Trauma and PTSD in the WHO World Mental Health Surveys

on behalf of the WHO World Mental Health Survey Collaborators

Research output: Contribution to journalReview article

107 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Article number1353383
JournalEuropean Journal of Psychotraumatology
Volume8
DOIs
StatePublished - Oct 27 2017

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Post-Traumatic Stress Disorders
Health Surveys
Mental Health
Wounds and Injuries
Global Health
Rape
Sex Offenses

Keywords

  • Burden of illness
  • disorder prevalence and persistence
  • epidemiology
  • post-traumatic stress disorder (PTSD)
  • trauma exposure

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Trauma and PTSD in the WHO World Mental Health Surveys. / on behalf of the WHO World Mental Health Survey Collaborators.

In: European Journal of Psychotraumatology, Vol. 8, 1353383, 27.10.2017.

Research output: Contribution to journalReview article

on behalf of the WHO World Mental Health Survey Collaborators. / Trauma and PTSD in the WHO World Mental Health Surveys. In: European Journal of Psychotraumatology. 2017 ; Vol. 8.
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title = "Trauma and PTSD in the WHO World Mental Health Surveys",
abstract = "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.",
keywords = "Burden of illness, disorder prevalence and persistence, epidemiology, post-traumatic stress disorder (PTSD), trauma exposure",
author = "{on behalf of the WHO World Mental Health Survey Collaborators} and Kessler, {Ronald C.} and Sergio Aguilar-Gaxiola and Jordi Alonso and Corina Benjet and Bromet, {Evelyn J.} and Gra{\cc}a Cardoso and Louisa Degenhardt and {de Girolamo}, Giovanni and Dinolova, {Rumyana V.} and Finola Ferry and Silvia Florescu and Oye Gureje and Haro, {Josep Maria} and Yueqin Huang and Karam, {Elie G.} and Norito Kawakami and Sing Lee and Lepine, {Jean Pierre} and Daphna Levinson and Fernando Navarro-Mateu and Pennell, {Beth Ellen} and Marina Piazza and Jos{\'e} Posada-Villa and Scott, {Kate M.} and Stein, {Dan J.} and {Ten Have}, Margreet and Yolanda Torres and Viana, {Maria Carmen} and Petukhova, {Maria V.} and Sampson, {Nancy A.} and Zaslavsky, {Alan M.} and Koenen, {Karestan C.}",
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T1 - Trauma and PTSD in the WHO World Mental Health Surveys

AU - on behalf of the WHO World Mental Health Survey Collaborators

AU - Kessler, Ronald C.

AU - Aguilar-Gaxiola, Sergio

AU - Alonso, Jordi

AU - Benjet, Corina

AU - Bromet, Evelyn J.

AU - Cardoso, Graça

AU - Degenhardt, Louisa

AU - de Girolamo, Giovanni

AU - Dinolova, Rumyana V.

AU - Ferry, Finola

AU - Florescu, Silvia

AU - Gureje, Oye

AU - Haro, Josep Maria

AU - Huang, Yueqin

AU - Karam, Elie G.

AU - Kawakami, Norito

AU - Lee, Sing

AU - Lepine, Jean Pierre

AU - Levinson, Daphna

AU - Navarro-Mateu, Fernando

AU - Pennell, Beth Ellen

AU - Piazza, Marina

AU - Posada-Villa, José

AU - Scott, Kate M.

AU - Stein, Dan J.

AU - Ten Have, Margreet

AU - Torres, Yolanda

AU - Viana, Maria Carmen

AU - Petukhova, Maria V.

AU - Sampson, Nancy A.

AU - Zaslavsky, Alan M.

AU - Koenen, Karestan C.

PY - 2017/10/27

Y1 - 2017/10/27

N2 - 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.

AB - 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.

KW - Burden of illness

KW - disorder prevalence and persistence

KW - epidemiology

KW - post-traumatic stress disorder (PTSD)

KW - trauma exposure

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