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Eur J Psychotraumatol. 2017 Oct 27;8(sup5):1353383. doi: 10.1080/20008198.2017.1353383. eCollection 2017.

Trauma and PTSD in the WHO World Mental Health Surveys.

Author information

1
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
2
Center for Reducing Health Disparities, UC Davis Health System, Sacramento, CA, USA.
3
Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.
4
Departament de Ciències Experimentals i de la Salut, Pompeu Fabra University, Barcelona, Spain.
5
CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
6
Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muniz, Mexico City, Mexico.
7
Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA.
8
Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal.
9
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
10
Unit of Epidemiological and Evaluation Psychiatry, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-St. John of God Clinical Research Centre, Brescia, Italy.
11
Sector "Mental Health", National Center of Public Health and Analyses, Sofia, Bulgaria.
12
Bamford Centre for Mental Health and Wellbeing, Ulster University, Northern Ireland.
13
National School of Public Health, Management and Development, Bucharest, Romania.
14
Department of Psychiatry, University College Hospital, Ibadan, Nigeria.
15
Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain.
16
Institute of Mental Health, Peking University, Beijing, People's Republic of China.
17
Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon.
18
Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon.
19
Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon.
20
Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan.
21
Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong.
22
Psychiatrie non sectorisée, Hôpital Lariboisière- Fernand Widal, Assistance Publique Hôpitaux de Paris, Paris, France.
23
INSERM UMR-S 1144, Universités Paris Descartes-Paris Diderot, Paris, France.
24
Mental Health Services, Ministry of Health, Jerusalem, Israel.
25
UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Murcia, Spain.
26
Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
27
Departamento Académico de Salud Pública, Administración y Ciencias Sociales, Universidad Peruana Cayetano Heredia, Lima, Peru.
28
La Unidad de Análisis y Generación de Evidencias en Salud Pública - UNAGESP, National Institute of Health, Lima, Peru.
29
Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogotá, Colombia.
30
Department of Psychological Medicine, University of Otago, Dunedin, New Zealand.
31
Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa.
32
Department of Epidemiology, Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands.
33
Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia.
34
Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil.
35
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

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

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