatic experience in cross-national surveys. However, much remains to be learned about PTSD after this experience. The WHO World Mental Health (WMH) Survey Initiative provides a unique opportunity to address these issues. Methods Data from 19 WMH surveys (n=78,023; 70.1% weighted response rate) were collated. Potential predictors of PTSD (respondent socio-demographics, characteristics of the death, history of prior trauma exposure, history of prior mental disorders) after a representative sample of UDs were examined using logistic regression. Simulation was used to estimate overall model strength in targeting individuals at highest PTSD risk. Results PTSD prevalence after UD averaged 5.2% across surveys and did not differ significantly between high and low-middle income countries. Significant multivariate predictors included: the deceased being a spouse or child; the respondent being female and believing they could have done something to prevent the death; prior trauma exposure; and history of prior mental disorders. The final model was strongly predictive of PTSD, with the 5% of respondents having highest estimated risk including 30.6% of all cases of PTSD. Positive predictive value (i.e., the proportion of high-risk individuals who actually developed PTSD) among the 5% of respondents with highest predicted risk was 25.3%. Conclusions The high prevalence and meaningful risk of PTSD make UD a major public health issue. This study provides novel insights into predictors of PTSD after this experience and suggests that screening assessments might be useful in identifying high-risk individuals for preventive interventions.

Trauma and PTSD in the WHO World Mental Health Surveys

“…For example, a large prospective study of victims of Hurricane Katrina found that socio-economic status was a significant predictor of speed of PTSD recovery after that natural disaster (McLaughlin et al, 2011). Previous research on the predictors of recovery in trauma-specific samples have focused largely on trauma characteristics and prior psychopathology (Atwoli et al, 2017; Bromet et al, 2017; Stein et al, 2016), neither of which was considered in the aggregate WMH analyses due to the small numbers of cases associated with each trauma type.…”

No pain, no gain: cross-lagged analyses of posttraumatic growth and anxiety, depression, posttraumatic stress and prolonged grief symptoms after loss

“…A dichotomous variable "sample" representing in which study the participant was included (i.e., Study 1 or Study 2), was included as covariate by regressing each construct at both time points onto this variable. To explore whether type of loss (expected vs. unexpected) influenced the findings (given that an unexpected loss is a correlate of PTSD; Atwoli et al, 2017), we ran a second round of analyses, but now only including people who had experienced an unexpected loss (n = 215). A maximum likelihood estimator was used.…”

Administration of moclobemide facilitates fear extinction and attenuates anxiety‐like behaviors by regulating synaptic‐associated proteins in a rat model of post‐traumatic stress disorder

“…The disorder develops after exposure to a traumatic event (e.g., traffic collisions, terrorist attacks, physical violence, unexpected death of a loved one, etc.) and is accompanied by poor fear extinction in the long term (Al‐Hadethe, Hunt, Thomas, & Al‐Qaysi, ; Atwoli et al, ). Currently, the exact pathogenesis of PTSD is not fully elucidated despite the presence of extensive research in animals and humans.…”