The Hong Kong Survey on the Epidemiology of Trauma Exposure and Posttraumatic Stress Disorder

Wu, Kitty K.; Leung, Patrick W. L.; Wong, Corine Sau Man; Yu, Philippa M. W.; Luk, Betty T. C.; Cheng, Jamie P. K.; Wong, Rose; Wong, Patsy P. S.; Lui, Joey C. C.; Ngan, J.; Leung, Flora L. T.; Lam, Linda Chiu Wa

doi:10.1002/jts.22430

Cited by 20 publications

(9 citation statements)

References 35 publications

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“…1 In the World Mental Health Survey 1 that assessed 68 894 adults in exposure of 29 traumatic event types based on the World Health Organization Composite International Diagnostic Interview 2 , the TE prevalence is estimated to be 82.7% in the United States and 69.7% for all countries that participated, with 30.5% of adults being exposed to ≥4 TE. In an epidemiology study of TE and posttraumatic stress disorder (PTSD) in Hong Kong Chinese 3 that based on the sample of the Hong Kong Mental Morbidity Survey, 4,5 the weighted prevalence of direct TE is 64.8% and increases to 88.7% when indirect TE is included, consistent with another study. 6 Patients with severe mental illness (SMI) have high prevalence of trauma victimisation (51%-98%) and PTSD (up to 43%).…”

Section: Introductionsupporting

confidence: 72%

“…Present findings on patients with SMI are consistent with the World Mental Health Surveys findings that TE is common globally. 1 Compared with a Hong Kong study on community-dwelling adults, 3 our study had lower prevalence of having direct TE (ie, happened to me) [59.7% vs 64.9%] and lower prevalence of having direct and indirect TE (when exposure types witnessed it and learned about it were also included) [84.5% vs 88.7%].…”

Section: Discussionmentioning

confidence: 52%

“…The prevalence of TE is affected by whether indirect exposures are included, 3,6 and whether rates of TE for different levels of exposures are presented. In an epidemiology study of TE and PTSD in Hong Kong, 3 both direct and indirect exposures of TE were included for analyses related to correlates. Pearson correlation was used to determine the association among various factors.…”

Section: Introductionmentioning

confidence: 99%

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Patients’ Reports of Traumatic Experience and Posttraumatic Stress in Psychiatric Settings

Cheng

Leung

et al. 2020

East Asian Arch Psychiatry

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Objective: To determine the prevalence of traumatic experience (TE) among patients in psychiatric settings in Hong Kong and the associations between TE, levels of distress, and anxiety and depressive symptoms. Methods: 129 patients who have received inpatient psychiatric services were recruited. Their lifetime TE was assessed using the Life Event Checklist (LEC), and TE in psychiatric settings using the Psychiatric Experiences Questionnaire (PEQ). Their level of distress symptoms was assessed using the Impact of Event Scale-Revised (IES-R), and the level of anxiety and depressive symptoms using the Hospital Anxiety and Depression Scale (HADS). Results: The prevalence of direct and indirect TE was 84.5%, as was the prevalence of TE in psychiatric settings. Common TE in psychiatric settings included witnessing another patient being taken down (61.2%), being put in restraints of any kind (41.1%), and witnessing another patient being physically assaulted by another patient (36.4%). TE in psychiatric settings associated with high prevalence of severe or extreme distress 1 week after the event included being forced to take medication against their will (52.2%), being threatened with physical violence (52.2%), and experiencing a physical assault (50.0%). Lifetime TE (the total number of LEC items reported) was associated with severity of distress, and anxiety and depressive symptoms, whereas TE in psychiatric settings (the total number of PEQ items reported) was associated with severity of distress only. The total number of LEC items reported is the only predictor of levels of distress, and anxiety and depressive symptoms. Conclusions: Lifetime TE and TE in psychiatric settings are common among patients with SMI. Traumainformed care is suggested for mental health services.

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Section: Introductionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

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Patients’ Reports of Traumatic Experience and Posttraumatic Stress in Psychiatric Settings

Cheng

Leung

et al. 2020

East Asian Arch Psychiatry

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“…A score of six or above suggests probable PTSD (Brewin et al, 2002). The TSQ has been shown to have good reliability in a Hong Kong epidemiological sample (α = 0.93; Wu et al, 2019). Depressive symptoms were assessed using the depression subscale of the Depression, Anxiety and Stress Scales (DASS-D; Lovibond and Lovibond, 1995).…”

Section: Methodsmentioning

confidence: 99%

The impact of social unrest and pandemic on mental health of young people in Hong Kong: The transdiagnostic role of event-based rumination

Wong

Hui

Suen

et al. 2021

Aust N Z J Psychiatry

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Objective: Co-occurring population-level events, such as social unrest and coronavirus disease 2019, are observed in many societies today. Few studies have explored their combined mental health effects on young people. While self-focused rumination has been suggested to be a key mechanism underlying depression, the role of event-based rumination in mediating the impact of population stressors has yet to be elucidated. Methods: Data were collected from 6988 young people in a large-scale community online survey in Hong Kong. The survey assessed symptoms of post-traumatic stress disorder and depression, direct exposure to social unrest-related traumatic events, coronavirus disease 2019 pandemic-related events, personal stressful life events, event-based rumination and other individual risk factors. Results: High levels of comorbid post-traumatic stress disorder and depressive symptoms were observed. Logistic regression analysis revealed that probable post-traumatic stress disorder was associated with traumatic events (odds ratio = 1.73, 95% confidence interval = [1.64, 1.82]), pandemic-related events (odds ratio = 1.08, confidence interval = [1.01, 1.16]), stressful life events (odds ratio = 1.20, confidence interval = [1.21, 1.37]), high event-based rumination (odds ratio = 3.00, confidence interval = [2.58, 3.48]), lower resilience (odds ratio = 1.18, confidence interval = [1.15, 1.21]), higher smartphone reliance (odds ratio = 1.09, confidence interval = [1.05, 1.13]) and financial concerns (odds ratio = 1.25, confidence interval = [1.18, 1.33]). The odds for probable post-traumatic stress disorder was also significantly higher when two or more traumatic events were experienced (odds ratio = 4.03, confidence interval = [3.52, 4.62]). Factors associated with moderate-to-severe level depressive symptoms were similar. Event-based rumination significantly mediated between different types of external events (traumatic events, pandemic-related events, stressful life events) and both post-traumatic stress disorder and depressive symptoms. Conclusion: These findings suggest that diverse types of stressful events during population-level crises could add to personal stressors to affect mental health outcomes in young people. Among other protective and risk factors, event-based rumination presented as a prominent transdiagnostic mediator for different symptom dimensions which may be a potentially important target for early risk detection and intervention.

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“…The TSQ has demonstrated good internal consistency in an epidemiological sample in Hong Kong (a ¼ 0.93). 21 Depressive symptoms were assessed with the 7-item depression subscale of the Depression Anxiety Stress Scales (DASS-D) 22 on a 4-point Likert scale. A score of 10 to 20 signifies mild to moderate symptoms and 21 or above signifies severe or extremely severe symptoms.…”

Section: Methodsmentioning

confidence: 99%

Mental Health Risks after Repeated Exposure to Multiple Stressful Events during Ongoing Social Unrest and Pandemic in Hong Kong: The Role of Rumination: Risques pour la santé mentale après une exposition répétée à de multiples événements stressants d’agitation sociale durable et de pandémie à Hong Kong: le rôle de la rumination

et al. 2020

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Objectives: The co-occurrence of different classes of population-level stressors, such as social unrest and public health crises, is common in contemporary societies. Yet, few studies explored their combined mental health impact. The aim of this study was to examine the impact of repeated exposure to social unrest-related traumatic events (TEs), coronavirus disease 2019 (COVID-19) pandemic-related events (PEs), and stressful life events (SLEs) on post-traumatic stress disorder (PTSD) and depressive symptoms, and the potential mediating role of event-based rumination (rumination of TEs-related anger, injustice, guilt, and insecurity) between TEs and PTSD symptoms. Methods: Community members in Hong Kong who had utilized a screening tool for PTSD and depressive symptoms were invited to complete a survey on exposure to stressful events and event-based rumination. Results: A total of 10,110 individuals completed the survey. Hierarchical regression analysis showed that rumination, TEs, and SLEs were among the significant predictors for PTSD symptoms (all P < 0.001), accounting for 32% of the variance. For depression, rumination, SLEs, and PEs were among the significant predictors (all P < 0.001), explaining 24.9% of the variance. Two-way analysis of variance of different recent and prior TEs showed significant dose-effect relationships. The effect of recent TEs on PTSD symptoms was potentiated by prior TEs ( P = 0.005). COVID-19 PEs and prior TEs additively contributed to PTSD symptoms, with no significant interaction ( P = 0.94). Meanwhile, recent TEs were also potentiated by SLEs ( P = 0.002). The effects of TEs on PTSD symptoms were mediated by rumination (β = 0.38, standard error = 0.01, 95% confidence interval: 0.36 to 0.41), with 40.4% of the total effect explained. All 4 rumination subtypes were significant mediators. Conclusions: Prior and ongoing TEs, PEs, and SLEs cumulatively exacerbated PTSD and depressive symptoms. The role of event-based rumination and their interventions should be prioritized for future research.

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The Hong Kong Survey on the Epidemiology of Trauma Exposure and Posttraumatic Stress Disorder

Cited by 20 publications

References 35 publications

Patients’ Reports of Traumatic Experience and Posttraumatic Stress in Psychiatric Settings

Patients’ Reports of Traumatic Experience and Posttraumatic Stress in Psychiatric Settings

The impact of social unrest and pandemic on mental health of young people in Hong Kong: The transdiagnostic role of event-based rumination

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