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Br J Psychiatry. 2016 Oct;209(4):300-305. Epub 2016 Jul 21.

A vulnerability paradox in the cross-national prevalence of post-traumatic stress disorder.

Author information

1
Michel L. A. Dückers, PhD, Impact - National Knowledge and Advice Centre for Psychosocial Care Concerning Critical Incidents, Arq Psychotrauma Expert Group, Diemen, and NIVEL- Netherlands Institute for Health Services Research, Utrecht, The Netherlands; Eva Alisic, PhD, Monash University Accident Research Centre, Monash University, Melbourne, Australia; Chris R. Brewin, PhD, Department of Clinical, Educational and Health Psychology, University College London, London, UK m.duckers@nivel.nl.
2
Michel L. A. Dückers, PhD, Impact - National Knowledge and Advice Centre for Psychosocial Care Concerning Critical Incidents, Arq Psychotrauma Expert Group, Diemen, and NIVEL- Netherlands Institute for Health Services Research, Utrecht, The Netherlands; Eva Alisic, PhD, Monash University Accident Research Centre, Monash University, Melbourne, Australia; Chris R. Brewin, PhD, Department of Clinical, Educational and Health Psychology, University College London, London, UK.

Abstract

BACKGROUND:

Determinants of cross-national differences in the prevalence of mental illness are poorly understood.

AIMS:

To test whether national post-traumatic stress disorder (PTSD) rates can be explained by (a) rates of exposure to trauma and (b) countries' overall cultural and socioeconomic vulnerability to adversity.

METHOD:

We collected general population studies on lifetime PTSD and trauma exposure, measured using the WHO Composite International Diagnostic Interview (DSM-IV). PTSD prevalence was identified for 24 countries (86 687 respondents) and exposure for 16 countries (53 038 respondents). PTSD was predicted using exposure and vulnerability data.

RESULTS:

PTSD is related positively to exposure but negatively to country vulnerability. Together, exposure, vulnerability and their interaction explain approximately 75% of variance in the national prevalence of PTSD.

CONCLUSIONS:

Contrary to expectations based on individual risk factors, we identified a paradox whereby greater country vulnerability is associated with a decreased, rather than increased, risk of PTSD for its citizens.

PMID:
27445357
DOI:
10.1192/bjp.bp.115.176628
[Indexed for MEDLINE]

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