Association of DSM-IV posttraumatic stress disorder with traumatic experience type and history in the World Health Organization World Mental Health surveys

World Health Organization World Mental Health Survey Collaborators

Research output: Contribution to journalReview article

54 Citations (Scopus)

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: TheWorld Health OrganizationWorld Mental Health 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 of PTSD assessed with the Composite International Diagnostic Interview. Results: Among the 34 676 respondents (55.4%[SE, 0.6%] men and 44.6%[SE, 0.6%] women; mean [SE] age, 43.7 [0.2] years), lifetime TE exposure was reported by a weighted 70.3%of respondents (mean [SE] number of exposures, 4.5 [0.04] among respondents with any TE). Weighted (by TE frequency) prevalence of PTSD associated with random TEs was 4.0%. Odds ratios (ORs) of PTSD were elevated for TEs involving sexual violence (2.7; 95%CI, 2.0-3.8) and witnessing atrocities (4.2; 95%CI, 1.0-17.8). Prior exposure to some, but not all, same-type TEs was associated with increased vulnerability (eg, physical assault; OR, 3.2; 95%CI, 1.3-7.9) or resilience (eg, participation in sectarian violence; OR, 0.3; 95%CI, 0.1-0.9) to PTSD after the random TE. The finding of earlier studies that more general history of TE exposure was associated with increased vulnerability to PTSD across the full range of random TE types was replicated, but this generalized vulnerability was limited to prior TEs involving violence, including participation in organized violence (OR, 1.3; 95%CI, 1.0-1.6), experience of physical violence (OR, 1.4; 95%CI, 1.2-1.7), rape (OR, 2.5; 95%CI, 1.7-3.8), and other sexual assault (OR, 1.6; 95%CI, 1.1-2.3). Conclusion and relevance: The World Mental Health survey findings advance understanding of the extent to which PTSD risk varies with the type of TE and history of TE exposure. Previous findings about the elevated PTSD risk associated with TEs involving assaultive violence was refined by showing agreement only for repeated occurrences. Some types of prior TE exposures are associated with increased resilience rather than increased vulnerability, connecting the literature on TE history with the literature on resilience after adversity. These results are valuable in providing an empirical rationale for more focused investigations of these specifications in future studies.

Original languageEnglish (US)
Pages (from-to)270-281
Number of pages12
JournalJAMA Psychiatry
Volume74
Issue number3
DOIs
StatePublished - Mar 1 2017

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Post-Traumatic Stress Disorders
Health Surveys
Diagnostic and Statistical Manual of Mental Disorders
Mental Health
History
Odds Ratio
Violence
Global Health
Rape
Sex Offenses
Sample Size
Surveys and Questionnaires
Outcome Assessment (Health Care)
Interviews
Health

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Association of DSM-IV posttraumatic stress disorder with traumatic experience type and history in the World Health Organization World Mental Health surveys. / World Health Organization World Mental Health Survey Collaborators.

In: JAMA Psychiatry, Vol. 74, No. 3, 01.03.2017, p. 270-281.

Research output: Contribution to journalReview article

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title = "Association of DSM-IV posttraumatic stress disorder with traumatic experience type and history in the World Health Organization World Mental Health surveys",
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: TheWorld Health OrganizationWorld Mental Health 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 of PTSD assessed with the Composite International Diagnostic Interview. Results: Among the 34 676 respondents (55.4{\%}[SE, 0.6{\%}] men and 44.6{\%}[SE, 0.6{\%}] women; mean [SE] age, 43.7 [0.2] years), lifetime TE exposure was reported by a weighted 70.3{\%}of respondents (mean [SE] number of exposures, 4.5 [0.04] among respondents with any TE). Weighted (by TE frequency) prevalence of PTSD associated with random TEs was 4.0{\%}. Odds ratios (ORs) of PTSD were elevated for TEs involving sexual violence (2.7; 95{\%}CI, 2.0-3.8) and witnessing atrocities (4.2; 95{\%}CI, 1.0-17.8). Prior exposure to some, but not all, same-type TEs was associated with increased vulnerability (eg, physical assault; OR, 3.2; 95{\%}CI, 1.3-7.9) or resilience (eg, participation in sectarian violence; OR, 0.3; 95{\%}CI, 0.1-0.9) to PTSD after the random TE. The finding of earlier studies that more general history of TE exposure was associated with increased vulnerability to PTSD across the full range of random TE types was replicated, but this generalized vulnerability was limited to prior TEs involving violence, including participation in organized violence (OR, 1.3; 95{\%}CI, 1.0-1.6), experience of physical violence (OR, 1.4; 95{\%}CI, 1.2-1.7), rape (OR, 2.5; 95{\%}CI, 1.7-3.8), and other sexual assault (OR, 1.6; 95{\%}CI, 1.1-2.3). Conclusion and relevance: The World Mental Health survey findings advance understanding of the extent to which PTSD risk varies with the type of TE and history of TE exposure. Previous findings about the elevated PTSD risk associated with TEs involving assaultive violence was refined by showing agreement only for repeated occurrences. Some types of prior TE exposures are associated with increased resilience rather than increased vulnerability, connecting the literature on TE history with the literature on resilience after adversity. These results are valuable in providing an empirical rationale for more focused investigations of these specifications in future studies.",
author = "{World Health Organization World Mental Health Survey Collaborators} and Howard Liu and Petukhova, {Maria V.} and Sampson, {Nancy A.} and Sergio Aguilar-Gaxiola and Jordi Alonso and Andrade, {Laura Helena} and Bromet, {Evelyn J.} and {De Girolamo}, Giovanni and Haro, {Josep Maria} and Hristo Hinkov and Norito Kawakami and Koenen, {Karestan C.} and Viviane Kovess-Masfety and Sing Lee and Medina-Mora, {Maria Elena} and Fernando Navarro-Mateu and Siobhan O'Neill and Marina Piazza and Jos{\'e} Posada-Villa and Scott, {Kate M.} and Victoria Shahly and Stein, {Dan J.} and {Ten Have}, Margreet and Yolanda Torres and Oye Gureje and Zaslavsky, {Alan M.} and Kessler, {Ronald C.} and Ali Al-Hamzawi and Al-Kaisy, {Mohammed Salih} and Corina Benjet and Guilherme Borges and Ronny Bruffaerts and Brendan Bunting and {De Almeida}, {Jose Miguel Caldas} and Graca Cardoso and Somnath Chatterji and Cia, {Alfredo H.} and Louisa Degenhardt and {De Jonge}, Peter and Koen Demyttenaere and John Fayyad and Silvia Florescu and Yanling He and Hu, {Chi Yi} and Yueqin Huang and Karam, {Aimee Nasser} and Karam, {Elie G.} and Andrzej Kiejna and Lepine, {Jean Pierre} and Daphna Levinson",
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month = "3",
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TY - JOUR

T1 - Association of DSM-IV posttraumatic stress disorder with traumatic experience type and history in the World Health Organization World Mental Health surveys

AU - World Health Organization World Mental Health Survey Collaborators

AU - Liu, Howard

AU - Petukhova, Maria V.

AU - Sampson, Nancy A.

AU - Aguilar-Gaxiola, Sergio

AU - Alonso, Jordi

AU - Andrade, Laura Helena

AU - Bromet, Evelyn J.

AU - De Girolamo, Giovanni

AU - Haro, Josep Maria

AU - Hinkov, Hristo

AU - Kawakami, Norito

AU - Koenen, Karestan C.

AU - Kovess-Masfety, Viviane

AU - Lee, Sing

AU - Medina-Mora, Maria Elena

AU - Navarro-Mateu, Fernando

AU - O'Neill, Siobhan

AU - Piazza, Marina

AU - Posada-Villa, José

AU - Scott, Kate M.

AU - Shahly, Victoria

AU - Stein, Dan J.

AU - Ten Have, Margreet

AU - Torres, Yolanda

AU - Gureje, Oye

AU - Zaslavsky, Alan M.

AU - Kessler, Ronald C.

AU - Al-Hamzawi, Ali

AU - Al-Kaisy, Mohammed Salih

AU - Benjet, Corina

AU - Borges, Guilherme

AU - Bruffaerts, Ronny

AU - Bunting, Brendan

AU - De Almeida, Jose Miguel Caldas

AU - Cardoso, Graca

AU - Chatterji, Somnath

AU - Cia, Alfredo H.

AU - Degenhardt, Louisa

AU - De Jonge, Peter

AU - Demyttenaere, Koen

AU - Fayyad, John

AU - Florescu, Silvia

AU - He, Yanling

AU - Hu, Chi Yi

AU - Huang, Yueqin

AU - Karam, Aimee Nasser

AU - Karam, Elie G.

AU - Kiejna, Andrzej

AU - Lepine, Jean Pierre

AU - Levinson, Daphna

PY - 2017/3/1

Y1 - 2017/3/1

N2 - 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: TheWorld Health OrganizationWorld Mental Health 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 of PTSD assessed with the Composite International Diagnostic Interview. Results: Among the 34 676 respondents (55.4%[SE, 0.6%] men and 44.6%[SE, 0.6%] women; mean [SE] age, 43.7 [0.2] years), lifetime TE exposure was reported by a weighted 70.3%of respondents (mean [SE] number of exposures, 4.5 [0.04] among respondents with any TE). Weighted (by TE frequency) prevalence of PTSD associated with random TEs was 4.0%. Odds ratios (ORs) of PTSD were elevated for TEs involving sexual violence (2.7; 95%CI, 2.0-3.8) and witnessing atrocities (4.2; 95%CI, 1.0-17.8). Prior exposure to some, but not all, same-type TEs was associated with increased vulnerability (eg, physical assault; OR, 3.2; 95%CI, 1.3-7.9) or resilience (eg, participation in sectarian violence; OR, 0.3; 95%CI, 0.1-0.9) to PTSD after the random TE. The finding of earlier studies that more general history of TE exposure was associated with increased vulnerability to PTSD across the full range of random TE types was replicated, but this generalized vulnerability was limited to prior TEs involving violence, including participation in organized violence (OR, 1.3; 95%CI, 1.0-1.6), experience of physical violence (OR, 1.4; 95%CI, 1.2-1.7), rape (OR, 2.5; 95%CI, 1.7-3.8), and other sexual assault (OR, 1.6; 95%CI, 1.1-2.3). Conclusion and relevance: The World Mental Health survey findings advance understanding of the extent to which PTSD risk varies with the type of TE and history of TE exposure. Previous findings about the elevated PTSD risk associated with TEs involving assaultive violence was refined by showing agreement only for repeated occurrences. Some types of prior TE exposures are associated with increased resilience rather than increased vulnerability, connecting the literature on TE history with the literature on resilience after adversity. These results are valuable in providing an empirical rationale for more focused investigations of these specifications in future studies.

AB - 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: TheWorld Health OrganizationWorld Mental Health 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 of PTSD assessed with the Composite International Diagnostic Interview. Results: Among the 34 676 respondents (55.4%[SE, 0.6%] men and 44.6%[SE, 0.6%] women; mean [SE] age, 43.7 [0.2] years), lifetime TE exposure was reported by a weighted 70.3%of respondents (mean [SE] number of exposures, 4.5 [0.04] among respondents with any TE). Weighted (by TE frequency) prevalence of PTSD associated with random TEs was 4.0%. Odds ratios (ORs) of PTSD were elevated for TEs involving sexual violence (2.7; 95%CI, 2.0-3.8) and witnessing atrocities (4.2; 95%CI, 1.0-17.8). Prior exposure to some, but not all, same-type TEs was associated with increased vulnerability (eg, physical assault; OR, 3.2; 95%CI, 1.3-7.9) or resilience (eg, participation in sectarian violence; OR, 0.3; 95%CI, 0.1-0.9) to PTSD after the random TE. The finding of earlier studies that more general history of TE exposure was associated with increased vulnerability to PTSD across the full range of random TE types was replicated, but this generalized vulnerability was limited to prior TEs involving violence, including participation in organized violence (OR, 1.3; 95%CI, 1.0-1.6), experience of physical violence (OR, 1.4; 95%CI, 1.2-1.7), rape (OR, 2.5; 95%CI, 1.7-3.8), and other sexual assault (OR, 1.6; 95%CI, 1.1-2.3). Conclusion and relevance: The World Mental Health survey findings advance understanding of the extent to which PTSD risk varies with the type of TE and history of TE exposure. Previous findings about the elevated PTSD risk associated with TEs involving assaultive violence was refined by showing agreement only for repeated occurrences. Some types of prior TE exposures are associated with increased resilience rather than increased vulnerability, connecting the literature on TE history with the literature on resilience after adversity. These results are valuable in providing an empirical rationale for more focused investigations of these specifications in future studies.

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U2 - 10.1001/jamapsychiatry.2016.3783

DO - 10.1001/jamapsychiatry.2016.3783

M3 - Review article

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JO - JAMA Psychiatry

JF - JAMA Psychiatry

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