Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis.

1,043

720

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.

Section: Discussionsupporting

confidence: 91%

Trauma and PTSD in the WHO World Mental Health Surveys

Kessler

Aguilar‐Gaxiola

Alonso

et al. 2017

1,043

720

“…Among the well-known risk factors or covariates of posttraumatic stress are high severity of exposure (Santiago et al, 2013), being female (Olff, Langeland, Draijer, & Gersons, 2007), low levels of social support (Charuvastra & Cloitre, 2008; Ozer, Best, Lipsey, & Weiss, 2003), and high neuroticism (Ormel et al, 2013). Despite the numerous studies that have investigated these factors as predictors of posttraumatic stress, few have examined why or how they lead to the development of posttraumatic stress symptomatology.…”

Section: Introductionmentioning

confidence: 99%

Making connections: exploring the centrality of posttraumatic stress symptoms and covariates after a terrorist attack

Birkeland

Heir

2017

Background: Posttraumatic stress symptoms are interconnected. Knowledge about which symptoms of posttraumatic stress are more strongly interconnected or central than others may have implications for the targeting of clinical interventions. Exploring whether symptoms of posttraumatic stress may be differentially related to covariates can contribute to our knowledge on how posttraumatic stress symptoms arise and are maintained. Objective: This study aimed to identify the most central symptoms of posttraumatic stress and their interconnections, and to explore how covariates such as exposure, sex, neuroticism, and social support are related to the network of symptoms of posttraumatic stress. Method: This study used survey data from ministerial employees collected approximately 10 months after the 2011 Oslo bombing that targeted the governmental quarters (n = 190). We conducted network analyses using Gaussian graphical models and the lasso regularization. Results: The network analysis revealed reliably strong connections between intrusive thoughts and nightmares, feeling easily startled and overly alert, and between feeling detached and emotionally numb. The most central symptom in the symptom network was feeling emotionally numb. The covariates were generally not found to have high centrality in the symptom network. An exception was that being female was connected to a high physiological reactivity to reminders of the trauma. Conclusions: Ten months after a workplace terror attack emotional numbness appears to be of high centrality in the symptom network of posttraumatic stress. Fear circuitry and dysphoric symptoms may constitute two functional entities in chronic posttraumatic stress. Clinical interventions targeting numbness may be beneficial in the treatment of posttraumatic stress, at least after workplace terrorism.

“…Variables modifying the risk of developing posttraumatic stress can be classified as pretrauma, peritrauma or posttrauma variables (Schnurr, Lunney, & Sengupta, 2004). In meta-analyses, peritrauma and posttrauma variables had a higher predictive value of posttraumatic stress than pretrauma variables (Brewin et al, 2000; Ozer, Best, Lipsey, & Weiss, 2003; Trickey, Siddaway, Meiser-Stedman, Serpell, & Field, 2012). …”

Section: Introductionmentioning

confidence: 99%

“…Among the peritrauma variables found to be predictive of posttraumatic stress are perceived life threat during the trauma, peritraumatic emotional responses and peritraumatic dissociation (Ozer et al, 2003). Although peritraumatic dissociation attained the highest effect size ( r = .35) in the meta-analysis performed by Ozer et al (2003), more recent findings question whether peritraumatic dissociation can be considered an independent predictor (Hagenaars, van Minnen, & Hoogduin, 2007; van der Velden & Wittmann, 2008).…”

Section: Introductionmentioning

confidence: 99%

Peritraumatic distress fully mediates the relationship between posttraumatic stress symptoms preoperative and three months postoperative in patients undergoing spine surgery

Shiban

Lehmberg

Hoffmann

et al. 2018

Background: Growing evidence shows the significance of illness and surgical procedures as traumatizing stressors. Risk factors are widely investigated in various settings and samples, using numerous measures of posttraumatic stress and posttraumatic stress disorder (PTSD). While pretrauma psychological distress is acknowledged as an influential factor, peritraumatic experiences are controversially still being discussed as relevant to the development of PTSD. Objective: In a group of patients consecutively undergoing elective spine surgery (N = 89) in a German hospital, this longitudinal study addressed the question of how pretrauma PTSD symptoms and peritrauma distress interact with one another in regard to the amount of posttrauma symptoms of PTSD. Methods: Pre- and posttrauma symptoms of PTSD as well as peritrauma distress were assessed through questionnaires one week before, one week after or three months after surgery. Results: Even though all three variables showed significant correlations with one another, mediation analysis revealed that peritrauma distress fully mediated the relationship between pre- and posttrauma PTSD symptoms. Conclusions: These results add new insights to the controversial discussion on the role peritraumatic experiences play in the development of PTSD, especially in medical settings.