The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium

Abstract

Background Considerable research has documented that exposure to traumatic events has negative effects on physical and mental health. Much less research has examined the predictors of traumatic event exposure. Increased understanding of risk factors for exposure to traumatic events could be of considerable value in targeting preventive interventions and anticipating service needs. Method General population surveys in 24 countries with a combined sample of 68 894 adult respondents across six continents assessed exposure to 29 traumatic event types. Differences in prevalence were examined with cross-tabulations. Exploratory factor analysis was conducted to determine whether traumatic event types clustered into interpretable factors. Survival analysis was carried out to examine associations of sociodemographic characteristics and prior traumatic events with subsequent exposure. Results Over 70% of respondents reported a traumatic event; 30.5% were exposed to four or more. Five types – witnessing death or serious injury, the unexpected death of a loved one, being mugged, being in a life-threatening automobile accident, and experiencing a life-threatening illness or injury – accounted for over half of all exposures. Exposure varied by country, sociodemographics and history of prior traumatic events. Being married was the most consistent protective factor. Exposure to interpersonal violence had the strongest associations with subsequent traumatic events. Conclusions Given the near ubiquity of exposure, limited resources may best be dedicated to those that are more likely to be further exposed such as victims of interpersonal violence. Identifying mechanisms that account for the associations of prior interpersonal violence with subsequent trauma is critical to develop interventions to prevent revictimization.

Trauma and PTSD in the WHO World Mental Health Surveys

“…Within the context of these limitations, our finding that 70.4% of respondents were exposed to one or more traumas at some time in their life is broadly consistent with previous research reviewed elsewhere (Benjet et al, 2016) documenting that the majority of people in the general population have experienced traumas. However, WMH went beyond previous studies in assessing frequency of exposure, documenting that trauma exposure is even more common than previously known, with a per capita mean of 2.0 trauma types and 4.6 trauma exposures.…”

“…WMH results regarding the most common types of trauma are consistent with previous research in finding that unexpected death of a loved one and motor vehicle accidents are the two most common types of trauma in the general population (reviewed by Benjet et al, 2016). We went beyond these previous results to show that traumas occurring to other people account for over 40% of all reported qualifying (for a diagnosis of PTSD) traumas (16.5% involving unexpected death of a loved one and an additional 25.0% other traumas that either occurred to a loved one or were witnessed), that accidents are the most common type of trauma occurring to people directly (24.6%), and that traumas involving intimate partner sexual violence (9.8%) and physical violence (13.8%) account for the bulk of other traumas.…”

“…Consistent with this evidence, a previous WMH report found that the vast majority of prior trauma types are significantly and positively associated with subsequent trauma exposure (Benjet et al, 2016). The strongest of these associations (OR = 2.0–2.5) are for one type of physical violence (e.g.…”

“…Socio-demographic predictors of trauma exposure in the WMH data have been reported previously (Benjet et al, 2016). Using survival analysis, these analyses showed that women are much more likely than men to be exposed to intimate partner sexual violence (OR 2.3), roughly equal to men in odds of unexpected death of a loved one (OR 1.1), and significantly less likely than men to experience any of the other specific trauma types considered in our analysis (OR 0.4–0.8).…”

“…The fact that only a small minority of people in the population develops post-traumatic stress disorder (PTSD) (Atwoli, Stein, Koenen, & McLaughlin, 2015) even though the vast majority are exposed to traumas at some time in their life (Benjet et al, 2016) has raised questions about individual differences in psychological vulnerability to PTSD. These questions are the subject of considerable research (Liberzon & Abelson, 2016; Sayed, Iacoviello, & Charney, 2015; Smoller, 2016).…”